When Pinnacle Regional Hospital in Boonville closed recently, it became the seventh rural hospital to shut its doors in Missouri since 2010.

In that same time frame, Illinois had two rural hospitals go out of business. The National Rural Hospital Association blames the difference on lack of Medicaid expansion.

The association reports there are nine factors that can lead to a rural hospital shutting down, and being in a state, like Missouri, that hasn't expanded Medicaid is No. 1.

“State-level Medicaid expansion is a major predictor,” said Brock Slabach, executive vice president of the association.

“The data show that being located in a Medicaid expansion state decreases the likelihood of closure by 62.3%,” Slabach said. “That could explain the difference between Missouri and Illinois in terms of closures.”

The Affordable Care Act included provisions for states to expand eligibility for Medicaid. Thirty-five states, including Illinois, Iowa and Arkansas, expanded Medicaid, while 15, including Missouri and Kansas, did not.

Slabach said rural hospitals have a higher percentage of uninsured and underinsured patients than their urban and suburban counterparts, and they feel the effects of cutbacks to Medicaid more.

“It should give policymakers a reason to take a look at expansion and understand that it goes beyond perhaps just the politics of the day,” Slabach said.

Missouri Gov. Mike Parson and the Republican majority leadership in the state Legislature oppose expansion of Medicaid, citing increased cost.

State Sen. Caleb Rowden, R-Columbia, whose district includes Boonville, has been an outspoken opponent of Medicaid expansion. He did not respond to repeated requests for comment.

The group Healthcare for Missouri is leading a petition drive to collect signatures to put Medicaid expansion on the ballot.

In Missouri, the Department of Social Services oversees Medicaid. The department did not respond to a request to comment on the rural hospital association’s assertion that the lack of Medicaid expansion was in part responsible for the closure of Missouri’s rural hospitals.

The department instead sent a statement regarding the possibility of a ballot initiative on the subject.

“The Department of Social Services does not have any comment on the ballot initiative. The Department, as other state agencies, will be responsible for providing a fiscal estimate on the ballot initiative if it is accepted by the Secretary of State,” Rebecca Woelfel, communications director of the department of Social Services, wrote in a statement.

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