Most Pressing Rural Health Problem Is Closing Hospitals

Guest op-ed from Patty Judge, chair of Focus on Rural America

For more than a decade, Iowa’s overall population has been steady.

With a very modest growth rate, our state population has hovered around 3.1 million people. If you live in Polk County this may surprise you, since the Des Moines metro area is experiencing one of the fastest growth rates of Midwest cities, growing by more than 15% since 2010, in part due to relocation of Iowans from rural communities to our larger cities.

While 27% of Americans wish they lived in a rural community, they’re being squeezed by resources and forced to move to metro areas for jobs and economic opportunity. Families that would like to stay where they are simply can’t because they don’t have access to resources necessary to compete, let alone access the health services we all need and rely on. 

Nearly 20% of Americans live in rural communities, but according to a new report by Iowa Voices, “Rural Health Care Crisis: The State of Rural Health Care Access in Iowa,” only 12% of doctors treat rural patients. In a survey of 1,031 rural hospital CEOs, our rural communities are forced to function with a physician shortage of 75%. Consider the impact this has not only on patients seeking services, but also the few doctors shouldering our care. 

The 2020 race for the Democratic presidential nomination brought a great deal of attention to Iowa and to rural communities. The candidates visited Iowa towns, small and large, with a focus on access to mental health care and visits with hospitals about keeping the lights on. Many, if not all, of the Democrats have drafted rural health care plans, committed to improving access to mental health care and expanding Medicaid. 

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However, the debate stages are often fraught with fights over ‘Medicare for All’ or whether a public option will take us far enough. The truth of the matter is the policies dominating the debate stage are not addressing the most pressing rural health care problems. 

Providing insurance coverage to a woman in North Dakota won’t guarantee she has access to a doctor for safe delivery for herself and her new infant. Covering a child with diabetes doesn’t guarantee affordable insulin or ensure access to emergency services. In fact, rural emergency services are struggling. For example, in one small Pennsylvania community, there aren’t enough funds to keep ambulances on the road and staff by the phone. Unfortunately, this is not an isolated example. In rural Iowa communities a call to 911 doesn’t necessarily promise you an ambulance or other emergency services.  

The Rural Health Care Crisis report finds that 166 rural hospitals have closed across America since 2005. In Iowa, 118 rural hospitals serve more than 1.1 million Iowans living and working in small, rural towns. While expanding Medicaid has delayed rural hospital closures in Iowa, the risk of closure is palpable as one in five rural hospitals are at risk and dozens have shuttered their maternity wards.  

The Iowa Voices report rightly calls for adequate funding for these hospitals. Long before Obamacare, and still today, Iowa legislators have been fighting for fair reimbursements and creative payment systems to keep our hospitals in the black. Without the Affordable Care Act, Iowa could be worse off. States that failed to expand Medicaid are taking the brunt of these closures. 

Access to health care is not a standalone issue. The viability of a community depends on good jobs, high-quality schools, and accessible health care. Losing a hospital impacts that economic vitality and quality of life for a community. Saving our hospitals must be met with economic investments in the community, to help retain the workforce and revitalize our small towns.

Until our nation figures out how to invest in rural economies to attract and keep health care providers, the rural towns many of us call home will continue to suffer.


By Patty Judge, chair of Focus on Rural America; former lieutenant governor and secretary of agriculture
Posted 2/27/20

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