First, there was hope for people in rural communities needing health care. As part of the Affordable Care Act, Medicaid was expanded in 31 states and the District of Columbia, offering new coverage to millions and renewed hope for rural hospitals struggling to remain financially viable — many serving a high percentage of Medicaid patients.

But now, since Congress’ unsuccessful attempt at “repeal and replace” of the ACA, is business as usual good for the states, regions, local citizens? With steps designed to weaken the effect of the law underway, what’s certain is there is no solution for covering the growing number of counties where no exchange insurance is available for individuals. As for Medicaid, cutting funds and limiting program expansion would most certainly be devastating for families, rural hospitals and the communities they serve.

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In Texas, for example, 46 percent of children in rural areas and small towns are enrolled in Medicaid or the Children’s Health Insurance Program compared with 41 percent in urban areas, according to a report by the Georgetown University Center for Children and Families.

Medicaid and CHIP are administered by states within broad federal guidelines and jointly funded by the federal government and states. Medicaid is vital to the 172 rural counties in Texas. Since 2010, more than 15 percent of the rural hospitals that have closed across the U.S. are in Texas, according to data from the Texas A&M Rural and Community Health Institute. The proposed Medicaid cuts would harm small towns and communities not only in Texas but across the country, most acutely in many Southern states that didn’t expand Medicaid.

Like Texas, Georgia didn’t expand Medicaid; it already ranks 45th in the nation in per capita Medicaid spending, according to the Georgia Budget and Policy Institute. Five rural hospitals closed in Georgia in the past five years and several have closed their emergency rooms. Medicaid cuts would cripple rural Georgia.

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In addition to the millions of Medicaid patients who could be negatively affected by program cuts, others could suffer, too. Employees working in rural hospitals will feel the pain from these proposed cuts when hospitals downsize operations or close. Communities, businesses and employers will agonize over the potential loss of their community hospitals.

While some policymakers have argued that Medicaid is a broken, inadequate system, it serves enrollees well, according to a Harvard T.H. Chan School of Public Health survey. Findings revealed that Medicaid is popular and vital to meet the health care needs of the vast majority of enrollees.

Let’s work together to make sure our neighbors have the health care services and resources they need.

Williams is president and CEO emeritus of the Rural & Community Healthcare Collaborative in Plano.

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Commentary: Rural hospitals are vanishing; keep Medicaid in Texas –