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Forbes
an hour ago
- Health
- Forbes
Closing The Distance: Fixing Access To Care In Rural America
Part 2 of the Rural Health Resilience Series GRUNDY, VIRGINIA - Optometry students administer vision tests to patients for a free pair of ... More eyeglasses at a Remote Area Medical (RAM) mobile dental and medical clinic on October 7, 2023 in Grundy, Virginia. More than a thousand people were expected to seek free dental, medical and vision care at the two-day event in western Virginia's rural and financially struggling area. RAM provides free medical care through mobile clinics in underserved, isolated, or impoverished communities around the country and world. (Photo by) Bridging the Gaps That Separate Care from Communities In the first essay of this series, I described the rural health crisis: how it affects nearly 60 million Americans and why its resolution should be a national priority. But if we want to fix it, we must first understand what 'access' really means in rural America. It's not simply a matter of miles. It's a complex web of economic, structural, cultural, and technological gaps that separate people from the care they deserve. As a physician, I've cared for transplant patients who came to me in Nashville from coal towns in Appalachia, from the Mississippi Delta, from isolated ranchlands in the West. I've treated veterans at VA hospitals and seniors from small towns served by Medicare. I've helped build companies like Aspire Health, Monogram Health, and Main Street Health that now deliver care to patients in their homes across rural America. And for years I had a front row seat on the explosion of telemedicine as a board member of Teladoc, which has served millions of rural residents. What I've seen, again and again, is this: geography is only the first barrier. The deeper challenge is designing care that rural Americans can reach, afford, and especially trust. Care that understands them. The Many Faces of 'Access' At its simplest, access to care means being able to engage a health provider when you need it. But in rural America, this ideal runs into five major roadblocks: According to national polling by KFF, 58% of Americans believe rural residents have a harder time accessing care than urban ones. And rural adults themselves overwhelmingly agree that their communities lack primary care, mental health providers, and specialists. This is not a perception problem; it's a systems problem. And this needs to be addressed as such. When the Nearest Hospital Is Hours Away Since 2010, over 130 rural hospitals have closed. In my own state of Tennessee, over this period 15 rural hospitals have either fully closed or ceased inpatient care, the second most of any state and the highest in the nation on a per capita basis. In many areas, emergency rooms, surgical units, and maternity wards have been eliminated, with nothing to replace them. Remaining facilities increasingly operate under severe financial strain. As Dr. Keith Mueller of the University of Iowa notes: 'In rural America, we haven't just lost hospitals. We've lost healthcare ecosystems.'¹ Doctors and nurses move away. Supporting clinics close. Pharmacies disappear. The closures don't just threaten lives. They impact the economy, jobs, and social cohesion. The loss of a hospital often signals the slow unraveling of the community around it. One analysis found that for every 100 rural hospital jobs lost, another 35 jobs disappear due to declining local spending. This is not an argument that all rural hospitals should necessarily stay open, because they may be too inefficient and may not be the best way to deliver care when resources are limited. But it is a call to explore newer models of care delivery to fill the gaps caused by the failure of traditional, legacy-type delivery of inpatient care. It is a call to explore more creative, rural-focused payment mechanisms that adequately support modern value-driven care. A Workforce Crisis—and an Opportunity More than 60% of federally designated Health Professional Shortage Areas are rural. Nearly 80% of rural counties lack a psychiatrist. Many have no dentist or OB-GYN. Some have no practicing physician at all. These are the hard facts we must work around. We know that the best predictor of whether someone will practice in a rural area is whether they grew up in one. This truth means we should more actively invest in rural high school health career programs, community college training, and rural-focused medical education. In Nashville, we're working to open a Nurses Middle College, a public charter high school where students receive a rigorous college-prep education infused with nursing content, including nurse mentorships and firsthand experiences in medical workplaces. Introducing medical career paths early in students' education, particularly in rural regions, is key to growing the workforce. A proven rural physician training model is East Tennessee State University's Quillen College of Medicine in Johnson City. With the clearly stated mission to prepare physicians for underserved and rural communities, Quillen consistently ranks #2 nationally for graduates practicing in underserved areas. Through programs like its Rural Primary Care Track, Quillen provides early and sustained clinical exposure in community settings. The results are compelling: over 63% of its graduates practice in medically underserved areas, and more than half enter primary care, many returning to serve in their home regions.⁵ Another example of a training institution addressing this challenge head-on is Meharry Medical College in my hometown Nashville. A historically Black medical school with a long-standing mission to serve the underserved and in particular rural areas, Meharry has produced generations of physicians who return to practice in rural and economically marginalized communities. Through rural-focused pipeline programs and partnerships designed specifically for rural health like its accelerated training track with Middle Tennessee State University for rural primary care, Meharry is helping build a future workforce rooted in the very communities most often left behind. In recent Senate testimony, Dr. James Hildreth, Meharry's President and CEO, stated: 'We have been training health care professionals who are really competent and skilled—connected to their communities—for decades.' He added, however, that 'our challenge is the infrastructure we have to do that.' Equally important is expanding the role of non-physician providers. Nurse practitioners, pharmacists, EMTs, and community health workers are the care infrastructure in many places. States should continue to examine how to best allow health