Rural areas lead decline in Obamacare policies' enrollment

As enrollment in Obamacare health-insurance policies declines nationwide, rural areas are leading the fleeing, Sarah Melotte reports for The Daily Yonder and its Rural Index.

The Affordable Care Act policies have become less affordable because Congress did not renew premium subsidies that were implemented during the Covid-19 pandemic and extended in the Biden administration.    "People who are no longer eligible for these subsidies have accounted for a disproportionate share of health insurance coverage drops, resulting in increases in monthly premiums for nearly all consumers." Melotte reports.

Melotte looked at the 30 states that used the national marketplace platform for Obamacare policies and found a 12 percent drop in rural counties, defined as those outside metropolitan areas, "representing 29,000 consumers," she writes. "Small metropolitan counties saw a drop of 11%, representing about 154,000 consumers, the next largest decrease in enrollment among all of the county types."

(Charts by Sarah Melotte, The Rural Index)

New study helps explain why rural Americans die younger: chronic ills, food deserts, health-care access, outmigration

Starting in the 1990s, life expectancy in rural areas fell below that in urban areas, and "The gap keeps growing . . . mainly among prime working-age adults (ages 25–54), which has important implications for rural health, productivity, and economic development," says a new study from the University of Illinois and the Agriculture Department, which tries to explain why. 

It "points to the structural, economic, and retail environments of the counties they live in," writes C.J. Miller of Hoosier Ag Today. The increasing rural death rate is increasingly driven by chronic illnesses such as "heart disease and diabetes, rather than external crises like suicides or drug overdoses. Crucially, the study found that these health disparities largely vanish when accounting for specific county-level characteristics, suggesting that the 'place' itself dictates survival. . . . when the researchers ran linear regression models that adjusted for the local environment—including the density of grocery stores, recreational facilities, local labor force participation, and per-capita income—the statistical significance of a person’s “rural” status virtually disappeared."

Past studies have usually pointed to personal choices; this one looks at the assets (or lack of them) in rural counties that contribute to health and wellness, as Miller describes:

• Food and retail deserts: Rural counties often feature a higher concentration of fast-food establishments relative to full-service grocery stores, making nutritional compliance a geographic challenge.
• Health care access: Decades of rural hospital closures and a persistent shortage of physicians mean chronic conditions like cardiovascular disease are frequently caught later and managed poorly.
• Socioeconomic stress: Lower personal income and suppressed labor force participation rates contribute to an elevated “allostatic load”—the medical term for the cumulative biological wear-and-tear caused by chronic stress.
• Digital divide: Modern health literacy increasingly relies on a robust information environment. A lack of high-speed broadband internet in rural areas limits access to telehealth services and health education.

"The study also touched on the complicated role of internal migration, noting that urban centers frequently attract healthier, upwardly mobile individuals from rural communities — a phenomenon known as the 'healthy migrant hypothesis,' leaving behind a rural population that is older, poorer, and less biologically equipped to withstand structural neglect," Miller reports.

The study was done by researchers at UI Urbana-Champaign and the USDA's Economic Research Service and published in the peer-reviewed journal Economics & Human Biology. It used "restricted-use files from the National Health and Nutrition Examination Survey spanning 1999 to March 2020. This allowed them to link individual health metrics, including objective laboratory indicators like blood-drawn cholesterol levels and glycohemoglobin (blood sugar tracking), with the specific federal county codes of the participants," Miller reports.

As health care insurance costs continue to climb, farm bureau health plans offer a lower cost alternative

Farm Bill health care plans have been offered in Tennessee
for over 75 years. (Tennessee Farm Bureau photo)

Affordable Care Act subsidies from the pandemic years made purchasing health insurance affordable for many Americans, but those tax credits expired at the end of 2025, leaving many individuals and families "confronting difficult choices because of rising Affordable Care Act premiums and other affordability issues," reports Michelle Andrews of KFF Health News. Farm bureau health care plans often offer a more budget-friendly alternative.

Farm bureau health plans tend to offer less comprehensive coverage and require physical exams to qualify; however, they can still provide substantial savings. Andrews explains, "Plan details vary by state, but they typically share many features of marketplace plans, including coverage of a wide range of services, a broad practitioner network, and a way to file complaints."

