COVID-19: The State of Health in Rural America

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Original story posted on: March 25, 2020

Rural America is facing a healthcare crisis.  

EDITOR’S NOTE: The global pandemic of the coronavirsus is further exacerbating the rural health crisis. This is the first in a series of reports on rural health.

Rural Americans, on average, are six years older than their urban counterparts, and make up about 20 percent of the population, but more than 23 percent of Medicare beneficiaries across the country. Rural health disparities continue to grow, as do mortality gaps between rural and urban populations; according to the Centers for Disease Control and Prevention (CDC), rural Americans are substantially more likely to die from the five leading causes of death nationally. (For example, diabetes mortality is 12.4 percent higher in rural areas.) Rural poverty rates also outpace those of urban and suburban populations. Nineteen percent of rural Americans, including 25 percent of rural children, are living in poverty. And the rural hospital closure crisis continues to grow. In fact, 119 rural hospitals have closed since 2010, and nearly 700 more are vulnerable to closure.

This closure crisis significantly impacts the health of rural residents. A study by the National Bureau of Economic Research found that rural hospital closures increased patient mortality within a hospital service area by 5.9 percent, whereas urban closures had no measurable impact. Analysis by the Medicare Payment Advisory Commission found that about one-third of hospitals that have closed since 2013 were more than 20 miles from the nearest hospital. This is notable for many reasons, most significantly that increased distance to care elevates the risk of bad outcomes for urgent conditions, such as high-risk child deliveriestrauma, and heart conditions. Although the loss of hospitals is devastating to rural communities, the loss of individual service lines is also detrimental. When rural hospitals close, other specialty services surrounding the hospital are more likely to close as well, especially mental health and substance use care centers. The threat of loss of EMS services has significant impact in communities that have already lost emergency room access.

Rural hospitals are typically one of the largest employers in their communities – on average, the health sector constitutes 14 percent of total employment. On average, a Critical Access Hospital (CAH) maintains a payroll of $6.8 million, employing 141 people. Rural hospitals also benefit the economy of their local communities by attracting and maintaining a workforce that is then able to support other businesses. In fact, economists at Kansas State University have demonstrated that for every dollar earned by a rural hospital, 59 cents is generated for other businesses in its community.

The potential economic fallout if these vulnerable hospitals close would include an increase in rural unemployment of 1.6 percent and a decrease in per-capita yearly income in rural communities by $703. Rural America also would lose more than $277 billion in GDP over 10 years, along with 99,000 direct healthcare jobs and 137,000 community jobs.

The National Rural Health Association is strongly advocating for Congress to stop the rural hospital closure crisis. To do this, it must provide short-term relief for struggling rural hospitals. Immediate relief to struggling rural hospitals in the most need could come in the form of reinstating the “necessary provider,” provision which would allow rural hospitals to convert to CAHs.

Longer-term relief to keep rural hospital doors open must come from Congress, along with the end of devastating payment cuts and the development of a new and sustainable rural hospital model that makes sense for patients and providers in rural America.

Programming Note: For a live update on this developing story logon to Monitor Mondays, Monday, March 30, 10-10:30 a.m. EST.

Maggie Elehwany, JD

Maggie Elehwany, JD is the Government affairs and policy vice president at the National Rural Health Association. She has over 20 years of federal legislative experience. She previously served as health counsel to U.S. Sen. Lisa Murkowski, a member of the Senate Health, Education, Labor and Pensions Committee, and to U.S. Sen. Frank Murkowski, a member of the Senate Finance Committee, where she worked on comprehensive Medicare and Medicaid legislation. Maggie also served as counsel to former U.S. Senate Finance Committee Chairman Bob Packwood. From 1999 to 2005, she served as assistant director of congressional affairs for the American Medical Association, where she advocated on patient and physician issues.

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