Rural hospitals have been struggling, citing financial and staffing issues. More than 140 have closed nationwide since 2010, with many more facing challenges that could see them shutting doors in the future as well. An additional 114 rural hospitals ended all inpatient services from 2010 to 2019.
One of the care units hit hardest by these problems has been the delivery room, which often pose unique challenges to many hospitals across the country due to their unprofitable nature under the current US healthcare system. In 2004, 55 percent of rural counties offered obstetric services. That number shrank to 45 percent by 2018, and continues to shrink to this day.
The Supreme Court's decision in Dobbs v Jackson has only exacerbated these issues. Dobbs held that the US Constitution does not provide a right to an abortion, representing a huge blow to women's rights and healthcare nationwide. Often overlooked, however, is the disproportionate effect the decision has on rural hospitals across the country. More reading on the Dobbs decision and the state of rural hospitals can be found on this blog here and here.
Following the outcome of Dobbs, trigger bills in many states across the country immediately went into effect. One of these states was Idaho, whose near-total abortion ban includes a provision which exposes physicians to both criminal and civil litigation for performing an abortion. Idaho is one of only six states in which health care providers are open to this type of prosecution. As a result, the already precarious situation rural hospitals find themselves in appears to be getting worse.
Bonner General Health, a hospital in Sandpoint, Idaho, recently announced that it would be discontinuing all obstetrical services starting mid-May of this year. As a result, labor and delivery care will be halted entirely. In a press release, the president of the hospital cited Idaho's political climate and staffing shortages as the main reason for these changes, saying:
Highly respected, talented physicians are leaving . . . the Idaho Legislature continues to introduce and pass bills that criminalize physicians for medical care nationally recognized as the standard of care . . . We hoped to be the exception, but our challenges are impossible to overcome now.
Sandpoint is a town with a population of roughly 9,000 residents, who recorded 265 births at Bonner General last year. New parents in labor will now have to travel to Kootenai Health in Coeur d'Alene, which is about an hour away from Sandpoint.
To make matters worse, Kootenai Health is experiencing its own troubles. Similar to rural hospitals all across the country, staffing shortages and financial hardships forced the hospital to shutter its addiction recovery and outpatient psychiatry programs. Due to a recent staffing shortage and Covid-19 surge, a US Army medical team was dispatched to Kootenai Health to help the overwhelmed hospital. Given the looming closure of Bonner general Health's obstetrical services, Kootenai will likely face similar challenges once this change is put into effect on May 19th.
Additionally, the Idaho legislature recently passed an "abortion trafficking" bill, which would bring criminal charges to those who help pregnant minors across state lines for the purposes of obtaining an abortion without parental consent. An amendment to the bill accepted by the House would add the ability for rapists to sue their victims for undergoing an abortion procedure. The bill could mean increased burdens on Idaho's neighboring states, who all currently allow abortions.
In Mississippi, a similar trigger bill went into effect post-Dobbs, banning all abortions except for cases of rape, incest, or danger to the pregnant person. Mississippi's only abortion clinic shut its doors shortly after. As a result, some in the state legislature predict an additional 5,000 babies will be delivered within the state. This reality will once again disproportionately affect rural hospitals already struggling to survive.
Hospitals in Mississippi's rural areas have already been suffering, as the state is one of only 10 to refuse federal Medicaid expansion funding. Medicaid currently finances roughly 42 percent of births in the US, and covers a majority of births from people with low incomes. While the funding is largely a temporary band-aid on a much larger problem, states that opted out of the program accounted for almost three-fourths of rural hospital closures from 2010 to 2021.
While the state's rural hospital situation has improved slightly in more recent times, danger still remains. 38 percent of Mississippi's rural hospitals are in danger of closing, which would put 28 of the state's 65 rural counties without a hospital. Staffing shortages will similarly put a strain on obstetrical services within the state, where already limited delivery room capacities in rural areas may quickly become overwhelmed.
It remains to be seen how these challenges facing rural hospitals can be solved, but it is clear that the Dobbs decision further worsens an already significant issue. Larger expansions to Medicaid may alleviate some stresses for the immediate future, but long-term solutions have yet to be offered by state legislators. Unfortunately, many hospitals in rural areas appear to be heading towards a bleak future, or complete closure.
5 comments:
This is extremely insightiful! I didn't even consider that part of the Dobbs blowback would be doctros leaving states with puntutive abortion laws, worsening the already terrible geographic health divide. I can't think of a positive point to make here, just an awful state of affairs.
While I was already upset with the Dobbs decision, I had mostly only ever considered the impact of the decision in the context of its effect on women’s’ rights to bodily autonomy, reproductive self-determination, and (individual) health. Reading your discussion of the ways in which the Dobbs decision is actually debilitating rural health care systems and infrastructure, as well as the concerning extent to which rural hospitals are currently struggling, was really informative. Adverse implications of the Dobbs decision for rural communities, such as this, are likely a contributing factor in the wave of rural anti-Dobbs sentiment that seems to be popping up in various state elections around the country.
What a heartbreaking reality for so many women in rural areas. Only 11% of rural hospitals offering OB services is madness!!!! I know how hard it is to get OBGYN services and I am surrounded by these doctors. I can only imagine how awful it is when they are so scarce. Knowing that laws are making their jobs so much more difficult, and even criminal, is a terrible reality for doctors who choose to help vulnerable, rural communities.
Thank you for your post! I think it's so important to consider the spatiality and geography of abortion rights. Abortion access is even harder when folks live in rural areas. Even the thought of being in a progressive state such as California doesn't mean that people don't have trouble getting abortion access. I also think you shed an important light on what these punitive abortion measures mean for the healthcare industry, hospitals, and doctors in general. Not having providers means that care can't be provided, and so the repercussions of Dobbs has so many chilling effects. I also think about how another one of these effects is in states where there are trigger laws there is an encouragement to tell on each other and out people to law enforcement, under the threat of criminal prosecution especially for health care professionals. It's scary out there! Thanks for talking more about this!
Thank you for bringing up this issue! As others have stated, this is just a horrible state of affairs with seemingly no positive light. It is awful to learn that physicians are becoming even more scarce in places where there is already limited access. I think your blog post is an excellent example of how issues affecting women affect people everywhere because the consequences of a lack of doctors will not only be felt by the women who seek medical/abortion care.
I also hate to think of the ways in which some of these "abortion trafficking" bills will negatively affect people. It reminds me of the bills in place that target parents for providing gender-affirming care to their children. I think that if things don't change, a lot of people will be displaced from their home states, and those who cannot afford to do so will suffer the most. Ultimately it seems that things are going to get a lot worse before they get better.
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