Kathy Corley remembers the day that Barnwell, South Carolina’s Southern Palmetto Hospital closed. It was a weekday in January 2016, and she and her colleagues were given 48 hours notice that the rural hospital would stop serving patients.
"You’ve been there for all those years, you’ve taken care of patients, you’ve made lifelong friendships with the employees that are there," said Corley, who retired from nursing in 2022. "Some of those people I’ll never see again."
But the story of Southern Palmetto’s closure is a microcosm of a national issue; since 2005, over 150 rural hospitals have closed, destabilizing communities and accelerating the decline of rural America. The shuttering of rural hospitals comes at a time of profound need for rural Americans; rural communities have higher rates of gun violence, deaths of despair and face unique vulnerabilities to the public health effects of pollution and climate change. While life expectancy rates continues to rise for urban Americans, rural Americans are dying younger and younger.
Since March, I've been investigating the root cause of America's rural health care crisis. What I found was a system in which insurers legally profit off of denying reimbursements to hospitals for procedures, creating a downwards spiral where the more health care a rural hospital provides to its community, the more money the hospital loses, forcing it into closure. Those patients without insurance are forced into medical debt, a billion-dollar industry run by private equity firms; taxpayers are then left to clean up the mess. The burden of this crisis has been placed on the rural health care workforce, which is underpaid, understaffed and traumatized.
“As a small rural hospital, we’re competing with larger systems," said Lari Gooding, a hospital CEO in Allendale County, the most rural county in South Carolina.
Responsible for the crisis is an insurance industry that has spent billions on campaign contributions to Democrats and Republicans across the country. According to Federal Election Commission disclosures, the top three campaign contributors in the insurance industry during the 2024 election cycle have been health insurance companies, with tens of millions already spent.
However, this is also a story of rural love and resilience, as one community has begun finding sustainability within a broken system.
Please read "‘I’m gonna fight for my patients’: How Barnwell and Allendale counties are navigating the rural health care crisis," which was just published as part of my work with Report for America:
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