Fourteen states "allow health coverage through state farm bureaus, grassroots membership organizations that advocate for the agricultural industry and rural interests," Andrews explains. In general, anyone can join their state farm bureau, which typically costs $30 to $50. "With membership comes the option of buying into the health plan."

To help keep premium costs low, farm bureau health care plans screen their applicants through an underwriting process and will often deny coverage to sicker people. ACA plans have to take anyone who applies. Andrews writes, "In 2026, average ACA premium payments were estimated to increase by 114% for subsidized enrollees."

Because farm bureau plans can turn down people or exempt coverage for expensive or pre-existing conditions, their plans "may be 30% to 50% cheaper than unsubsidized marketplace plans," Andrews reports. For a healthier Americans, a farm bureau health plan presents a viable solutions to spiking premium prices.

Despite their stricter rules, farm bureau health plans are becoming more popular. Andrews adds, "Last year, Missouri was one of four states that passed laws permitting farm bureau health plans." Currently, farm bureau health plan coverage is allowed in Arizona, Arkansas, Indiana, Iowa, Kansas, Mississippi, Missouri, Nebraska, North Dakota, South Dakota, Tennessee, Texas, Ohio and Wisconsin.

Independent primary care doctors see banding together as one way to remain solvent and keep their autonomy

Valley Medical Group joined an IPA to help regain its
financial footing. (New England Public Media photo)

As the number of primary care doctors in the U.S. continues to decrease, the number of independent primary care practices has also fallen. A practice in the Connecticut River Valley, Valley Medical Group, has sought to maintain its independence while boosting its bottom line by joining with other independent primary physicians, reports Karen Brown of New England Public Media.

Founded during the 1990s, Valley Medical Group has become one of the "largest independent practices in western Massachusetts," Brown writes. But the practice's patient volume and focus on quality family medical care haven't shielded it from the financial pitfalls of the American insurance payment system, which rewards specialists and physicians who perform procedures over primary care.

Valley Medical Group owners found themselves stuck in insurance contracts that didn't pay well or accurately. "In January, the practice laid off 40 employees — 10% of its 400-person staff — mostly in support positions," Brown writes. "Thousands of primary care practices, a key gateway to the medical system, are fighting to remain financially viable — and independent."

VMG doctors also wanted to avoid selling their practice to a hospital, which would likely take away some of their clinical autonomy. Instead, the group opted to join an Independent Physician Association. Brown explains, "Like a union, an IPA combines individual primary care offices, giving them power in numbers when negotiating contracts with Medicaid, Medicare, and private insurance companies."

While not all IPAs are equal -- some are owned by hospitals or private equity funds -- most help level the financial playing field for smaller practices. According to Brown, when independent practices band together, they can accept insurance contracts that pay them a per-patient allotment rather than billing for each visit or procedure.

Chris Kryder, CEO of Arches Medical IPA in Cambridge, Massachusetts, told Brown, "If we keep people out of the ER, keep them out of unnecessary hospitalizations, we save money for the system. . . And we create more income for the primary care providers, which is dreadfully needed."

Rural hospitals will be hurt the most from Minnesota Medicaid cuts

Government action, such as cuts to Medicaid in Minnesota, has an “outsized impact” on rural residents, Sarah Melotte reports for the Daily Yonder.

The Trump administration recently announced its intent to withhold $259 million from Minnesota’s Medicaid reimbursements due to fraud concerns. CMS Administrator Mehmet Oz said Medicaid funds in Minnesota were going to "bogus" centers for autistic children and a behavioral health organization that had bills showing doctors working 24 hours a day for more than 450 days.

Percentage of hospital revenue coming from low-income health insurance programs. (Map by Sarah Melotte, Daily Yonder, data from the Center for Healthcare Quality and Payment Reform, Click to enlarge)

Rural hospitals are disproportionately affected by these cuts. Melotte explains that rural hospitals are more likely to operate with negative profit margins than urban hospitals, and 39 of Minnesota’s 98 rural hospitals have negative operating margins. This means the rate of uncompensated care will increase even more in these rural hospitals.

Some of these hospitals are able to stay open using non-operating revenue, such as taxes or philanthropy, but this isn’t the case for all of them, reports Melotte. More than 100 rural hospitals throughout the U.S. have had to close in the last decade, causing rural residents to have to travel farther to access the care that they need.

One nonprofit in Minnesota that houses people with disabilities reported to Minnesota Public Radio that “any cuts to Medicaid funding will directly result in reduced services.”

