Belhaven, North Carolina, Mayor Adam O’Neal has already walked 273 miles to Washington, D.C., to protest the closure of his town’s only hospital. Now, he wants to do it again, and is asking members of the National Rural Health Association to join him.
"I believe in Americans and I believe that when enough people find out the injustice that's going on, they'll do something about it," he said Tuesday at the association’s conference in Washington.
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He and Belhaven residents, along with the state NAACP chapter, are protesting last year’s closure of Vidant Pungo Hospital in Hyde County, North Carolina. But O’Neal doesn’t want to stop there: He wants Congress to start paying attention to the health of all rural Americans, and to help them get access to care.
“Some people don’t care that people die,” he said. “It’s going to be uncomfortable for some folks but i’m going to talk about it.”
Rural citizens in the U.S., many of whom work in agriculture, live in remote areas that are far from hospitals. This means primary care can be delayed, and families risk not being able to access emergency care when they need it.
“Do you know people don’t have cars? A lot of people don’t have cars,” O'Neal said. “Do you know what it’s like to need a car and have to go to the hospital?”
In a video presented at the conference, a Belhaven resident shared why she lived in the small town instead of moving to a city. “This is home,” she said. “We may not have things in the ways of malls and departments stores and conveniences – but we have slow-paced lives and beauty and family … and it’s irreplaceable.” She noted as well that the existence of rural communities also allowed for people around the country to have access to food and other necessities.
[SPECIAL REPORT: Hospital of Tomorrow]
Belhaven is a 1,600-person town is about 2.5 hours southeast of Raleigh, with a median income of $17,670.
The town’s hospital was built in 1968 and just over three years ago was bought by Vidant Health, a large hospital system in North Carolina. Vidant shut down the hospital in July 2014, citing environmental and structural concerns and saying it would build a clinic instead. Now, the nearest hospital is 35 miles away. “People can die getting there,” O’Neal said.
This story is becoming familiar for rural hospitals across the country. According to the American Hospital Association, more than a third of the nation’s 5,700 hospitals are in rural areas. The National Rural Health Association says the nation is in a "rural health crisis," estimating that 470 rural hospitals have closed during the past 25 years. Forty-seven of them closed during the last five years, and 283 more are in danger of closing soon, according to the association.
Doctors also are scarce. According to the National Rural Health Association, a quarter of Americans live in rural areas, but only about 10 percent practice in these areas.
There also are fewer options for health insurance in rural areas. In November of last year the Urban Institute found that the largest increases in premium prices were likely to occur in rural areas.
[READ: How Will Hospitals Handle the Newly Insured?]
Health disparities is only part of the problem. Severe economic costs also are at play. In many cities – both urban and rural – hospitals often are the largest employers. In Belhaven, the economic impact is estimated to be between $14 million and $16 million a year.
O’Neal also noted that the lack of Medicaid expansion in the state had hurt the hospital. Currently 29 states and the District of Columbia are expanding Medicaid, a provision of the Affordable Care Act that the Supreme Court made optional for states. Half a million previously uninsured North Carolinians would be covered if the state legislature and governor were to accept the funds from the federal government.
In 2013, Vidant Health CEO David Herman acknowledged to the Huffington Post that lack of Medicaid expansion in North Carolina also had played a role in shutting down the hospital.
O’Neal, who is a Republican, said Tuesday that expanding Medicaid in the state would have been the right thing to do. “They need to stand up and do the right thing,” he said of the state government.
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