One in five of the remaining 2,160 rural hospitals in the U.S. are at risk of closing, according to a recent analysis from the Chartis Center for Rural Health. That's after a decade in which 120 rural hospitals were forced to close, 34 of them in the last two years. It's a feature of Republicans' efforts to kill people—the majority of closures are in states where Republican governors and legislatures refused to expand Medicaid, funding that proved crucial to those hospitals.
The result is hospitals like the one in Dayton, Washington, featured in this Washington Post article, scrambling to figure out how it will respond to COVID-19. They are "getting low" on masks and protective gear, the supply manager told the hospitals CEO, Shane McGuire. Worse, "I can’t buy anything. Everything's out of stock." They are even more strapped for staff: a "pharmacy department of one," a"70-year-old doctor, who was working alone in the emergency room," a "lab director, who was now also in charge of infection control."
"We'll improvise and make it work however we can," McGuire said, as they have been for several years without obstetrics, endoscopy, or any ability to do surgery of any kind. The nearest medical care for this community of 5,000—which has an average age 13 years older than the rest of Washington state—is 35 miles away. Of course it's not just Dayton, in a state which did take Medicaid expansion. "A facility in the Berkshires had lost much of its nursing staff to a 14-day quarantine. A critical access hospital in North Texas had only one face shield in storage and couldn’t acquire any others. A hospital in Wisconsin was borrowing sterilized medical gowns from local dentists."
We have a health system that is reactive rather than proactive and vulnerable to pandemics by its very nature. It's been made far worse by Trump administration efforts to destroy the Affordable Care Act and pretty much everything related to health care that the Obama administration had tried to fix. That includes nursing home regulations intended to protect vulnerable residents. That goes for the elimination of epidemic response teams at the CDC and NSC under Trump as well.
The loss of Medicaid funding in states that didn't expand is another Republican failure. The ACA was written on the assumption that every state would expand Medicaid, so it saved funding by cutting back other payments to rural and underserved area hospitals. When the Supreme Court decided that states had the option of taking Medicaid, the Republican-held Congress refused to take action to restore the lost funding to those hospitals. And here we are.
One of Dayton hospital employees scored by finding four boxes of respirator masks at the local tractor and lumber supply store. They had gloves, hand sanitizer, and gowns as well as cash to last a normal two weeks. There is no normal anymore.