When a county is without a hospital, that has lasting effects on the most vulnerable residents. Upshur County has experienced it before, as health care systems have struggled to maintain a hospital there. East Texas Medical Center Gilmer joins several other hospitals around the country closing primarily because of declining reimbursement rates from Medicare and Medicaid. Since January 2010, at least 43 rural hospitals have closed across the country, according to the North Carolina Rural Health Research Program. "I think you'd find that most small cities don't have hospitals anymore," said Jeff Ellington, Gilmer city manager. "There was a time when it was pretty common, but it's becoming less and less common."
