The Case of Hospital Closures in Rural America –

Access to Healthcare and Voting: The Case of Hospital Closures in Rural America

By Christan Cox, The University of Arizona, Derek A. Epp, The University of Texas at Austin, and Michael E. Shepard, The University of Texas at Austin

We investigate how hardships affect rural politics, considering the case of hospital closures. In the last two decades, more than two hundred rural hospitals have closed their doors or drastically reduced their services. Drawing from resource models of voting, our hypothesis is that personal- and community-level deprivations brought about by hospital closures should reduce election turnout. Empirical tests pair geographic information on the location of open and closed hospitals with data from state voter files to create a panel of over 10 million rural residents for the 2016, 2018, and 2020 national elections. Results show that individuals whose nearest hospital closed prior to the proximate election were less likely to vote than their unaffected counterparts. These effects are strongest for older and lower-income residents, but they decay over time so that voting likelihood resembles a pre-closure baseline within 12 months.