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Independence is a pleasant community of just under 10,000 people in southeastern Kansas. Named in honor of the Declaration of Independence, the town is best known for two things: the birthplace of Pulitzer Prize-winning playwright William Inge and, by some accounts, the first night game in organized baseball, in 1930 between the Muskogee (Oklahoma) Chiefs and the Independence Producers. Muskogee won, 13-3.

Independence is also known for something else these days. It is a city without a hospital.

Mercy Hospital Independence closed in October. Many factors were involved in that decision, but Kansas’ refusal to expand Medicaid coverage under the Affordable Care Act was a catalyst. By one estimate, $1.6 million in revenue could have been generated for the hospital through Medicaid expansion, enough to offset more than $500,000 in looming cuts to Medicare reimbursements and in federal disproportionate share hospital payments, designed to help cover costs of treatment for uninsured patients.

Why discuss the problems of one hospital in another state? Because small hospitals in Oklahoma are in the same fix. More than 50 percent of the state’s rural hospitals are or have been operating at a financial loss; seven have filed for bankruptcy since 2010.