Medicaid now accounts for around 19% of discharges in rural hospitals nationwide, Melotte writes. “In communities where hospitals operate on thin margins, even small cuts in federal spending can destabilize entire systems of care.”

Newly formed nonprofit can help with heath care copays, prescription payments and heath insurance denials

Last year the two companies awarded $200k to patients who
needed financial health care help. (Photo by J. Trierweiler)

Uninsured Americans or those with health insurance coverage who are facing sky-high bills or insurance denials might be able to turn to a newly merged nonprofit for assistance.

The Patient Advocate Foundation and the Patient Access Network Foundation joined together and are now operating as the Patient Advocate Foundation. Peter Loftus of The Wall Street Journal reports, "The merger created a nonprofit with more than $800 million in assets to help patients pay for drug copays and appeal health-plan coverage denials."

For many Americans dealing with expiring Affordable Care Act subsidies, job loss or employment that doesn't offer health care benefits, the merger offers a safety net. Loftus writes, "The nonprofits said the combination will allow them to better serve low- and middle-income patients facing rising healthcare costs, including many who have lost insurance coverage."

Patient Advocate Foundation Chief Executive Alan Balch told the Journal, "More people are struggling to pay for care and basic needs than ever before, and the safety net’s being stretched thinner and thinner."

Before the merger, the two nonprofits focused on different health care challenges faced by many Americans. The PAN Foundation helped patients "defray co-pays and other out-of-pocket costs for prescription drugs," Loftus explains. The Patient Advocate Foundation assisted patients who needed to file appeals for health care insurance denials.

In 2025, the two companies made "$273 million in direct payments to patients," Loftus adds. "They awarded financial assistance to nearly 200,000 people during that period."

As one company, the Patient Advocate Foundation will need patients to complete only one application to access all its services. 

Study: More Americans ages 18-54 are dying from severe first heart attacks

Even some 35-year-olds are at risk for severe heart
attacks. (Photo by E. Akurt, Unsplash)

Death by heart attack used to be a worry for only older Americans, but a new study revealed an alarming increase in heart attack deaths among younger Americans. The results are particularly worrisome for younger rural Americans who tend to have less access to preventative medical treatment, are more likely to smoke cigarettes and often face longer drives to reach emergency care. 

"The proportion of adults ages 18 to 54 who died in a hospital of a severe first heart attack rose 57% between 2011 and 2022, according to the study published in the Journal of the American Heart Association," reports Betsy McKay of The Wall Street Journal. The study data showed that more than 75% of severe heart attack deaths were men, and 71% were between the ages of 45 and 54 years.

The increase in heart attacks deaths is yet another indicator younger Americans aren't as healthy as previous generations. McKay writes, "Poorer health among younger adults is one reason heart disease remains the leading cause of death in the U.S."

Americans who died after a heart attack often had other underlying chronic health issues or smoked. "About 60% had high blood pressure, while more than half also had high cholesterol and smoked. About a quarter had diabetes."

Younger adults need to be warned that the risk of heart attacks can begin "as early as age 35," McKay adds. "Younger people could use a risk calculator on the AHA’s website." Experts recommend using the 30-year estimate rather than a 10-year one for greater accuracy.

A 'Nursery to Nursing Home' campaign for a rural Wisconsin community could help the well-being of children, older adults

Members of Groundswell Collective advocate for their 
'Nursery to Nursing Home' campaign (Photo The Yonder)

In Walworth County, Wisconsin, a local community group called Groundswell Collective proposed to turn a vacant wing of the county’s nursing home into a combined childcare center and senior-living space, reports Madeline de Figueiredo for The Daily Yonder.

Like many rural communities, this county has faced challenges such as a lack of child care and senior care, as well as the loneliness and isolation that can come with living in a rural area with long winters.

Abriana Krause, who lives and works in the area as a childcare provider, told the Yonder, "In Walworth County, all 2,240 licensed childcare slots, spread across the 35 active centers listed on the DCF [Department of Children and Families] website, are already full. That leaves nearly 2,680 children without stable care." Similarly, Wisconsin is projected to need 33,000 long-term care beds by 2030.

To support their proposal, the Groundswell Collective has relied on research that shows the benefits of intergenerational care, such as "boosting the well-being of both children and older people, reducing isolation, improving cognitive and physical health for older people, and cultivating empathy and connection in young children," Figueiredo explains. Intergenerational care has also been linked to dispelling age stereotypes and a renewed sense of care that affects entire communities and fosters lasting relationships.

