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A recent Wall Street Journal article on hospital divestitures and closures “fails to acknowledge the critical roles that low government reimbursement, population shifts and old infrastructure play” when nonprofit health care systems make access decisions, AHA President and CEO Rick Pollack writes in a letter to the editor published yesterday.

“Population trends have shown for years people leaving urban and rural areas in favor of smaller cities and suburbs,” the . “Meanwhile, payments from Medicare and Medicaid don’t cover the cost of providing care. In 2020, Medicare paid only 84 cents on the dollar, resulting in $75.6 billion in underpayments for hospitals. Further, since 2000, hospitals of all kinds have provided nearly $745 billion in care for which they received no payment. Today, more than half of U.S. hospitals are operating at a loss, while expenses and inflation are at historic highs. The conversation on how to provide the best care to everyone, especially those most in need, is too important not to be done right. We owe that to our hospitals and the millions of caregivers who sustain them.”