ARUN RATH, HOST:
For millions of Americans, rural hospitals are the only way to get quick emergency medical care. But in the last five years, they've been shutting down at a quicker pace than in the past. So a group of activists from across the country are walking nearly 300 miles from North Carolina to Washington, D.C., to get lawmakers' attention. NPR's Will Huntsberry went for the walk.
WILL HUNTSBERRY, BYLINE: Two hundred thirty miles down, 50 to go.
A small but committed band of activists...
(SOUNDBITE OF SONG)
UNIDENTIFIED PEOPLE: (Singing) Oh, all around Virginia, I'm going to let it shine.
HUNTSBERRY: ...Led by an unlikely figure.
ADAM O'NEAL: We're doing about 20 miles a day, which is extreme walking.
HUNTSBERRY: Adam O'Neal, blisters and all, is the Republican mayor in a small town in eastern North Carolina, walking, he says, to get more money for rural health care.
O'NEAL: People die when rural hospitals close - it's a fact - needlessly.
HUNTSBERRY: Last July, the hospital in Mayor O'Neal's town - the only one for miles - closed.
O'NEAL: When a hospital closes in rural America, like the one in Belhaven - we got people now that have to go 80 miles to get emergency help.
HUNTSBERRY: O'Neal has heard from his consistence of people who died because they said they couldn't get care in time. And he says that's because the rural hospital in his town is gone - one of 53 across the country to close in the last five years. Brock Slabach is a vice president with the National Rural Health Association, a group that represents rural hospitals.
BROCK SLABACH: I just hope that we, as a nation, can understand that we would like to act before there's a real crisis.
HUNTSBERRY: He says 283 more rural hospitals are at risk for closing. To understand all of these closures and at-risk hospitals, you've got to understand something else. Most are in the South, about 80 percent in states that didn't expand Medicaid under the Affordable Care Act.
SLABACH: And some of that is driven by the realities of the Affordable Care Act, and some of it is just driven by the realities of rural healthcare.
HUNTSBERRY: Chas Roades heads up research for The Advisory Board Company, that consults with rural hospitals. He says these hospitals have always had razor thin margins, and they've been cut into a lot lately. You've had small changes in payment structure and federal sequestration reducing reimbursements to hospitals. Then the latest - many Republican-controlled states have opted out of expanding Medicaid, saying in the long run, it would cost too much.
CHAS ROADES: It's really a tale of two cities. If you look at states that did expand Medicaid, the closure rate for rural hospitals is - has been significantly lower.
HUNTSBERRY: Maybe the most unique thing about this walk is that it's pulling far sides of the ideological spectrum into agreement on expanding Medicaid. Justin Jones is a young social justice activist who goes to school in Tennessee.
JUSTIN JONES: When I found out this was a Republican mayor, I said if he has that political courage to stand up for his constituents and the people of a party, that's the kind of leadership that we need.
HUNTSBERRY: If it were up to Mayor O'Neal, he'd take the Medicaid money.
O'NEAL: I'm not a huge Obama fan. But when you look at Medicaid expansion, you look at the numbers and you look at statistics, it's something that you have to do. If you don't do it, you're penalizing your people pretty harshly.
HUNTSBERRY: The walk arrives at the capital Monday morning. And supporters say a bill is in the works called Save Our Rural Hospitals that they hope to see past very soon. Will Huntsberry, NPR News, Washington, D.C. Transcript provided by NPR, Copyright NPR.