personnel to practice 'at the top of their license' to maximize workforce reach. And the shortages are not just traditional health providers. In many rural areas, broadband technicians and community health workers are as critical to healthcare access as doctors and nurses. Telehealth: Promise and Pitfalls Telehealth surged during the pandemic and demonstrated real promise for rural care. Behavioral health visits, routine check-ins, and consults have all benefited. We've likely just touched the surface of its potential; to be fully realized will take newer alliances among providers and more modern flows of payment to reimburse where value is added. Farmer uses telemedicine to access remote care. Teladoc Health, on whose board I served for eight years, provides a good example. During the COVID pandemic, Teladoc Health emerged as a vital lifeline for rural Americans, illuminating how virtual care can break through geographic barriers. In early 2020, total visits soared. Teladoc nearly tripled its capacity, rising from handling around 100,000 virtual visits per week to nearly 2.8 million visits per month at mid‑year. While telehealth growth was nationwide, Teladoc's platforms proved especially valuable in rural, underserved regions with few nearby providers or limited public transportation options. As a board member, I saw firsthand how Teladoc's operations not only expanded reach into medically underserved counties but also reduced travel time, alleviated strain on fragile local health systems, and provided critical continuity of care where in-person follow-up was unfeasible. Telehealth has proved especially beneficial for mental health treatment, with some patients actually preferring a virtual visit due to persisting stigma around mental healthcare. And its value goes beyond connecting a rural patient to a provider in another zip code. It can be a lifeline for isolated rural providers who want to connect with specialists on cases and procedures they are less familiar with – becoming a medical force multiplier. But telemedicine engagement generally requires broadband, and millions of rural Americans don't have it. The FCC estimates at least 19 million Americans lack high-speed internet, the majority in rural areas. Even where broadband exists, it may be unaffordable or unreliable. Inconsistent access means rural residents are being left behind in a system increasingly reliant on digital care. Without broadband, rural communities can't participate in modern healthcare. Behavioral Health: The Sharpest Edge Behavioral health care is arguably where the rural access gap is most dangerous. Many counties have no licensed mental health provider at all. And yet, as pointed out in our first essay, rural communities face some of the nation's highest rates of suicide, overdose, and depression. States are in the best position to facilitate local solutions. In neighboring Kentucky, peer counselors, primary care teams, and churches have come together to form informal behavioral health safety nets, especially in rural areas where clinicians are scarce. One powerful initiative is Recovery Kentucky, which operates eight rural residential recovery homes offering peer-led support, life skills training, and transitional housing. An independent evaluation found it serves up to 2,200 people annually with measurable improvements in substance use, housing stability, employment, and health outcomes.⁵ Another innovation, the state's Crisis Co-Response Model, pairs trained mental health professionals with law enforcement in rural communities to provide in-the-moment intervention and post-crisis follow-up, bridging gaps where conventional crisis services are hours away. These grassroots models reflect the power of trust-driven, community-rooted care that meets people where they are, both geographically and socially. In rural America, the most effective health infrastructure is sometimes the church basement, the school gym, or the farm supply store bulletin board. Something common to all of these rural models: they are built on trust, often from the community level up and not from bureaucracy, top down. WISE, VA - Early-morning screening takes place in a barn during the Remote Area Medical (RAM) clinic ... More at the Wise County Fairground in Wise, Virginia. Rural families, most with little or no insurance, lined up for hours to receive free health care from hundreds of professional doctors, nurses, dentists, and other health workers. (Photo by, 2007) Culture, Trust, and Local Voice Many rural residents hold deep skepticism toward government-led systems, ironically even when they benefit from them. According to KFF polling, many residents on Medicaid or Medicare say they 'don't rely on the federal government' for health support.⁴ That belief is not hypocrisy; it's identity. Self-reliance, pride, and cultural values shape how rural residents interact with healthcare. For many rural Americans, healthcare is much more than a service; it's a cultural encounter. It intersects with deeply held values of personal independence, skepticism of bureaucracy, and strong community ties. Health programs that emphasize entitlements or top-down aid can clash with this ethos. But solutions that build trust, use local messengers, and frame care as earned or community-rooted are far more effective. That's why programs like culturally aware Main Street Health and peer-led behavioral health models work: they feel local, personal, and dignified. As one rural stakeholder said, 'What matters is whether this person knows us, not what their credentials say.' Reaching rural America means respecting not just the need, but the values that shape how care is received. Effective models don't dismiss that; they honor it. They empower trusted messengers. Main Street Health: A Working Solution At Main Street Health, a company on whose board I serve that delivers value-based care exclusively to rural populations, we're seeing what's possible. The company has placed 'health navigators,' trusted individuals drawn locally from their own communities, into hundreds of rural clinics across the country. These navigators, who are personally known locally, help seniors manage chronic conditions, access care, coordinate medications, and navigate the healthcare system. The program now operates in more than a thousand clinics across the country. Its rapid growth is not because of marketing. It's because it is built on community-centered relationships and trust, and it works. Access isn't a fixed obstacle. It's a challenge of systems design and one we are capable of solving. What's Next In the next essay, we will explore how technology can be a transformative vehicle for health in rural America, and why we need to make these investments now to bring aging systems into the 21st century to help eliminate the 'rural health penalty.' It just may be a model for the rest of America. Footnotes
