This is an opinion column.

I wasn’t surprised to read the hospital in my hometown closed. The surprise came four years ago, when it opened in the first place.

Hospitals in rural Alabama are a bit like newspapers or shopping malls. We can mark the passage of time by their creeping demise, but a new one’s arrival is the sort of man-bites-dog story that gets your attention.

It was supposed to be a come-back.

Since 2000, Thomasville had lost more than a fifth of its population, due in no small part to the lack of quality health care there. That was especially true after its old hospital closed in 2011. For comparison, the U.S. population grew 18% during that time, and Alabama grew 14%.

The Thomasville Regional Medical Center had been a sort of Hail Mary play to save the town itself, not just the lives of those living there.

The mayor, Sheldon Day, was the chief cheerleader behind the project, which received local support and federal loans to subsidize the privately run facility. Not only would the new hospital be a literal lifeline for those needing medical care, but it would also attract professionals to live there, too.

It was the sort of gamble that had to work.

Only now, it hasn’t.

The hospital struggled since it opened, and in recent months it failed to make payroll. Last week, the hospital announced its closure with a handwritten sign on the main entrance.

“I know very well how everyone feels,” Day said in his Facebook message to the town. “I have experienced anger, hurt, and said some things to the owners of TRMC a few days ago that I had to ask the Lord to forgive me for saying.”

Day has said he hopes creditors will soon put the hospital into receivership and a new operator can be found.

As hopes go, receivership might not seem very, well, hopeful. But for communities throughout our state, this sort of thing is increasingly common.

In the Clarke County seat, Grove Hill, that town’s hospital recently ended its delivery room services, making the county one of more than half of Alabama counties without a place to give birth to a baby.

At the south end of the county, in Jackson, the city council recently agreed to pay $3 million to buy — and save, at least for now — that town’s hospital.

Hospitals throughout rural Alabama are dying — as are the communities and people they serve.

If only there could be something done to help them.

And there has been something. For more than a decade now there has been something. Only our last two governors have stubbornly resisted.

We could expand Medicaid.

During his term and a half in office, Robert Bentley, a doctor, refused to expand Medicaid in Alabama. Now that he’s out of politics, he says that was a mistake and has pleaded with the Alabama Legislature and his successor to change their minds.

However, Bentley’s Ghost of Governors Past routine did little to persuade Kay Ivey.

“On the question of expanding Medicaid, she remains concerned for how the state would pay for it long-term,” Ivey’s spokeswoman said when my AL.com colleague Patrick Darrington asked if now she would change her mind.

Ivey’s been saying that since Bentley turned in his notice. You’d think in the eight years she’s been in office, she might have found a way. After all, she found more than $1 billion for a new prison, and she directed millions to a waterpark in Montgomery.

And look around. There are 40 states that have expanded Medicaid under the Affordable Care Act. None of them have gone broke doing so, and one of those states is West Virginia, where the average income is less than in Alabama.

In fact, research by the nonpartisan Center on Budget and Policy Priorities found that Medicaid expansion actually saved those states money, while increasing the quality of health care at the same time.

This shouldn’t come as a surprise to Ivey or anyone else in Alabama government. Our state’s own experts have been telling officials for years that expanding Medicaid would be revenue-positive for the state.

It’s not especially complicated. Alabama kicks in 10% and the feds give us 90%.  When you draw down billions of dollars from the federal government, and that money circulates through the local economy, local and state taxes eventually recapture enough to pay for the 10% match.

Likewise, it has been explained to them many times that Medicaid expansion rewards work. It doesn’t punish it. Those who would be eligible under the program are working people who make too much to qualify under Medicaid but not enough to afford private insurance.

The ones here not working are Alabama’s elected officials.

Ivey knows all this. She just doesn’t care.

Jane Adams, an Alabama lobbyist for the American Cancer Society, categorized Ivey’s excuses as succinctly as anyone can.

“That’s a lie,” she told AL.com.

Most folks in Alabama state government understand that Medicaid expansion is the sensible thing to do, but they’ve dug themselves into an ideological hole. Ivey chief among them.

Medicaid expansion was part of Obamacare, and relenting now would mean they have passed up billions that could have helped people, towns and hospitals. She’d have to admit that the first Black president did something right.

Kay Ivey’s stubbornness is fed by her pride and her prejudice.

And it should be noted that Clarke County has supported Ivey both times she’s run for governor, with 59% voting for her in 2022 and 56% behind her four years before that.

She’ll let her own supporters suffer and die before she’ll admit she’s done anything wrong.

Making matters all the stranger, her stubbornness is in defiance of what Alabamians want. A 2022 poll by the firm Cygnal paid for by Alabama Arise showed that 72% of Alabamians supported Medicaid expansion.

Including 66% of Alabama Republicans.

Look, I’ve been making this argument for years, and I don’t know what else I can say to change the governor’s mind. I’ve argued. I’ve pleaded. I’ve begged. And so have many others.

But I know whatever else I write, whatever curse I let out of my mouth, the Lord will forgive me when I’m done.

Can Kay Ivey say the same?