Research also shows that the benefits intergenerational spaces offer can "extend to the caregiving staff," Figueiredo reports. "Daily interaction with both children and older adults can enhance the work environment and make intergenerational centers more rewarding for staff." There’s hope that this initiative will help the county retain nursing staff.

After almost a year of the community organizing around the proposal, the Walworth County Board approved funding in November for a feasibility study on the intergenerational care center.

Quick hits: Yosemite's 'firefall' is coming; high school newsroom produces this town's paper; give blood before the storm; buying American

Yosemite's 'firefall' only happens once a year. 
(Photo by Leo Visions, Unsplash)

It's almost here, and it's not to be missed. "Every year from mid-to-late February, the setting sun hits Yosemite’s Horsetail Fall along the eastern edge of the soaring El Capitan at just the right angle, creating the illusion that the 1,575-foot waterfall is on fire," reports Lyndsey Matthews for Afar. This Yosemite National Park phenomenon, aka 'firefall,' is ultra-popular, and this year is expected to be even more crowded."

In rural Pulaski, Wisconsin, a high school newsroom has produced the area newspaper for the past 83 years. "Pulaski News remains the community’s primary news outlet, and high school students still staff the newsroom," reports Bob Sillick for Editor & Publisher. "Published every two weeks, Pulaski News is the product of Pulaski High School’s journalism course. . . The content of the 12- to 20-page newspaper is community-focused, sharing the information and news important to the local populace."

Americans who want to buy American-made goods may struggle to find them, but U.S. manufacturers are working to change that experience. "Right now, though, the Buy American movement faces stiff headwinds. Inflation has raised prices dramatically over the past five years, making cheap imports look all the more appealing," report Daniel de Visé and Veronica Bravo of USA Today. "Gallup polling suggests only about 40% of Americans consistently know where their toasters and T-shirts are made. . . American manufacturers want attitudes to change." USA Today includes a list of still-thriving U.S. manufacturers and where to find them.

Marty Durlin (Writers on the Range photo) 

For community journalists new to their rural community, covering local government may seem like an onerous evening beat. But as Marty Durlin shares, there's a lot to be learned from covering city councils in small-town America. "For the past year and a half, I’ve been reporting weekly on municipal government in three rural Western Colorado towns. . . .I’ve come to understand that the job of a council member is challenging and important. The task demands attention to detail and a grasp of everything from high finance and road repair to solutions for the unhoused. It’s also time-consuming and basically unpaid."  

Giving blood before a major weather event can
save lives. (Axios graphic)  

Milk, bread and blood are all in demand before blasts of snow, ice and bitterly cold temperatures hit the U.S. "The Red Cross said blood donations were already down 35% nationally in the past month and asked people to donate to boost the supply before the winter weather hits," reports April Rubin of Axios. "Extreme weather affected about 400 blood drives in December — more than three times the number during that same period in 2024."

New USDA nutritional guidance changes 30-year-old food triangle and calls for far fewer ultra-processed foods

The inverted nutritional triangle recommends Americans 
eat more dairy than whole grains. (USDA graphic)

The Trump administration rolled out new U.S. dietary guidance this week that "inverts" the 30-year-old food triangle and advises Americans to "limit highly processed foods, such as those high in added sugars and sodium," reports Rachel Roubein of The Washington Post. "The administration [used] a revised pyramid with images of steak, a block of cheese and a carton of whole milk at the top," and whole grains at the bottom.

The guidelines focus on strictly limiting ultra-processed foods, which currently make up more than 50% of the American diet. The overhaul reflects Health Secretary Robert F. Kennedy Jr.'s opinion that processed foods are major contributors to chronic illnesses, particularly those in children, such as obesity and diabetes.

The recommendations emphasize "eating whole foods — such as fruits and vegetables in their original forms — and foods rich in protein and whole grains." Kennedy told reporters he wants Americans to “Eat real food.”

"Nutrition experts generally praised some of the main changes, such as the move away from processed foods, while a few raised concerns about promoting some fatty foods," Roubein writes. "The American Medical Association praised the dietary guidelines as offering 'clear direction.'"