Medscape
17 hours ago
- Business
- Medscape
Foundations Rethink Research Dollars as Funding Is Pulled
This spring the notices came without warning: Federal funding for thousands of approved research projects, many already under way, had been delayed or canceled. Among those left in the lurch were grant recipients seeking to do things like reduce vaccine hesitancy, improve access to healthcare for minority populations, or treat an aggressive form of brain cancer. All told, the National Institutes of Health (NIH) and the National Science Foundation withdrew or placed on hold almost $4 billion in funding. And that money may be gone for the foreseeable future because the White House's proposed budget for the next fiscal year slashes support for those agencies themselves by 40% and 56%, respectively. 'So much has been cut by the wrecking-ball, bludgeoning approach that went on at NIH,' said Alonzo Plough, PhD, chief science officer at the Robert Wood Johnson Foundation (RWJF), Princeton, New Jersey. 'They're not just cutting bureaucrats and funding for projects that are not efficient. These are the pipelines that have put American bioscience at the forefront of the world, provided treatments that saved your family members' lives.' Foundations are trying to meet the moment, doling out emergency support to the extent they can. RWJF, for its part, has several such initiatives, including grants for information gathering on climate change and health, tracking AIDS/HIV, and science-based assessments of childhood vaccines. Still, foundations can't replace the government. 'The billions and billions that have been cut are orders of magnitude bigger than anything philanthropy can patch,' Plough said. 'We can keep certain things on life support, but life support is not a good thing to be on.' Private-Public Partnerships Drive Discovery It won't surprise you to hear that medical and health research requires a lot of money — $245.1 billion in 2020 alone. Industry investment accounts for more than half of that, but corporations generally don't step up until a concept is pretty far along, when they're confident it will pay off. Most early-stage research doesn't qualify. 'Basic, fundamental research may not have an obvious application. Some of it may never lead to one,' said Cynthia Friend, PhD, chief executive officer of the Kavli Foundation, Los Angeles, which helps fund early research. 'When those applications do come forth, the time scale is on average 20 years to end up at something useful.' Support for the long haul, beginning at a stage when researchers may not know the usefulness of their findings, is where the federal government has made a big difference. It normally supplies 25.1% of all medical and health research funding. In comparison, foundations, associations, and societies provide just 1.2%. 'All of science philanthropy together, if you add it up, doesn't come close to the amount of support in the federal budget,' Friend said. The government also plays a large role in building and maintaining complex machinery and large-scale facilities where significant discoveries may be made. Case in point: the synchrotron, a sophisticated x-ray machine used, for example, with CRISPR gene editing technology. The one at Brookhaven National Laboratory costs nearly $1 billion. 'An individual could never make these things or have them,' Friend said. 'But individuals can go use them because they've been built for the overall community.' There's a compelling upside to such spending: Economists estimate that for every dollar invested in research, the US gets $5-$20 in benefits. Foundations Seek New Strategies Although they can't match the government's financial clout, philanthropic organizations are looking for ways to address the extraordinary, nationwide funding gap. When the Council on Foundations surveyed its members in March, 80% of respondents said they were making or considering at least one change to their approach. Many indicated that they were open to ideas like collaborating with other funders, reexamining priorities to address the gaps, and increasing their flexibility in grant-making. 'Philanthropies that care about a particular area have an opportunity,' said Shaady Salehi, co-executive director of the Trust-Based Philanthropy Project. 'What's the range of things they fund as an institution — and what is being defunded? They can step in and support the necessary research.' While many science-focused foundations have yet to comment on how they're dealing with the new reality, some have gone public: The Kavli Foundation is offering bridge funding to early-career scientists who've lost federal support, Friend said. Its relatively small, individual grants are good for up to 2 years. The Spencer Foundation — along with the Kapor Foundation, the William T. Grant Foundation, and the Alfred P. Sloan Foundation — has also made bridge funding available: $25,000 grants to 'address immediate needs following grant cancellations.' The Prebys Foundation has designated $7 million in emergency support for biomedical research in San Diego. The American Association for Cancer Research (AACR) has created new AACR Trailblazer Cancer Research Grants: $15 million to support early-stage and mid-career researchers. The Breast Cancer Research Foundation has announced new grants for early-career investigators facing delays or disruptions, emergency funding for affected projects, and nine new research grants. Funders Emphasize Coordinated Efforts Even before the current crisis, the Kavli Foundation had invited fellow funders to preliminary discussions. That conversation will continue as the foundation works with scientists to shape the projects that receive its support. 'The idea is that if you have more resources to focus in a particular area that you think is important, that will accelerate progress,' Friend said. 'And it will also accelerate if something doesn't work out. We have to be prepared for things not working.' Other foundations are also looking for fresh ways to work together. More than 170 philanthropic organizations of all kinds have signed on to a pledge from the Trust-Based Philanthropy Project. It calls for them to go beyond business as usual — to collaborate, to pool funds, and to be responsive to grantees in a coordinated way. As Salehi sees it, this is essential. 'I think the next level up is going to be a higher level of coordination among private funders, comparing notes on who they're funding, who's not funding, who's being left behind,' she said. 'Where are the gaps?'
