Rural hospital closings are killing rural America. A strong push by DSA to combat the trend through building support for single-payer healthcare could give rural Americans hope. According to a Huffington Post report on rural hospital closings in Georgia by Lauren Weber and Andy Miller, if you want to watch a rural community die, destroy its hospital.
After the Lower Oconee Community [Georgia] Hospital shut down in June 2014, other mainstays of the community followed.The bank and the pharmacy in the small town of Glenwood shuttered. Then the only grocery store in all of Wheeler County closed in the middle of August this year. Opportunity has been dying in Wheeler County for the last 20 years. Agriculture was once the primary employer, but the Wheeler Correctional Facility, a privately run prison, is now the biggest source of jobs. —“A Hospital Crisis Is Killing America. This State is ‘Ground Zero.’” Huffington Post, September 27, 2017
Since 2010, nearby Tennessee has had the second highest number of hospital closures in the nation after Texas and the most hospital closings in the U.S. per capita. Help in the form of Medicaid expansion will not arrive anytime soon. The likely Democratic nominee for the U.S. Senate seat that Bob Corker is vacating, Phil Bredesen, a former healthcare company CEO, made his political reputation as governor in 2005 by throwing more than 200,000 Tennesseans off of TennCare, the state’s expanded version of Medicaid. By the end of his administration in 2011, enrollment cuts had eliminated a total of 350,000 Tennesseans from TennCare, including those with serious medical conditions who earned just enough to exclude them from coverage. Current governor Bill Haslam, a conservative Republican, sought to use federal Medicaid expansion funding in 2015 to fill the gap between traditional Medicaid and buying subsidized health insurance on the Affordable Care Act federal exchange. Two Senate committees killed Haslam’s plan, Insure Tennessee, before it could be considered on the floor of either chamber of the General Assembly. Thirty more hospitals in Tennessee are at risk of closing.
As healthcare analyst and DSA member Tim Faust told a crowd in Knoxville on January 29, “By not expanding Medicaid, you force these rural hospitals to shut down.” The trend is not limited to the South. More than 120 rural hospitals have gone out of business nationwide since 2005, and the trend is accelerating. Large swaths of the Midwest lack rural hospitals, especially in those states that declined to expand Medicaid. According to the Knoxville News Sentinel, a recent study in the journal Health Affairs concluded that “hospitals in (Medicaid) expansion states were over six times less likely to close than hospitals in non-expansion states.”
If DSA wants to organize in rural areas, it should agitate where possible for single-payer/Medicare for All as the long-term solution for rural hospital closings. Rallies against rumored hospital closings could focus on the combined role of legislative stinginess and predatory capitalism in closing off health justice for local communities. We could point to how the unnecessary duplication of services (for example, the proliferation of magnetic resonance imaging [MRI] machines in urban centers) feeds corporate cost-cutting and results in the disappearance of services in rural areas. DSA could highlight the long distances that poor and disabled rural people must travel to neighboring counties or states to get care. We could combine this approach with loudly and visibly opposing the “Work for Medicaid” waivers being given to states around the nation. In predominantly rural states plagued by high unemployment rates, such requirements are a truly cruel joke and a literally sickening one for Medicaid recipients.
Travis Donoho is the chair of Knoxville-area DSA.