U.S. nutritional guidance is developed by the Department of Health and Human Services and the Department of Agriculture every five years. Its goal is to promote health, and the document is "considered a cornerstone of federal nutrition policy," Roubein explains. "The guidelines influence federal nutrition programs and the foods served in school lunches and to members of the military."

Tribal lands need broadband to improve health care access, but progress is slow

Shoshone-Bannock tribal lands are vast with a rocky terrain, which poses a challenge in building fiber-optic cable lines for high-speed internet to homes. (Photo by Sarah Jane Tribble, KFF Health News)

The lands of the Shoshone-Bannock Tribes in Idaho span seemingly endless miles. But the beauty of this vast tribal expanse comes with a cost: Profound broadband gaps that limit health care for Native Americans throughout the region. "Tribal members are historically underserved and, on average, live with the highest rates of chronic illnesses and die 6.5 years earlier than the average U.S. resident," reports Sarah Jane Tribble of KFF Health News.

Accessing medical treatment without broadband connectivity presents a range of challenges. Tribal members have to drive to medical appointments because telehealth isn't an option. "Tribal field nurses update charts in paper notebooks at patients’ homes, then drive back to the clinic to pull up records, send orders, or check prescriptions," Tribble writes. Getting care and medicine all takes longer.

All the while, millions in federal dollars have been set aside to address tribal broadband infrastructure. "Three years ago, the Shoshone-Bannock Tribes were awarded more than $22 million during the first round of the federal Tribal Broadband Connectivity Program," Tribble explains. "But tribes that were awarded millions in a second round of funding saw their payments held up under the Trump administration."

Shoshone-Bannock Tribes Broadband Infrastructure Deployment project
(Map by Lydia Zuraw and Sarah Jane Tribble, KFF Health News)

For some tribal members, waiting for fiber isn't an option. Instead, they pay for Starlink, which uses low-earth-orbit satellites and costs between $80 and $120 a month. "For 53-year-old Carol Cervantes Osborne, who lives with constant pain from severe rheumatoid arthritis, having internet is a necessity," Tribble explains. "She signed up for Starlink so that she can connect with doctors remotely through telehealth appointments." 

Despite the wait for broadband and the current lack of care access on their lands, tribal leaders say Starlink is too expensive for most of their members.

This year, the Shoshone-Bannock Tribes started work on their high-speed internet installation, but progress will be slow. "To build fiber-optic cables underground, the tribes must navigate lava rock and work with the Bureau of Indian Affairs to get permits," Tribble explains. "Eventually, the old radio station will be central to operations, with fiber-optic cable lines that web out over about 800 square miles to reach the reservation’s five district lodges."

The price of hospital services is driving health care costs and insurance premiums to climb nationwide

Patients and employers are impacted by increases health premiums. 
(Graphic by wildpixel/iStock/Getty+ via Conversation CC)

The American public may perceive hospitals as part of their community’s care network, but in reality, many hospitals and specialty clinics are businesses that strive to make a profit. 

As more medical systems in communities of all sizes have consolidated, hospital pricing has become the biggest driver of rising medical costs and steep health care insurance premium hikes.

“Health insurance premiums in the U.S. significantly increased between 1999 and 2024, outpacing the rate of worker earnings by three times, according to our newly published research in The Journal of the American Medical Association Network Open,” write economic experts Vivian Ho and Salpy Kanimian from Rice University in Houston, Texas, for The Conversation. 

Using federal information and data from the Kaiser Family Foundation, Ho and Kanimian found that “the cost of hospital services increased the most, while the cost of physician services and prescription drugs rose more slowly.”

Many hospitals, including those with nonprofit designations, often aggressively price their services and care well above their costs, Ho and Kanimian point out.

“One study found that for nonprofit health systems, the greatest pay increases between 2012 and 2019 went to hospital CEOs who grew the profits and size of their organizations the most,” Ho and Kanimian explain. In contrast, any emphasis on charity care by those systems was not linked to CEO pay. 

Ho and Kanimian suggest a way to help “ensure that nonprofit hospitals make the health of their local communities a top priority by requiring their boards to disclose their executive compensation guidelines for salary and bonuses, similar to the information that for-profit health care companies disclose to their stockholders.” Such a shift could help communities push for better care and lower costs for patients as determinants of executive pay and bonuses. 

Some economists suggest that “hospital prices should be regulated. This approach involves capping prices for health care services at the most expensive hospitals and restricting price growth for all hospitals,” Ho and Kanimian write.

