Hospital closure left rural Ga. town reeling; trend dominant in South, where most states haven't expanded Medicaid

Cuthbert, the seat of Randolph County
(Wikipedia map)

A recent Kaiser Health News profile shows how a hospital's closure in rural Georgia is hurting its community, the factors that contributed to its closure, and how it fits in with a larger trend.

After Southwest Georgia Regional Medical Center closed in October 2020, the majority-Black community of Cuthbert, pop. 3,520, had no access to nearby emergency treatment. The closest hospital is 27 miles away in Eufaula, Ala., and that can mean the difference in life and death, Andy Miller reports for Kaiser Health News. A Cuthbert woman died from a heart attack this year; the ambulance took 20 minutes to respond and had to drive all the way to Eufuala. Her roommate said she could have been saved by a local hospital.

"University of Washington researchers have found that rural hospital closures led to increased mortality for inpatient stays in that region, while urban closures had no measurable effect," Miller reports. "Among the reasons they cited were the increase in the time people had to travel to get hospital care and that some medical providers leave communities when hospitals close." Rural ambulance services are often stretched thin and may take longer to answer calls.

Southwest Georgia RMC was one of 19 hospitals that closed in rural America last year, the highest single-year number since the University of North Carolina's Cecil G. Sheps Center for Health Services Research began tracking the data in 2005. Most were in the South, where most states have not expanded Medicaid, which has kept rural hospitals open in other states. "In the past 10 years, eight rural hospitals have shut down in Georgia; only Texas and Tennessee have had more closures," Miller reports. "The center’s data shows that 86 of the 129 hospitals that closed in that time were in Texas and the Southeast." They're more likely to be in communities with large Black and/or Hispanic populations.

"None of the eight states with the most rural hospital closures since 2014, when Medicaid expansion was first implemented through the Affordable Care Act, had chosen to expand the insurance program by the start of 2021,: Miller notes. "In several of those states, including Georgia, Republican-led governments have said such a step would be too costly." Former Cuthbert mayor Steve Whatley told Miller that Georgia's failure to expand Medicaid "hurt us probably more than anybody else."

Rural hospitals treat higher shares of uninsured patients and those with chronic illnesses, who are often unable to pay but often don't qualify for unexpanded Medicaid, Miller writes. The local populations also tend to be older, which means increased costs of care. On top of that, rural hospitals often have a hard time recruiting physicians, even as they struggle with infrastructure and maintenance costs.

Today, a quarter of rural hospitals—an estimated 453—are at risk of closure, according to the National Rural Health Association. Federal Covid relief funding has helped slow the trend of closures this year, but more solutions will be needed. Local, state and national lawmakers in many areas are applying for grants and exploring public-private partnerships.