NASHVILLE, Tenn. — Tennessee leads the nation in rural hospital closures per capita, and the top candidates for governor are staking out different fixes as voters head toward the Nov. 3 election.
Advocates say the closures create hospital deserts that force rural residents to travel hours for emergency and maternal care. Twelve rural hospitals are currently at risk of immediate closure, according to reporting on the candidates plans. Tennessee has rejected Medicaid expansion and has been ordered to return hundreds of millions of dollars in federal matching funds over compliance audit issues.
Independent Lauren Pinkston said TennCare reimbursements are too low to keep rural facilities open and that the state relies too heavily on emergency rooms. She wants more preventive care, employer-based clinics and a harder crackdown on medical-supply fraud, including shifting fraud investigations toward the attorney general or the Tennessee Bureau of Investigation.
Independent David Hatley called hospital closures a life-or-death issue for small towns and said he would bring rural hospitals to the table to learn what it takes to keep them open. Democratic nominee Jerri Green and Republican nominee Marsha Blackburn have also framed rural access and maternal health as campaign issues, with proposals that range from budget changes and free-standing emergency rooms to federal funding strategies.
The state Maternal Mortality Review report covering 2021-2023 found mental health conditions were the leading cause of pregnancy-related deaths at 27 percent, most tied to substance use disorder, followed by cardiovascular conditions at 24 percent. Non-Hispanic Black women experienced the highest burden of pregnancy-related mortality with a rate of 116 per 100,000 live births. Substance use disorder was the underlying cause in 22 percent of pregnancy-related deaths and a contributing factor in another 17 percent. Reviewers judged 74 percent of 2023 pregnancy-related deaths preventable.
