Another rural hospital in Georgia closed this week due to financial problems partly related to the state’s refusal to expand Medicaid. An increasing number of rural hospitals are suffering due to high rates of unemployed and uninsured patients. Lower Oconee Community Hospital in southeast Georgia is the state’s fourth rural hospital to close in the past two years and health officials say more may follow suit, the Albany Herald reports.

“We just did not have sufficient volume to support the expenses,” CEO Karen O’Neal told local news channel WMAZ. “It’s a terrible situation, and it’s tragic – the loss of jobs and the economic impact.” Residents will now be forced to drive about 30 miles to get care in case of an emergency.

Medicaid expansion would help rural hospitals “by turning many of their uninsured patients into paying patients,” the Herald notes. The Obama administration’s Affordable Care Act sought to expand Medicaid to the nation’s poorest residents; however, states can now opt-out of Medicaid expansion.

Georgia’s governor, Nathan Deal (R), and Republican lawmakers have refused Medicaid expansion. The state’s Medicaid spending per capita is among the lowest of all the states in the nation. Recently, GOP lawmakers went a step further by introducing a bill that will require approval from a GOP-dominated state legislature in order to expand Medicaid in the state.

And Georgia is not alone. Other hospitals closed last year in North Carolina and Virginia. In Tennessee, where lawmakers haven’t decided whether or not to expand Medicaid, hospitals are preparing for cut backs. Almost half of the state’s 61 rural hospitals “may face major cuts or closure,” Bloomberg reported last year.

Many state legislators have said they oppose Medicaid expansion because their states cannot afford it, although their reasoning is not supported by fact. The federal government covers 100 percent of the cost of Medicaid expansion through 2016 and states begin paying a small amount of that share afterwards. States would begin paying 10 percent of the cost in 2020.

Every state that chose to opt-out of Medicaid expansion had a Republican governor and state legislators who were against the Affordable Care Act, although some states have now reversed their decision to opt-out. Many of the states that opted-out have some of the highest rates of uninsured residents in the country and would benefit greatly from expanding the program.

The Wheeler Country area, where Lower Oconee Community Hospital was located, has a 23 percent uninsured rate and 10 percent of citizens are unemployed, according to County Health Rankings from the University of Wisconsin and the Robert Wood Johnson Foundation. Forty-one percent of children in the county live in poverty.

“It’s a crisis for rural health care [that], ‘if left unattended, will create a Third World Nation,’ system of medical care in these areas of Georgia,” Jimmy Lewis, a member of Home Town Health, an organization for Georgia’s rural hospitals, told the Herald.

Medicaid expansion benefits low-income individuals and families with incomes up to 133 percent of the federal poverty level ($30,675 for a family of four in 2012), and will particularly help childless adults, who, in more than 40 states, cannot currently qualify for Medicaid, regardless of their income level, according to the American Public Health Association.

Alisha is a writer and researcher with Ring of Fire. You can follow her on Twitter @childoftheearth.