Of the 22 rural hospitals that have closed in the last year, 20 are in states that didn't implement Medicaid expansion.....
Rural hospitals are already more dependent on Medicaid and Medicare, which usually reimburse doctors at lower levels than private insurance. More than 40 percent of rural hospitals in the U.S. are regularly running deficits, according to the National Rural Health Association. Many of these facilities depend on subsidies from local or county governments, which often own the hospital outright.
Twenty-four states, including most of the South, have yet to expand the state-federal health program for the poor to adults earning up to 138 percent of the federal poverty level. People earning between 100 percent of the federal poverty line and 138 percent in those states generally don’t quality for public health care or for subsidies to purchase private health insurance through the exchanges created by the Affordable Care Act. The law’s designers never envisioned that gap would exist, but the Supreme Court made Medicaid expansion optional in a 2012 decision that largely upheld the rest of the law.
The Supreme Court decision also further imperiled rural and urban hospitals serving large numbers of the poor and uninsured because the law also cuts billions of dollars in payments those safety-net providers received to keep them afloat under the assumption that they wouldn’t need as much compensation because many of their patients would receive Medicaid coverage.