A Medicare pilot program will use artificial intelligence for prior authorizations. Doctors and lawmakers are alarmed.

Some prior authorization requests are already decided
by artificial intelligence. (Adobe Stock photo) 

A Medicare pilot program that allows private companies to use artificial intelligence to approve or deny medical care requested by their members has some doctors and lawmakers worried. Companies included in the pilot would get paid, "based on how much money they save Medicare by denying approvals," reports Anna Claire Vollers of Stateline.

The pilot, known as the Wasteful and Inappropriate Services Reduction (WISeR) Model, will launch after Jan. 1 in six states: Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington. WISeR is more likely to impact health care treatments for rural Americans in those states because rural populations often skew older and sicker than their suburban and urban counterparts.

At its core, the WISeR model effectively introduces a prior authorization process into traditional Medicare. Prior authorization is already unpopular with many patients and doctors because it requires members or medical providers to request an insurance company's approval for certain treatments or medications before proceeding.

While some Medicare Advantage and private insurance companies have already deployed AI into some of their prior authorization processes, its use has "attracted intense criticism, legislative action by state and federal lawmakers, federal investigations and class-action lawsuits," Vollers explains. "It’s been linked to bad health outcomes. Dozens of states have passed legislation in recent years to regulate the practice."

The new program has "alarmed many physicians and advocates in the affected states," Vollers reports. In practice, the prior authorization process can create obstacles to care by requiring physicians to spend hours fighting with an insurance company to justify the care they believe their patient needs. At times, medical providers may avoid treatments that would be best because an insurance company is likely to deny them, at least initially.

Last month, congressional representatives from several states "introduced a bill to repeal the WISeR model. It’s currently in committee," Vollers reports. The program is scheduled to run from 2026 to 2031.

Small businesses and their employees could lose health care coverage if ACA subsidies are cut

Farmers and their employees are among those who stand to 
'lose the most' if ACA subsidies are cut. (KFF Health photo)

As the debate over federal Affordable Care Act subsidies stalls efforts to reopen the government, small business owners worry that their employees won't be able to afford health insurance if the subsidies are cut. 

For lawmakers grappling with ACA decisions, any cuts could impact the 2026 Congressional elections.

Small-business owners such as farmers, dentists and barbers are among those "who stand to lose the most should Congress let the additional, generous federal subsidies put in place during the Covid-19 pandemic lapse," reports Amanda Seitz of KFF Health News. 

ACA subsidies cover nearly 24 million Americans -- and almost half of all those enrollees either own a small business or work for one. Collectively, the group "is more likely to vote Republican and overwhelmingly backed President Donald Trump in last year’s election," Seitz writes. But "even Trump’s own pollsters found deep support for the Obamacare subsidies."

According to Seitz, "Nearly 6 in 10 Obamacare enrollees live in a Republican-held congressional district."

U.S. Rep. Marjorie Taylor Greene, a Georgia Republican who is up for reelection in 2026, "broke with her party last month, calling on the GOP to extend the subsidies," Seitz adds. "Greene said in an interview that rising health care costs are the 'No. 1 issue' she hears about from people living in her district."

Rural hospitals struggling to stay open can't use the newly created $50 billion federal fund to survive

President Trump signs his bill of tax breaks and spending cuts.
(Photo by Julia Demaree Nikhinson, AP via the Yonder)

Rural hospitals struggling to stay open will be unable to manage financial shortages caused by ongoing Medicaid cuts with funds from the Rural Health Transformation Program, which sets aside $50 billion in federal dollars for rural hospitals. Liz Carey for The Daily Yonder reports, "The legislation itself specifically says RHTP funds cannot be used as an offset for Medicaid. And the administration in multiple avenues has specifically said this cannot be used to keep rural hospitals open, period.”

During summer budget negotiations, lawmakers created the RHTP program and touted it as a way to protect rural hospitals; however, the totals don't balance each other out. "Federal Medicaid spending in rural areas is expected to drop by about $15.5 billion per year over the next 10 years," Carey explains. The Rural Health Transformation Program "will provide about $10 billion per year over five years. Many industry experts say that’s not enough."

Although lawmakers may have said the fund was to keep rural hospitals open, the program isn't designed to save struggling medical centers in the short term. Instead, states that apply to the program must include a "rural transformation plan" that outlines how they will improve services, cut costs and deploy technology with RHTP funding aimed at long-term solvency.

