Health care access for more than 72 million people in the United States is under threat. As Congress moves to cut spending across the board, critical Medicaid funding is on the chopping block—we’re looking at up to $880 billion in cuts—which would impact those in small town and rural communities most. 

Why’s that? 

Rural communities and small towns already face great challenges to health care access. Oftentimes people who live in rural areas have to travel great distances to access care, with limited transportation options. Historically, rates of negative health outcomes—such as maternal and infant mortality rates, rates of heart disease, cancer, and stroke, mental illness, and overdose deaths—-are higher for rural residents. Also, people in rural areas tend to have lower incomes and less access to employer-sponsored health insurance than those in metro areas, meaning that Medicaid coverage has played an essential role in these communities. And all of this comes at a time when hospitals and providers have struggled to keep doors open. Over the last 10 years, over 120 rural hospitals have closed or terminated inpatient services.

Not only that, this impact is even greater for children, adults under the age of 65, and Indigenous communities. Children and non-elderly adults that live in rural areas are more likely than those in metro areas to use Medicaid for health care coverage. Additionally, many Indigenous communities live in rural areas and historically have higher mortality rates and rates of chronic illness. Medicaid has been critical for protecting Indigenous communities from large amounts of medical debt, and the absence of this support would pose a severe threat to the health and financial stability of these communities. 

What would this look like? 

In addition to people losing their health care coverage, hospitals and providers in rural communities may be forced to shut down, creating even less access to essential health care services. Rural hospitals, which already operate on tighter budgets, depend heavily on Medicaid to pay for patient care. Often, hospital units that turn the least profits—such as maternity wards—are the first to go. This is already happening: as of 2022, a majority of rural hospitals have lost their maternity wards.

We’re at a major crossroads in the fight for high-quality, accessible, and affordable health care for all. Cuts to Medicaid will be a disaster for rural families!

For more information and state-by-state data, see Georgetown's Center on Children and Families report on Medicaid’s Role in Small Towns and Rural Areas.

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