At the University of North Carolina’s Rural Health Research Program, Director Mark Holmes and colleagues are tracking the increasing numbers of rural hospital closures across the United States with this dynamic map.  As part of this work the Rural Health program has also looked at the impact on rural populations nationwide of state decisions not to expand Medicaid under the Affordable Care Act in this July paper here.  Based on the Rural Health data, I’ve created a map below that shows the large number of rural hospital closures in states that have yet to expand Medicaid.  While being sure to keep firmly in mind that most basic of public health principles – correlation is not causation –  there are increasing reports, like this one from Georgia, South Carolina and Florida, and this one from North Carolina, where rural hospitals are highlighting the financial strains they are under, especially in states that have yet to expand Medicaid.  This is a trend that bears watching as rural hospitals, health centers and clinics are critical to the delivery of care in the large rural areas comprising many of these reluctant states.  [Additional Note (10/23): Also check out what rural Chickasha, Oklahoma Mayor Hank Ross had to say about rural hospitals and Medicaid expansion to the Oklahoma legislature.]