The assault on rural hospitals is an assault on all

Recently, St. Mary’s Sacred Heart Hospital in Lavonia announced it would close its labor and delivery unit.

For families in Northeast Georgia, this means the nearest maternity care may now be an hour’s drive away. For expectant mothers in labor, that can be the difference between life and death. Hospital administrators pointed to many factors behind the decision — shrinking rural populations, difficulty recruiting doctors and the outmigration of patients.

But the tipping point was unmistakable: the sweeping Medicaid cuts pushed through Congress in Trump’s terrible, tyrannical, no-good budget, which passed earlier this year. For a state where Medicaid covers nearly 60% of rural births, that’s a deadly blow. 

One doesn’t often connect the dots between hospital closures and the end of democracy, but the signs here are unmistakable. In the 10 steps to authoritarianism, breaking the government so it doesn’t work is Step 4 — and blocking health care access is a clarion call.

The closure of a maternity ward is both a tragedy and a warning. Authoritarianism in the 21st century doesn’t often arrive with tanks in the street. As we’re seeing play out in America today, it seeps into daily life when governments deliberately weaken the safety nets people rely on to survive.

This is part of the authoritarian playbook. First, gut public services. Then normalize inequality. Finally, convince communities that they are on their own. We’ve seen this in other countries: dismantling health care systems, stripping social supports and allowing infrastructure to crumble until despair becomes the norm. When people stop believing democracy can deliver the basics — like safe childbirth — they start believing autocracy might be worth a try.

But Georgia is on a fast track, aided by decades of failed health care policies and the refusal to expand Medicaid. As a direct result of this neglect, Georgia has already lost more than a dozen labor and delivery units in the past decade, not to mention our record number of hospital closures and looming shutdowns.

Each time, the loss ripples beyond the maternity ward and beyond the redirected ambulance. Hospitals are often the largest employer in rural towns. These closures hollow out local economies, drive away families and accelerate the decline of our communities. That is not accidental; it is the predictable result of policies that privilege political ideology over the well-being of our neighbors.

What makes authoritarianism possible is the slow, grinding destruction of trust. Every time a pregnant woman is told her nearest hospital cannot help her, every time a community loses its only lifeline, our trust erodes further. Why vote when elected officials ignore your demand for safety and security?

The resilience of a democracy can be measured in its hospitals and classrooms, as much in its courthouses and statehouses. A flourishing society makes care accessible — because dignity is not a luxury and health care is a right. When leaders choose instead to strip away the very systems that sustain life, giving the wealthy tax breaks that bankrupt health care for thousands, they are turning democracy on its head — making it smaller, crueler and more fragile.

If we want to fight against the authoritarian assault seeping into our lives, we must see the regular signs of assault — not military juntas or tanks but closed signs on hospitals in the wealthiest nation on earth and new mothers turned away because our political leaders cared more about donors than new Americans.

We must refuse to accept the scarcity that is being pushed upon us as normal. We must demand a government that sees rural mothers and babies as worthy of care and not as collateral damage.

Democracy lives — or dies — in places like Lavonia.

Stacey Abrams is a bestselling author, entrepreneur and host of the podcast “Assembly Required.” She previously served as minority leader in the Georgia House of Representatives.