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Illustration: Sarah Grillo/Axios

Rural America is stuck in a cycle of increasingly vulnerable patients with declining access to health care.

Why it matters: Rural patients often can't afford care, are being hounded by hospitals and collection agencies over their unpaid bills, and are facing the reality of life in communities where the last hospital has closed.

Rural Americans tend to be older, sicker and lower-income than urban Americans. They suffer from higher rates of obesity, mental health issues, diabetes, cancer and opioid addiction, as my colleagues Stef Kight and Juliet Bartz reported.

  • They're also more likely to be uninsured or covered by Medicare or Medicaid, which pay doctors and hospitals less than private insurance does.
  • A small and shrinking population, mostly covered by insurance plans that don't pay very much, many of whom need a lot of care, puts more financial pressure on providers, especially hospitals. Physician shortages are common.

What they're saying: “Rural hospitals have long been right there on the edge on average, and we’re seeing more and more of them flip over to red," said Mark Holmes, a professor at UNC-Chapel Hill and director of the Cecil G. Sheps Center for Health Services Research.

And hospital closures often exacerbate the problems communities were already facing.

  • Hospitals are often the largest or second-largest employer in a rural community.
  • 113 rural hospitals have closed since 2010, according to the Sheps Center.
  • These are disproportionately located in the South — the region with the nation's worst health outcomes, and where most states haven't expanded Medicaid — leaving hospitals with more uninsured patients.
  • A 2018 study in Health Affairs found that Medicaid expansion is "associated with improved hospital financial performance and substantially lower likelihoods of closure, especially in rural markets."

The bottom line: "What we have here is not one root cause; there’s multiple things going on here," Holmes said. "All these sort of modest kind of trends are adding up to something that’s quite considerable.”

Go deeper:

  • Bloomberg Businessweek reported on eastern Montana's sole psychiatrist, despite being the state with the nation's highest suicide rate.
  • The Washington Post detailed a hospital in Missouri's practice of suing its patients for payment — money that the hospital needed but patients generally don't have.
  • Kaiser Health News and NPR have profiled the fallout in a rural community in Kansas after its sole remaining hospital closed, which included a 2-week lapse in nearby emergency care.

Go deeper

48 mins ago - Sports

Jill Biden cheers on Team USA at Tokyo Olympics

Jill Biden congratulates U.S. women 3x3 basketball team after the first round 3x3 basketball match. Photo: Mustafa Yalcin/Anadolu Agency via Getty Images

First lady Jill Biden attended three Olympic events on Saturday and hosted a watch party at the U.S. Embassy for the Team USA-Mexico softball game.

Driving the news: On her first day as a spectator at the Games, Biden attended a women's 3x3 basketball game, cheered on American swimmers during preliminary heats and caught the second half of the U.S. women's soccer game against New Zealand.

58 mins ago - Sports

Team USA closes out Day 1 of Summer Olympics with no medals

Eli Dershwitz of Team United States reacts in his men’s sabre individual bout against Junghwan Kim of Korea of the fencing on day one of the Tokyo 2020 Olympic Games. Photo: Elsa / Getty Images

Team USA concluded the first official day of competition at the Tokyo Olympics on Saturday without winning a single medal despite several close contests.

Why it matters: Olympic historian Bill Mallon noted that this was the first time the United States did not receive any medals on Day 1 of the Summer Olympics since Munich in 1972.

G20 coal impasse previews fraught UN climate summit

A man tends to vegetables in a field as emissions rise from nearby cooling towers of a coal-fired power station in Tongling, Anhui province, China, Jan. 16, 2019. (Qilai Shen/Bloomberg via Getty Images)

G20 environment ministers ended talks without agreeing to phase out domestic coal-fired power generation and funding for such plants abroad, a deadlock that foreshadows difficult negotiations looming for this fall's critical climate summit.

Driving the news: Officials who met in Naples, Italy, on Thursday and Friday could not find consensus language on the use and financing of the most carbon-emitting fuel.