Research from iVantage Health Analytics suggests the rural healthcare crisis may be worse than previously thought, with nearly 13% of rural hospitals nationwide vulnerable to closure. The analysis of 2,224 rural hospitals, rated on strength based on more than 60 different measurements, identified 283 hospitals at risk of closure, which would in turn potentially restrict care access for 700,000 Medicare patients, reduce gross domestic product by $10.6 billion and cost rural communities 86,000 jobs. Among the factors contributing to the vulnerability are myriad states' failure to expand Medicaid under the ACA, and reimbursement cuts as a result of sequestration. While Medicaid expansion states aren't immune to the crisis, with 8.5% of their rural hospitals at risk of closing, the number is nearly twice that in nonexpansion states. Rural providers in Southern and Midwestern states are especially affected, according to the research. On a state-by-state basis, Mississippi had the highest percentage of at-risk hospitals, with more than one in three vulnerable to closure, followed by Louisiana, with 28.1%, and Texas, with 27.5%. States with no at-risk hospitals include Utah, Wyoming and Alaska.