Peters Urges GAO to Study Impact of Rural Hospital Closures on Access to Affordable, Quality Health Care

WASHINGTON, DC – U.S. Senator Gary Peters (D-MI), Ranking Member of the Senate Homeland Security and Governmental Affairs Committee, is urging the U.S. Government Accountability Office (GAO) to examine the impact of rural hospital closures on access to health care. Peters’ request stems from a 2018 GAO report, which found that rural hospitals in the United States are closing at an increasing rate. These closures can cause significant gaps in access to both primary and specialty care, and increase the burden on rural residents who will have to travel further to receive care. A recent study found that more than 25 percent of rural hospitals in Michigan are at high financial risk of closing, which could impact health care access for hundreds of thousands of Michiganders.

“Rural communities in Michigan and across the country already face a shortage of health care providers, and additional hospital closures will only make access to care more difficult for rural residents,” said Senator Peters.  “Local hospitals not only play a vital role in addressing the unique health care challenges rural communities face, such as caring for older residents and fighting the opioid epidemic – they also create jobs and drive economic growth in their local area. This study will help us determine the impact of possible hospital closures and possible solutions so that we can ensure Michiganders can access quality health care in their own communities, regardless of which part of our state they call home.”

Peters’ request seeks information about how Michigan residents may be impacted in the event of more rural hospital closures. About one in four Michigan residents live in rural areas where the local hospital is often the primary health care provider. Michigan is also home to seven of the nation’s top 100 critical access hospitals, a designation aimed at improving access to health care in rural areas by preserving essential services and reducing the financial vulnerability of rural hospitals.

Rural hospital closures can also severely disrupt the local economy. In many rural areas, the local hospital is one of the community’s largest employers, providing good-paying jobs and contributing to local businesses. According to the National Rural Health Association, critical access hospitals invest an average of $7.1 million in their surrounding communities.

Senator Peters has strongly supported efforts to increase access to quality, affordable health care for all Americans. Earlier this year, Peters introduced bipartisan legislation to expand health care access in rural and underserved communities by providing additional pathways for Medicare to cover increased telehealth services. In May, Peters introduced a bill to help senior citizens continue living healthy and independent lives in their communities by supporting aging in place initiatives and expanding senior access to preventive and long-term care, including home- and community-based health services and caregivers

The text of the letter is copied below and available here:


July 15, 2019 

The Honorable Gene L. Dodaro
Comptroller General of the United States
U.S. Government Accountability Office
441 G Street, NW
Washington, DC 20548

Dear Mr. Dodaro:

I am writing to request that the Government Accountability Office (GAO) conduct a study into the impact of rural hospital closures on communities across the United States.

Rural hospitals are a critical part of the fabric of communities across the country. In Michigan, 1 in 4 residents live in a rural area, where the most comprehensive and sometimes only source of health care is at the local hospital. These facilities give annual check-ups, set broken bones, respond to overdoses, and provide a vast array of badly needed care to millions of individuals and families. Seven of the nation’s top 100 critical access hospitals, which are located in rural areas, are currently in Michigan.

Rural hospitals are also key economic drivers in their communities. Rural hospitals provide jobs, employing doctors, nurses, social workers, and other staff, and they purchase goods and services, contributing to local businesses. According to the National Rural Health Association, each critical access hospital invests an average of $7.1 million in the surrounding community every year in wages, salaries, and benefits from hospital operations.

In recent years, rural hospitals have been closing at an increasing rate. In an August 2018 report, GAO found that 64 rural hospitals closed from 2013-2017, over double the number of closures in the preceding 5-year period. These closures can have devastating effects on individuals and communities. When hospitals close, residents must travel further for medical treatment, and many may not be able to make the trip. Closures are associated with providers leaving the area and gaps in access to primary and specialty care. In Michigan, over 25% of rural hospitals are at high financial risk of closing, according to a recent analysis.

To better understand the impact of rural hospital closures on local residents and communities, and as a continuation of GAO’s work on this issue, please address the following questions:

  1. How many rural hospitals have closed in the past six years? Please provide the number and location of closures for each year from 2013 through the most recent year available.
  2. What has been the impact of rural hospital closures on residents of rural areas, and which residents have been most impacted by these closures?
  3. How have rural hospital closures affected rural residents’ access to needed health care services, including inpatient and outpatient care? Please include information on access to emergency room care, primary care, and behavioral health care, such as treatment for opioid addiction.
  4. How many jobs have been lost due to rural hospital closures? In particular, how many people did rural hospitals employ, and how many full-time positions did they offer, in the years leading up to closure? Were there any patterns in rural hospital employment as hospitals neared closure?
  5. What is known about the financial health of the remaining rural hospitals?

Thank you for your attention to this request.