Many of these states are in the south, where rural communities are more likely to be non-white than in the midwest, for example. These are also areas where hospitals—particularly emergency services—are more essential, as people who don’t have insurance coverage are more likely to seek emergency care than preventive and ongoing services. Many of these states with rural minority populations have not passed the Medicaid expansion contained within the Affordable Care Act, which increases the financial threshold to qualify for Medicaid, leaving more people uninsured and hospitals are more likely to struggle, Probst said.

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