The hospitals that serve low-income and rural Americans have been shutting down more frequently in recent years, a shift that’s partially been spurred by reforms under the Affordable Care Act. Some analysts say that consolidating hospitals may be a good thing in the long term, because it will help make health care delivery more efficient. But the advocates rallying in Washington, D.C. this week say it’s an untenable situation that’s disproportionately affecting vulnerable Americans, who are increasingly losing their access to nearby emergency services.
Led by Adam O’Neal — the Republican mayor of a small North Carolina town named Belhaven where a rural hospital, Vidant Pungo, was recently shuttered — a group of activists from 11 states walked 283 miles on foot over the past two weeks to draw more attention to the hospitals in peril.
Each mile they walked represents a rural hospital, that, according to a recent report from the Advisory Board Company, is currently at risk of closure without sufficient funding. Their journey took them from North Carolina to the nation’s capital, where the group gathered on Monday morning for a press conference.
O’Neal, who says that some Belhaven residents have died because they couldn’t be treated at a nearby hospital, made the same journey last year to raise awareness about the issue. This summer, it’s been dubbed simply “The Walk” and has picked up additional supporters, including civil rights leader Bob Zellner, who marched on Washington more than 50 years ago.
Even though O’Neal is a Republican, he says that lawmakers need to think carefully about how their positions on Obamacare may be affecting rural hospitals. That’s because failing to expand Obamacare’s optional Medicaid expansion leaves hospitals struggling to remain profitable without an influx of newly insured patients. Rural health care experts have long warned that refusing to accept Medicaid expansion threatens to have negative consequences for their constituency. In addition to closures in North Carolina, multiple rural hospitals have also shuttered in other red states where GOP lawmakers have resisted expanding the public health program — including Texas, Tennessee, Georgia, and Alabama.
Some of those closures have resulted in tragic stories. For instance, in 2013, the loss of a hospital in a rural East Texas town became quite personal after an 18-month old died from choking on a grape. The baby’s family rushed her to the closest hospital, but it was closed and locked — it had been shut down just months earlier. By the time they reached the next emergency room facility, which was about 20 miles away, it was too late.
O’Neal and his supporters suggest that future tragedies may be averted by finding ways to prevent small hospitals from suffering big financial losses, like accepting the Medicaid expansion. “I’m not a huge Obama fan. But when you look at Medicaid expansion, you look at the numbers and you look at statistics, it’s something that you have to do. If you don’t do it, you’re penalizing your people pretty harshly,” O’Neal told NPR this week.
Many of the activists who walked alongside O’Neal agreed. Laura Guerra, who lives in Texas, wrote in a blog post documenting her fifteen-day journey that she decided to take a stand in response to her state lawmakers’ refusal to expand Medicaid. “I joined The Walk frustrated because of political inaction. But now, I walk in hope that a new moral movement is possible and beginning to take hold,” Guerra wrote.
Activists have long been making a moral case for Medicaid expansion, pointing out that there’s a human cost to lawmakers’ refusal to accept the policy. The president of North Carolina’s NAACP, Rev. William Barber — who has been an instrumental player in the state’s ongoing Moral Monday movement — joined O’Neal on part of his walk.
“Hospitals are not like hardware stores; we can’t simply close them and not expect people to be affected. The Walk must start a national debate about the condition of rural hospitals today,” O’Neal said in a press release marking the beginning of his trek to the U.S. Capitol. “We must demonstrate to lawmakers in D.C. how we the people can cross party lines to work on this vital issue.”