Hospital Monopolies Create Health Deserts

When one hospital system dominates a poor county and the state limits Medicaid expansion, the market incentive to provide affordable primary care collapses: residents face high uninsured rates, postponed treatment, and deep distrust of the sole provider. That combination functions like a local health desert — care exists physically but is effectively inaccessible to the largest share of residents. — Recognizing hospital monopoly plus coverage gaps as a distinct driver of local health inequality reframes policy debates from 'insurance coverage only' to also include market structure and local provider incentives.