"I would have never lasted to get to
But like Yarbrough, the 10-bed
At Evans Memorial, many blue-collar workers are unable to afford insurance but are too well-off for
But the hospital can't and won't turn away the uninsured — federal law prohibits it in emergencies. Recently, Dr.
Evans Memorial, which opened in 1968, has managed to keep operating by seeking new revenue — for example, a new wing for dementia patients scheduled to open soon. But the hospital was in the red for four years before finding itself
"We do not have fear of the doors closing, but we remember those days and we never get comfortable," said
Meantime, other rural hospitals have shuttered — 80 since 2010, mostly in the South and Midwest, according to the North Carolina Rural Health Research Program. A wave of closures also hit in the 1980s and early '90s with changes in
At Evans Memorial, about half the patients are covered by
The ACA was intended to slash the number of uninsured patients seeking care they could never afford at hospitals. It succeeded in rural areas, where overall the rate of uninsured people fell by 8 percent since full implementation of the law in 2014, said
Snap Lewis has been selling property and casualty insurance in
"I thought it was a very good plan," Lewis said, "if you can stand the hours."
But not all rural residents can — and many can't find jobs with insurance at all. At Evans Memorial, 10 percent of patients are uninsured.
Beyond the insurance,
When rural hospitals are forced to close, the effects reverberate, a 2016
And for many rural health care workers, the
"I wouldn't want to be in a position where I needed to say, 'Here's what we need to do to fix it,'" said Parks, the hospital's surgeon. "Because I honestly don't know what that would be."
Santana reported from