Any state that receives RHTP funding will also be "assessed for additional funding based on its population, the number of rural health facilities it has, and the situation of the hospitals in the state to receive additional funds," Carey explains. "Additional funds would also be allocated based on 'how well state applications align with program strategic goals,'" which includes the HHS Make America Healthy Again initiative.

At its core, RHTP funds won't help financially strapped hospitals stay open, and rural residents will likely face more struggles to access providers and care. Alan Morgan, president of the National Rural Health Association, told the Yonder, "The $50 billion cannot by legislation (and is not by the administration) going to be used to help rural hospitals keep their doors open. This $50 billion is about sustaining healthcare for the future. It has nothing to do with maintaining access today.”

If Congress doesn't extend enhanced health care tax credits, 4 million rural Americans could face steep premium hikes

Average health care premium comparison before and after ACA credits for 10 'farm states.'
(Robert Woods Johnson Foundation graph)

Without the Affordable Care Act's enhanced tax credits, roughly four million rural Americans could see significant increases to their health care insurance premiums. Last year, the Health and Human Services reported that 17% of individuals who purchased insurance through the ACA marketplace were rural residents, reports Chris Clayton of Progressive Farmer.

While Washington lawmakers focus on eliminating programs that could use American tax dollars to pay for health insurance for illegal immigrants, "there is less talk about how much rural America relies on those tax credits," Clayton explains. "The tax credits have been a major driver for reducing the number of uninsured Americans."

In 2024, the Robert Wood Johnson Foundation reviewed "enrollment of Medicaid and marketplace policies in ten 'farm states,'" Clayton reports. "In that study, eight states -- all but Iowa and Kentucky -- showed more than 5% of residents were enrolled in ACA marketplace policies."

Without ACA enhanced tax credits, health insurance premiums may be out of reach for many rural Americans. According to the article, an individual making $35,000, with enhanced tax credits, would pay a health care premium of $1,033 per year. Without ACA credits, the premium jumps to $2,615 annually, representing a $1,582 increase.

"Overall, the enhanced tax credits saved rural enrollees an average of $890 per year, about 28% more than their urban counterparts," Clayton reports.

Clinicians in rural Idaho brace for Medicaid cuts that 'are already creating hurdles'

Pregnant women in Idaho often drive hours for
prenatal care. (Adobe Stock photo)

New rules for Medicaid have Idaho clinicians predicting more emergency visits, fewer residents with health care coverage and more maternity care deserts, reports Madeline de Figueiredo for The Daily Yonder. The systemic Medicaid changes will be the hardest on rural residents who tend to be more reliant on Medicaid.

Many Idaho medical providers see new Medicaid work requirements, income checks and possible co-payments as "changes [that] are already creating hurdles and could lead to major coverage losses and reduced access to care," according to the article. 

Coverage losses often increase emergency room visits because people delay care until their symptoms are so severe that they have no choice but to go to the emergency room. Individuals can be left with costly ED bills for care that could have been affordable if it had been sought sooner.

Idaho is already facing rural hospital closures and provider shortages, both of which impact prenatal care for expecting mothers and their babies. Figueiredo reports, "Bonner General Health, the only hospital with OB-GYNs in Bonner County, closed its obstetrics services in 2023. . . . All four OB-GYNs from Bonner County told NBC that Idaho’s strict abortion laws influenced their decision to leave."

The lack of obstetric care throughout the state means pregnant women often have to travel hours for care. Many are told to purchase insurance for emergency medical flights. Amy Klingler, a primary care physician assistant in Stanley, Idaho, told Figueiredo, “We encourage everyone, really, in our community to have that [coverage]. . . . Helicopter rides are probably anywhere from $25,000 to $50,000."

Parents who skip or postpone vaccines for their kids are more concerned about vaccine safety, a new poll finds

 Photo by Mika Baumeister, Unsplash

Parents who skip, avoid or postpone standard vaccinations for their kids often share vaccine safety concerns and other attributes, a new poll from The Washington Post and KFF Health News shows.

The poll found that one in six parents have delayed or skipped some vaccines for their children, with most reporting "concerns about the vaccines themselves," report Lauren Weber, Scott Clement, Emily Guskin, and Lena H. Sun of The Washington Post. "About half of parents overall lack faith in federal health agencies to ensure vaccine safety, mirroring the findings of other surveys."

