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Illustration: Sarah Grillo/Axios

As hospital prices rise and much of the sector continues to rake in cash, rural hospitals continue to shutter.

Why it matters: There's no way to address U.S. health care spending without cutting hospital costs. But blanket cuts could hurt hospitals that are already struggling to keep their doors open, leaving vulnerable patients without access to care.

Driving the news: At least 30 hospitals entered bankruptcy in 2019, Bloomberg reported last week.

  • Rural hospitals' hardships have been well-documented: They serve a shrinking population that has high health needs and is disproportionately uninsured or covered by government insurance.
  • The shutdown of an urban hospital in Philadelphia is evidence that it's not just rural areas that are facing hospital closures.

Yes, but: Some hospital systems are reaping in hefty profits.

  • In an analysis of 48 not-for-profit hospital systems, my colleague Bob Herman last year found that their net profit margin was 8.6%.
  • Bob has also reported that "not-for-profit hospital systems increasingly operate more like corporate titans on the stock exchanges than the charities they promote themselves to be."
  • Private insurers pay hospitals, on average, 241% of what Medicare pays for the same services, and hospitals are by far the largest contributor to U.S. health spending.

Go deeper: How "Medicare for All" would affect hospitals

Go deeper

Michigan board certifies Biden's win

Poll workers count absentee ballots in Detroit, Michigan on Nov. 4. Photo: Salwan Georges/The Washington Post via Getty Images

The Michigan Board of State Canvassers certified the state's election results on Monday, making President-elect Joe Biden's win there official and granting him the state's 16 electoral votes.

Why it matters: Republican Party leaders had unsuccessfully appealed to delay the official certification, amid the Trump campaign's failed legal challenges in key swing states.

Biden to nominate Janet Yellen as Treasury secretary

Photo: Photo by Alex Wong/Getty Images

President-elect Joe Biden is preparing to nominate former Fed Chair Janet Yellen as his Treasury Secretary, four people familiar with the matter tell Axios.

Why it matters: Yellen, 74, will bring instant economic celebrity to Biden’s team and, if confirmed, she will not only be the first female Treasury Secretary but also the first person to have held all three economic power positions in the federal government: the chair of Council of Economic Advisers, the chair of Federal Reserve and the Treasury Secretary.

2 hours ago - Podcasts

Bob Nelsen on AstraZeneca and his plan to revolutionize biotech

AstraZeneca and the University of Oxford on Monday reported promising efficacy data for their COVID-19 vaccine, which has less stringent storage requirements than the Pfizer and Moderna vaccines and may be distributed earlier in developing countries.

Axios Re:Cap digs into the state of vaccine and therapeutics manufacturing with Bob Nelsen, a successful biotech investor who on Monday launched Resilience, a giant new pharma production platform that he believes will prepare America for its next major health challenges.