Rural hospital closures endanger Tennesseans
Rural communities are in crisis.
In the midst of a pandemic, more than one quarter of Tennessee’s rural counties have no hospital and one fifth have no emergency room services. That number will continue to grow unless a concerted effort is made to prevent more closures. The threats to health due to these losses affect thousands of Tennesseans. And the economic impact is far reaching.
When a hospital closes, the elderly, the chronically ill, mothers and babies lose access to the specialized care they need. Ambulance services are seriously stretched as they try to respond to emergencies that now demand extra hours in transit. People worry about what will happen in emergency situations. What if their child has an asthma attack at school or their wife goes into premature labor? What if a tourist is injured? With the nearest hospital over an hour away, in the words of one rural resident, “The ambulance became our emergency room.” That is not an acceptable alternative.
As board president of the Tennessee Health Care Campaign, I participated in a three-year communitybased research project in collaboration with the Vanderbilt Medical Center to hear directly from rural communities about hospital closures. What we learned is alarming.
When a hospital closes, the rural economy suffers. It becomes harder to attract and keep employers, residents or retirees who might otherwise enjoy rural communities. In addition, the loss of health care jobs affects the whole community.
Rural hospitals may have originated as charitable religious or civic concerns, but those days are long gone. Health care is big business and health care corporations now make profit-based decisions about where or whether to deliver needed care. Communities are seldom meaningfully engaged by hospital systems in the planning and decision making. Usually the decision to close is made with no advance notice and the community is left to pick up the pieces. Rural communities are crying out for state oversight and investment.
Rural hospitals are closing because the funding model is unsustainable. Rural hospitals care for a high proportion of uninsured and underinsured patients. Tennessee’s failure to draw down federal funds for
Medicaid expansion leaves rural hospitals with high levels of uncompensated care. Communities along the Kentucky and Arkansas border are particularly frustrated knowing that those states have implemented solutions that Tennessee has scorned. We now hear that Alabama is seriously considering Medicaid expansion as well. Meanwhile, Tennessee lawmakers have been sitting on their hands for a decade.
Suggested solutions
Tennessee needs innovative solutions to address the health needs of rural communities, including:
• Increasing Tenncare coverage for the disproportionately high number of low-income, uninsured and chronically ill Tennesseans who live in rural areas.
• Increased state planning and financial investment in rural health care, including innovative service options for distressed communities.
• State oversight of hospital ownership transfers to ensure experience in hospital management and verification of adequate funding.
• Prioritizing infrastructure improvements in roads, broadband and regional emergency call centers.
Tennessee leads the nation in hospital closures per capita and trails the nation in the health of its citizens. It is time for Gov. Bill Lee and the Tennessee General Assembly to offer some long-term solutions to the rural constituents they represent.
Randall Rice is the board president of the Tennessee Health Care Campaign, a non-profit health care advocacy organization.