While the poll revealed that the majority of parents support child vaccinations, it also showed that "skipping or delaying vaccines is more common among parents who homeschool children, are Republicans, are young, or are White and religious," the Post reports.

Some polled parents believe in the effectiveness and necessity of childhood vaccinations -- just not on the schedule set by the federal government, which favors multiple shots in a single visit, rather than a more graduated immunization schedule.

Most interviewed parents did not support claims about vaccines causing autism or chronic disease. The Post reports, "But at least 4 in 10 parents say they don’t know enough to say whether those claims are true or false."

Poll results do seem to indicate some level of distrust in how the government manages vaccines. The Post explains, "Six in 10 Democrats are confident in federal health agencies overseeing vaccine safety, compared with 48% of independents and 41% of Republicans."

"Despite Republican parents being more likely to skip vaccines, 77% still follow vaccine recommendations," the Post reports. "Most of President Donald Trump’s voters believe vaccines save lives."

Fund with $50 billion for rural hospitals got off to a rough start; experts predict the money won't be enough

Delays, last-minute changes and a poor rollout have already plagued the newly created $50 billion rural hospital fund GOP lawmakers put together to pass the One Big Beautiful Bill Act. But analysts predict the "money to be spent over five years is less than the estimated $137 billion in cuts to rural health systems over 10 years," reports Aneeta Mathur-Ashton of U.S. News & World Report.

The Rural Health Transformation Program was designed to help rural hospitals weather Medicaid cuts included in the GOP's package and support longer-term cybersecurity and infrastructure improvements hospitals need to stay afloat; however, fund critics say the program is a short-term solution for a long-term problem.

States that receive RHTP grants must use the funds for at least three purposes outlined by the Centers for Medicare & Medicaid Services (CMS), including "promoting care interventions, paying for health care services and expanding the workforce," Mathur-Ashton explains.

As rural hospitals receive funds, they will need to apply them carefully. Alan Morgan, chief executive officer of the National Rural Health Association, "praised the fund as a 'fabulous program that hopefully, if done correctly, can transform rural health going ahead, to a sustainable model,'" Mathur-Ashton writes.

Some Democrats consider the $50 billion to be a slush fund with unclear guidelines that can't undo the harm planned cuts will cause. "The bill gives [CMS] the authority to determine which applications to approve and deny, but does not spell out the criteria it should be using to do so," Mathur-Ashton reports. 

Rural health advocates say they want states to apply for RHTP, but many are pushing to have the $150 billion in Medicaid cuts rescinded. Morgan told U.S. News, "Congress either later this year or next year, is going to have to repeal those cuts for rural hospitals, or you're just going to see hundreds of rural hospitals close. It's non-workable.”

To avoid closures, mergers or reduced services, some rural hospitals are banding together

A mobile MRI machine services and costs can be
shared by a network of hospitals. (KFF Health photo)

A growing number of independent rural hospitals are joining networks that allow them to meet their community's health care needs without operating in the red or being pushed into a merger, reports Arielle Zionts of KFF Health News. While such medical networks have existed for decades, their popularity as a lifeline for rural hospitals is relatively new.

In North Dakota, 22 hospitals banded together to form the Rough Rider Network, which "used its members' combined patient rolls to negotiate better prices," Zionts writes. "The networks are an alternative to shutting down or reducing services, or to giving up local autonomy and joining a large hospital system."

The Rough Rider Network was formed with the help of an independent company, Cibolo, which worked on hospital partnerships. Zionts writes, "Cibolo Health has helped start networks in Minnesota, Nebraska, Montana, and Ohio."

Hospitals that team up with other hospitals can opt to share specialist providers, expensive diagnostic equipment, mobile clinic opportunities, and even "pool staffers for a network-wide employee health insurance plan," Zionts adds.

Rural health care providers are "increasingly interested in forming such networks, said Marnell Bradfield, executive director of the Community Care Alliance, a network of hospitals and independent primary care offices in rural western Colorado," Zionts reports. "About once a month, she said, she gets a call from health care leaders exploring similar networks and asking about her experience."

Banding together to keep small town hospitals open does more than provide nearby medical care for a community. It's also "beneficial for the economy of rural areas, where hospitals are often major employers," Zionts writes. "Some networks also invest in broadband, housing, and other community development projects that can help people stay healthy and access care."