Last month, the only hospital in the sleepy town of Belhaven in eastern North Carolina closed its doors, prompting Belhaven Mayor Adam O'Neal to step out of party lines and call for an expansion of Medicaid in North Carolina. And then he took a lot more steps.
The Republican mayor and self-proclaimed conservative spent the last two weeks walking the 237 miles from eastern North Carolina to Washington, D.C., to raise awareness of the need to save his and other rural hospitals around the nation.
O'Neal did it with the support of the North Carolina chapter of the NAACP. O'Neal, Belhaven residents and NAACP members met on the front steps of a U.S. Senate building on Monday. They demanded the reopening of the hospital and hoped to draw attention to what they call a rural health care crisis.
The protesters fear that the 20,000 residents of Beaufort and Hyde counties will have to travel as far as 75 miles for emergency department facilities. O'Neal asserts that people will die as a result of the hospital's closure and that one woman, 48-year-old Portia Gibbs, was the first victim of Vidant Health's "shameless and immoral" decision to close the hospital.
Barry Gibbs, husband of Portia Gibbs, joined O'Neal at the rally in D.C. He says his wife died as a result of delayed care, waiting for a helicopter to airlift her to Norfolk, Va., because the hospital in Belhaven had closed. There aren't any doctor practices or hospitals in Hyde County.
In general, rural hospitals are more financially distressed, have lower profit margins than their urban counterparts and are disproportionately affected by states' decisions to opt out of Medicaid expansion, according to Mark Holmes, director of the North Carolina Rural Health Research and Policy Analysis Center.
The Vidant Pungo Hospital is one of dozens that have closed since last January. Holmes says that 14 of the 16 rural hospitals that have closed in the last 18 months are in Southern states that chose to not expand Medicaid.
Vidant Health is the largest health care provider in an area historically referred to as the "Stroke Belt." Since the company announced last September that the hospital would close, town officials, residents and the NAACP have been actively fighting to keep the hospital's lights on.
The North Carolina chapter of the NAACP filed a complaint against Vidant Health in January, alleging discrimination against residents who are "very poor minorities" and need access to emergency department services due to a high burden of chronic diseases.
In April, the town of Belhaven, the NAACP and Vidant Health signed an agreement brokered by the U.S. Department of Justice to transfer ownership of the hospital from Vidant Health to a community-based board, and the complaint was dropped.
But what had been hailed as a promising and historic agreement between these parties fell through, and on June 24 the NAACP refiled the complaint. Instead of a transfer of ownership, the hospital doors were padlocked and bolted.
More than a loss of health care
The closure of the Vidant Pungo Hospital has caused a wave of anxiety among Belhaven residents, both for the loss of health care and for the loss of jobs and people. They say the closure of a community's sole hospital can risk putting the local economy in a downward cycle from which it's very difficult to recover.
Roads leading into this town that once had a thriving shrimping and lumber industry are conspicuously lined with signs reading "Save our Hospital."
Belhaven's local businesses, property values and tax base depend on attracting retirees who not only seek warm weather and beaches, but also access to health care, the mayor says.
"They have ripped our economic heart out of our community," O'Neal said in a recent interview. "How many people go retire somewhere where it doesn't even have a hospital?"
Roger Robertson, president of Vidant Community Hospitals, said that the decision to close the hospital was influenced by a number of reasons, including the hospital's location in a flood zone, the deteriorating building and the state's decision to opt out of Medicaid expansion as allowed for under the Affordable Care Act.
"We had to factor in a lot of different things; Medicaid expansion is one factor out of many," he says. "It does influence people's access to that form of payment."
As of now, 21 states have not expanded Medicaid under the Affordable Care Act, including most southern states. In North Carolina, an estimated 318,710 poor and uninsured adults would be eligible for Medicaid if the state expands it.
O'Neal and the North Carolina chapter of the NAACP are determined to see the hospital in Belhaven up and running again.
"We're not going anywhere until people quit dying from lack of emergency room services," O'Neal says.
Hyun Namkoong is a reporter for North Carolina Health News. This story is part of a reporting partnership between NPR and Kaiser Health News.