A triple disaster: Uninsured, living far from a hospital, and sick with COVID-19
Rural areas in North Carolina have seen numerous hospitals closed resulting in dwindling options on where to receive medical care. Out of the 100 counties in North Carolina, seventeen do not have state-licensed hospitals resulting in residents — if they are able — traveling up to 30 miles in some cases to the nearest medical facility.
Since 2010, over six rural hospitals have closed in North Carolina, and others are at high risk of financial stress due to lack of funding. On top of residents relying on very few urgent care centers, rural health clinics and county health departments, over 1 million North Carolinians did not have health insurance in all of 2018.
As COVID-19 continues to sweep across North Carolina, the concerns for rural area residents could not be any higher.
Ten of the 17 hospital-less counties have reported positive cases of COVID-19, although the number of cases is likely an under count because of testing limitations. As of April 7, that total was 88, according to the state Department of Health and Human Services. (Most of Northampton County’s total originated at a nursing home.) No deaths have been reported in these 17 counties from the virus.
According to state health department statistics, 354 of the state’s 3,220-plus known cases are hospitalized. However, that data is incomplete because only two-thirds of hospitals have reported their totals. Forty-six people have died.
Although most people with the virus don’t require hospitalization, those who do often have underlying medical conditions that put them at risk of dying. And rural residents, who tend to be older, poorer and geographically isolated, are also more likely to be in poor health than their urban and suburban counterparts.
Unable to financially survive, seven rural hospitals have closed in North Carolina since 2010, according to the NC Rural Health Research Program at UNC Chapel Hill. In some cases, rural hospitals are shutting down as a result of mergers; in other instances, declines in rural population mean there are fewer patients and fewer dollars. And the lack of Medicaid expansion also cuts into hospital revenue because the facilities aren’t reimbursed for services for uninsured patients.
Without adequate medical facilities, COVID-19 may be silently spreading across rural counties in not only North Carolina, but the entire country. With the lack of financial resources, hospital funding cuts and understaffed facilities, the stress imposed by not expanding Medicaid and not prioritizing hospitals could prove devastating for states like North Carolina.
Where testing is limited and medical supplies are scarce, rural counties need to be equipped to handle their local patient capacities. Yet, state lawmakers continue to put aside Medicaid expansion as many rural residents remain without health insurance during the public health crisis.
There has always been an inequitable distribution of health resources between urban and rural areas. Because of the lack of investment, rural communities are now being preyed upon by the coronavirus and it is time that state lawmakers protect those who are most vulnerable.
State lawmakers need to ensure that these rural areas receive the aid they need to diagnose, treat, and stop the further spread of the virus. The first and biggest step forward would be for lawmakers to expand Medicaid now.
