Illustration: Melanie Lambrick

America’s Small Rural Hospitals Are Dying

For the ones that survive Covid-19, another gut punch awaits: Trump’s tax law.

Peter Cary
Published in
11 min readMay 19, 2020


This story was published in partnership with the Center for Public Integrity, a nonprofit news organization in Washington, D.C.

Paul Taylor wept when his hospital closed.

It was July 21, 2016, and Taylor, the CEO of a hospital system that owned the Ozarks Community Hospital in Springfield, Missouri, had to lay off 200 employees. The small hospital, which served many low-income residents with no insurance, could no longer afford to stay in business.

The closure didn’t seem that consequential to some. Springfield, a city of 167,000 nestled in a landscape dotted with small farms and surrounded by the Ozark Mountains, has other medical facilities. But Taylor’s community hospital, with just 11 beds when it closed, was special. Located near a census tract where 42% of residents live in poverty and nearly one in five is African American, it served a heavy load of patients on Medicare and Medicaid. And 40% of the people who came to his emergency room had no insurance at all.

Taylor had bet on Missouri expanding Medicaid under the Affordable Care Act, which would have increased the number of insured patients and, he said, “at least get payment on a lot of that uninsured that we were seeing.” But Missouri chose not to.

The lack of insured patients has wreaked havoc on small and rural hospitals’ balance sheets for years — especially in the states that did not expand Medicaid. Then came the Covid-19 pandemic, which has brought more pain to hospitals everywhere. Even the venerable Mayo Clinic in Rochester, Minnesota, laid off or cut the pay of 30,000 employees nationwide because it had to postpone elective patient care. On top of that, the massive job losses caused by the coronavirus shutdowns have likely caused more than 27 million people to lose their employer-based coverage, with states in the industrial Midwest especially hard hit.



Peter Cary
Writer for

Peter Cary is currently a consulting reporter for the business team at the Center for Public Integrity, and was previously at U.S. News & World Report.