https://www.motherjones.com/politics/2018/07/rural-hospital-closures-trump-republicans/
"What’s more, rural communities tend to be both poorer and sicker than their urban counterparts. According to US census data from 2016, 46 percent of the country’s rural population uses a form of government insurance, compared with 36 percent of the urban population. CDC data shows that rural areas have higher death rates from cancer, heart disease, unintentional injuries, chronic lower respiratory disease, and stroke than urban areas do. Infant mortality rates are roughly 20 percent higher in rural counties than they are in large urban counties. But there’s another crisis linked to hospital closings: job losses. In many rural communities, the hospital is the largest employer. Brad Gibbens, a researcher at the University of North Dakota, estimates that when one shuts its doors, up to 25 percent of the surrounding region’s economy disappears. A cascading shortage of physicians and other health care professionals soon follows. So why are so many hospitals closing? Carole Myers, an associate professor at the University of Tennessee-Knoxville who studies health care policy, says medical facilities in rural areas have long struggled thanks to sparse populations and high poverty rates. But the situation is significantly worse in the 17 states that have not joined Obamacare’s Medicaid expansion, most of them heavily rural. Those states have a higher rate of uninsured people, which means hospitals—which can’t turn anyone away from the emergency room—have to provide more uncompensated care. According to a recent study from the Colorado School of Public Health, hospitals in states that did not expand Medicaid are six times more likely to close than hospitals in states that did, because they see more uninsured patients and provide more free care."
