Viewpoints: Rural Hospital Closures Are a North Carolina Problem

A hospital closure in an area with a small population may not seem important but the ripple effect is vast and may end up impacting you. The root cause of most rural hospital closures is straightforward: rural hospitals cannot negotiate as effectively as larger urban systems with private insurers. The consequences reach far beyond those rural communities. When a rural hospital closes, unemployment rises, surrounding local businesses suffer, and Triangle hospitals are forced to absorb complex patients who should have been treated locally, at earlier and less expensive stages of their illness. This translates to higher personal costs for patients, longer wait times, and emergency departments pushed past capacity in your own community.

The answer is not simply pumping more taxpayer money into struggling rural hospitals. It is leveraging a model that already exists and is working right here in North Carolina. In Eastern NC, Nash operates as a managed affiliate of UNC Health retaining its own board and community-based decision making while gaining access to UNC Health’s expanded primary care, specialist outreach, and most critically, its negotiating leverage with insurers. The result is diseases caught earlier, families spending less, residents staying employed, and local businesses remaining viable.

This is not an isolated experiment. Nationally, rural hospitals are turning to structured partnership models to negotiate collectively with insurers, access capital, and survive in an environment where individual small hospitals hold almost no leverage. In early 2025, 26 rural hospitals across Ohio and West Virginia formed one of the country’s largest rural clinically integrated networks, spanning 37 counties and 2.5 million patients, expressly designed to pursue value-based insurance contracts they could never have secured alone. The evidence is overwhelming: these partnerships improve outcomes for patients, stabilize hospital finances, protect healthcare jobs, and relieve pressure on urban systems like the ones in your backyard.

Our legislators have a clear choice. They can embrace this model, or risk further rural hospital closures that will raise unemployment, reduce average household income by as much as 4%, and accelerate the overcrowding of Triangle hospitals. Those are not abstract statistics. They are the lived consequences of policy inaction that will reach into urban communities regardless of zip code.

If you are someone who takes action to improve your community, contact your state legislator today. Ask them specifically to support the Rural Hospital Stabilization Act at the federal level and to champion state-level legislation requiring insurance companies to negotiate with rural hospital networks collectively rather than with individual hospitals. The solution already exists. The research already supports it. The only missing ingredient is the political will to make it statewide policy.

Michael Andora is a Carrboro, North Carolina resident and author with a background in the biotech industry.