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Commonwealth Forum: Should the State Provide 

Support to Rural Hospitals?

YES

Health care is a human right. In a nation as wealthy as the United States, not 
providing basic health care to every citizen is immoral. There are fifteen 
hospitals in the state of Pennsylvania considered “critical access,” a designa-
tion given by the Centers for Medicare and Medicaid to some rural hospitals 
in response to closures in the late twentieth century. This means these hos-
pitals provide care when the next-closest option might be more than forty 
miles away. In the event of a heart attack or another acute-care issue, access 
means the difference between life and death. Rural Pennsylvanians deserve 
the same ability to attend to their health needs as any other urban or subur-
ban citizen.

In recent years, rural hospitals across the United States have been facing 
increasing closures. First, the lack of health insurance means hospitals pro-
vide care but are uncompensated for it. People simply cannot pay the bills. 
Second, rural hospitals serve small populations, an often shrinking market, 
who are not as wealthy as their counterparts in other regions. Thankfully, 
the passage of Medicaid expansion has enabled more rural citizens to have 
health insurance and has financially stabilized some of the most vulnerable 
rural hospitals. Those rural hospitals in nonexpansion states provide more 
uncompensated care, putting them at risk of closure. During the budget im-
passe of Governor Wolf ’s first year, rural hospitals in the Commonwealth 
were operating on the brink of closure because of delayed Medicaid pay-
ments from the state. When lives are on the line, state government needs to 
fulfill its responsibilities to the people. Politicians should not play politics 
with the basic needs of the people they are supposed to represent.

NO

There are nearly seven hundred rural hospitals on the brink of financial col-
lapse in the United States. They stay open because of huge injections of tax-
payer money into an unsustainable system. The numbers simply do not add 
up. Rural populations are shrinking, yet residents of these areas believe they 
have a right to a hospital. Rural areas have plenty of other amenities. For 
example, they are much less polluted with car exhaust and concentrated 



heavy industry than their suburban and urban counterparts. They have open 
vistas, and peace and quiet. Residents do not have to sit in traffic for hours 
simply to get to work. However, what rural areas do lack is easy access to a 
hospital. But why should the residents of a state or the citizens of the rest of 
the country fund what comes down to a personal decision about where to 
live?

Rural hospitals are falling apart because of the realities of our market 
economy, and it is no place for government to continue to waste public 
money sustaining them. Rural areas often have trouble attracting enough 
doctors and medical personnel to staff a hospital. Rural residents tend to lack 
good health insurance or have no insurance at all, and so the hospital is 
forced to function while providing services for free or at far under market 
value. In addition, in many areas, there simply are not enough people re-
questing services at the hospital to justify keeping the doors open. Should 
rural residents be provided with medical care? Of course. But a general phy-
sician or small clinic could suffice, and patients could travel for more-severe 
conditions. Sustaining failing rural hospitals is just another reason the cost 
of health care in the United States continues its exponential climb.

For More Information

The Pennsylvania Office of Rural Health (http:// www .porh .psu .edu/) at 
Pennsylvania State University is a partnership among the federal govern-
ment, the Commonwealth, and the university. There are fifty state of-
fices funded by the Federal Office of Rural Health Policy in the U.S. 
Department of Health and Human Services and Pennsylvania Depart-
ment of Health.

The U.S. Department of Health and Human Services Federal Office of 
Rural Health Policy (https:// www .hrsa .gov/ rural -health/ index .html) 
was created in 1987 to address rural access to health care, study the mar-
ket stability of rural hospitals, and the role of Medicaid and Medicare in 
financing rural hospitals.

The National Organization of State Offices of Rural Health (https:// nosorh 
.org/) provides news, studies, and discussion of best practices related to 
rural health issues across the country.

From Pennsylvania Politics and Policy: A Commonwealth Reader, Volume 1. Edited by
Michelle J. Atherton and J. Wesley Leckrone (Philadelphia, Temple University Press,
2018).




