Inequalities in health are likely to widen and the lamentable failure of profit-based health care are being ruthlessly exposed in the many rural areas of the USA where almost 900 hospitals are at risk of closure – 42% of the total.

A staggering 547 are at “immediate” risk according to the Center for Healthcare Quality and Payment Reform (CHQPR). For these hospitals the writing had been on the wall prior to the Covid pandemic: they were running persistent financial losses and had low or non-existent financial reserves.

In all but ten states a quarter of more of their rural hospitals could close – with four states set to lose over 60%, 14 states – many of them core Trump-voting heartlands – losing over 50% and nine more with more than four in ten hospitals on the danger list.

Worst hit of all could be Kansas, with 47 facing the axe immediately and 29 at high risk, followed by Texas with 31 set to close immediately and another 51 at high risk.

The CHQPR warns that margins at many of these hospitals will have been hit by higher costs of coping with Covid and reduced revenues as scare patients stay away from elective services for fear of catching the virus. Its report warns:

“Almost all of the rural hospitals that are at immediate or high-risk of closure are in isolated rural communities. Closure of the hospital would mean the community residents have no ability at all to receive emergency or inpatient care without traveling long distances.

“In many small rural communities, the hospital is the only place where residents can get laboratory tests or imaging studies, and it may be the only or principal source of primary care in the community.”

The situation presents a challenge and an opportunity for the Biden administration to show some commitment to reaching out to the rural communities in a way Trump never did in practice: failing to do so will trigger a heavy toll of rural ill-health and further political alienation.

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