North Carolina is the #3 state with the most rural hospital closures since 2005

Photo byMary Blake

Rural hospitals in North Carolina and across the U.S. have long struggled financially, and the situation continues to worsen.

Many of these hospitals were built in the mid-20th century with federal funding, but by the 1980s, closures became common, partly due to changes in Medicare spending.

Since 2005, 195 rural hospitals have shut down nationwide, with 11 closures in North Carolina alone, costing the state 361 beds. Among North Carolina’s remaining rural hospitals, 30% are at risk of closing due to financial deficits, with six considered most vulnerable.

Key factors include an aging population, the rise of outpatient procedures, and the lack of Medicaid expansion in many Southern states, including North Carolina.

The closures leave many residents without access to trauma centers and obstetric care, putting health at risk. States that have expanded Medicaid under the Affordable Care Act (ACA) have seen rural hospitals 62% less likely to close, highlighting the importance of policy decisions in sustaining rural health care.

While federal COVID-19 relief funds aim to alleviate the burden on rural hospitals, more action from policymakers is needed to address the growing number of health care deserts in rural America.

Texas and Tennessee have also been severely impacted, with 29 and 14 rural hospitals closing, respectively, since 2005.