POINT CLEAR, Alabama – Alabama's unwillingness to expand Medicaid is adding to the economic distress of the state's rural communities and further impeding their economic development efforts, officials said today.

Danne Howard, senior vice president of government relations and emergency preparedness for the Alabama Hospital Association, was the lead speaker of a rural economic development session to kick off the Economic Development Association of Alabama's summer 2014 conference.

She said a dozen rural hospitals have closed across the state and more than a dozen more could be lost over the next two years.

"Things are tough," Howard said.

Some of the challenges rural healthcare faces can blame Obamacare while others are due to the decisions of individual operators, Howard said.

But she said Gov. Bentley's decision not to expand Medicaid in Alabama is making it more difficult and putting more pressure on healthcare providers in the state.

First of all, the costs of uninsured patients are now the burden of providers and the insured, Howard said. She said 75 percent of those who come to the emergency room for care are uninsured and come at a stage of illness that makes it more costly to treat. Those costs are then passed on to others.

"Emergency room care is the most expensive form of care," she said.

An expansion of Medicaid would help expand coverage and more preventive care, she argued, saving money for everyone.

But the loss of healthcare facilities in rural areas is making it more difficult in the recruitment of industry in parts of the state already having a difficult time luring business, Howard said. A workforce without suitable access to healthcare is also less attractive to industry, she said.

A new website, alabamasbest.org, has been established to make the economic argument for Medicaid expansion with a running counter of how many millions of dollars the state is losing in federal dollars for not expanding Medicaid.

But Gov. Bentley and other Republican leaders in the state argue that accepting Medicaid expansion may benefit the state in the short term, but could put it on the hook for millions more in the future as more of those costs are scheduled to shift to the state.

The six rural economic development regions defined by EDAA. (contributed)

Beyond healthcare, the rural economic development session looked at the importance of regionalism in helping rural parts of the state recruit and expand industry.

Marsha Gaylard, president of the Pike County Economic Development Corporation, said working as a region to recruit industry can be beneficial because often big industries employ workers from neighboring counties.

Gaylard, whose region includes 10 counties in the southeastern part of the state, said while each county may compete to lure a company, the next best thing is to get a prospect in the region.

That way of thinking has fostered regional cooperation among the state's six rural economic development regions, said Brenda Tuck, executive director of the Marengo County Economic Development Authority.

Tuck's region includes nine counties in the south central part of the state.

Tuck and Gaylard said they have even had communications about region-to-region cooperation.

"I know we've talked about regionalism for years, but it's where the rubber meets the road," Tuck said.

The EDAA has identified the six rural economic development regions in the state and has fostered cooperation within and between them.

Wayne Vardaman, executive director of the Selma & Dallas County Economic Development Authority, has chaired the EDAA rural economic development committee. He passed the position to David Hutchison, executive director of the Butler County Commission for Economic Development.

This is the first post from the EDAA's summer conference. Follow our live Twitter updates through Wednesday at the conference under the hashtag #edaagrand14 tweeted by @MAJ_Chicken and @JacobyKathryn