Fact Check: Rural hospital closures are more likely in Republican-controlled states that did not expand Medicaid.

Fact Check: "Rural hospital closures are more likely in Republican-controlled states that did not expand Medicaid."

What We Know

Rural hospital closures have been a significant issue in the United States, particularly in states that have not expanded Medicaid under the Affordable Care Act (ACA). Research indicates that states which opted to expand Medicaid have seen a dramatic reduction in rural hospital closures, with rates dropping to nearly zero. In contrast, non-expansion states have experienced a continuous increase in closures. According to a study, approximately 80% of rural hospitals that closed since the ACA was enacted were located in Republican states that chose not to expand Medicaid (source-1).

The financial viability of rural hospitals is heavily reliant on Medicaid reimbursements. In fact, rural hospitals often depend on Medicaid for a substantial portion of their funding, with many rural residents covered by the program. For instance, 23% of rural Americans are insured by Medicaid, compared to 19% nationally (source-1). A report from the National Rural Health Association highlights that in over half of the states, proposed reductions in Medicaid funding could exceed 20%, placing additional financial strain on already vulnerable rural hospitals (source-2).

Analysis

The claim that rural hospital closures are more likely in Republican-controlled states that did not expand Medicaid is supported by substantial evidence. A significant body of research indicates that the lack of Medicaid expansion correlates with higher rates of hospital closures. For example, a report noted that two-thirds of rural hospital closures from 2014 to 2024 occurred in states that had not expanded Medicaid at that time (source-6).

Moreover, the financial implications of Medicaid cuts are dire. A study predicted that independent rural hospitals could lose an average of 56% of their net income due to federal Medicaid cuts, which would exacerbate the already precarious financial situation of these institutions (source-7). The credibility of these findings is bolstered by the involvement of reputable organizations and researchers, such as the University of Michigan and the National Rural Health Association, which have a vested interest in rural health policy and outcomes.

However, it is essential to consider potential biases in the sources. While many of the studies and reports come from reputable health organizations and academic institutions, there may be an inherent bias in the framing of the issues, particularly from sources advocating for Medicaid expansion. Nonetheless, the overwhelming consensus across multiple studies supports the claim that non-expansion states, particularly those led by Republican governors, face higher rates of hospital closures.

Conclusion

The evidence supports the claim that rural hospital closures are more likely in Republican-controlled states that did not expand Medicaid. The correlation between Medicaid expansion and the survival of rural hospitals is well-documented, with a significant majority of closures occurring in states that opted out of expansion. Therefore, the verdict is True.

Sources

1. What proposed Medicaid cuts could mean for rural communities, hospital access Q&A with Michael Shepherd Assistant Professor of Health Management and Policy June 5, 2025. Link
2. Republicans' big bill could hit rural hospitals hard. Link
3. Republican bill slashing Medicaid could cause rural hospitals to close. Link
4. Estimated Impact on Medicaid Enrollment and Hospital Closures. Link
5. Rural Hospitals Brace for Financial Hits or Even Closure Under Republicans' $1 Trillion Medicaid Cut. Link
6. 10 Things to Know About Rural Hospitals. Link
7. Federal Medicaid Cuts Would Force Rural Hospitals to the Brink. Link
8. Medicaid Cuts one pager. Link