This blog is part of a series highlighting recent research illustrating various benefits of expanding Medicaid – from improving health and state budget savings to reducing rates of uninsurance and uncompensated care costs. Previous blogs in this series can be found here, here and here.

Rural hospitals in states that expanded Medicaid were better able to continue being a lifeline for their communities, a new study published in Health Affairs finds. Researchers at the University of Colorado found that the Affordable Care Act’s expansion of Medicaid can be tied to significant reductions in the probability of hospital closures. Since Medicaid expansion helped millions of previously uninsured adults gain coverage for the first time, hospitals in these states saw an increase in patients covered by Medicaid and a corresponding decrease in uncompensated care, which improved their overall bottom lines and helped them keep their doors open.

Overall, hospitals in states that expanded Medicaid were over six times less likely to close than hospitals in non-expansion states. Perhaps the most striking finding, however, is that half of the hospital closures that occurred since 2014 could have been avoided if the respective state had expanded Medicaid. The researchers also found that hospitals in expansion states experienced additional benefits – including significantly better financial performance – than those in non-expansion states.

The decreased closure probability was most significant for rural hospitals in areas with more than 10 percent uninsured rates prior to expansion. Hospitals in these areas were 81 percent less likely to close on average than rural hospitals in non-expansion states.

This research now sits atop a mountain of evidence on the various benefits of expanding Medicaid. In September, a comprehensive literature review of the impacts of expansion found dramatic differences in access to and affordability of coverage, overall health and financial security for residents of expansion states versus non-expansion states. Most recently, a report from the Brookings Institution concluded that Medicaid expansion initiatives, both prior to and as a result of the Affordable Care Act, and be linked to a significant reduction in crime.

With so much to gain from expanding Medicaid, it is disappointing and concerning that 18 states have unfortunately still decided against expanding their programs, leaving their hospitals to bear the burden of uncompensated care and thousands of their residents to remain uninsured. But each new piece of evidence makes the message of expansion louder and clearer. Now is the time for policymakers in non-expansion states to heed that message and do what is best for their state and its residents.