CBS News
04-07-2025
- Business
- CBS News
Medicaid cuts in "big, beautiful bill" worry some Tri-State Area families
The nonpartisan Congressional Budget Office estimates President Trump's "big, beautiful bill" will add $3 trillion to the deficit. To pay for that, lawmakers made deep cuts to safety net programs, including Medicaid, which is concerning for some families in the Tri-State Area. "What are we supposed to do?" Theresa Luoni, of Basking Ridge, New Jersey, is a full-time caregiver for her autistic twin sons. "They both get speech and occupational therapy through Medicaid, and they rely on these systems for not just their health care but their education," she said. She now worries what will happen to her family as the federal tax and spending bill passed by Congress aims to cut nearly $1 trillion from Medicaid. "So to think that there won't be a reduction in services is kind of silly when there's so much money being cut from the budget," Luoni said. Luoni is waiting to see what, if any, of her sons' services that are funded by Medicaid will be impacted. "I think all the parents of vulnerable children — whether you're living in poverty or have disabled children — are feeling the same way I am right now. Like, what are we supposed to do?" Luoni said. "How do you trade somebody's life over overtime?" The Congressional Budget Office estimates the Medicaid cuts could leave nearly 12 million Americans uninsured. "It's going to kick over 1 million New Yorkers off their medical coverage," said Nancy Hagans, president of the New York State Nurses Association. The legislation will eliminate federal taxes on tips and overtime pay, including for nurses like Hagans. "How do you trade somebody's life over overtime?" she said. "We are being asked as health care workers to say, I would rather receive an extra 50 cents over somebody else's life." One of the biggest changes will be strict work requirements for some Medicaid recipients. There are exceptions for poor parents of children under 14 years old. Rep. Mike Lawler praises increased cap on SALT deductions The 900-page bill boosts security and United States Immigration and Customs Enforcement, increases defense spending and extends Trump's 2017 tax cuts, which includes an increase in the child tax credit and raises the cap on state and local tax deductions. "This will cover, in my district, 90 percent of my constitutions will be able to fully deduct their state and local taxes, and I live in one of the highest taxed districts in the country," Rep. Mike Lawler said.
Yahoo
29-06-2025
- Health
- Yahoo
Louisiana hospitals press Johnson over megabill Medicaid cut proposals
As the 'big, beautiful bill' teeters towards passage in the Senate, every major health system in Louisiana sent a letter Saturday to the state's entire congressional delegation, including Speaker Mike Johnson (R), warning that planned cuts to Medicaid would be 'historic in their devastation.' The letter said that the Senate's version of the bill would cut more than $4 billion in Medicaid funding, with a loss of more than 16,000 jobs. Even the House's version of cuts, the letter stated, would be a more palatable solution. However, the 'economic consequences pale in comparison to the harm that will be caused to residents across the state, regardless of insurance status, who will no longer be able to get the care that they need,' the letter reads. 'Steep cuts will force consolidation of services, staffing reductions and closures, reducing healthcare access to everyone in our communities. Our rural communities will especially feel the impact as many of these hospitals are already in difficult financial situations and are likely to experience a significant reduction of services.' The letter was also sent to Sen. Bill Cassidy (R-La.), who expressed concerns about the cuts to Medicaid in the Senate version of the bill Thursday and said that the House version would be preferable. However, Cassidy has not since spoken out against the bill, a vote for which kicked off in the Senate Saturday night. Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
Yahoo
26-06-2025
- Health
- Yahoo
Hospital Leaders Call for Action to Protect Healthcare in Oklahoma
OKLAHOMA CITY, June 26, 2025--(BUSINESS WIRE)--As the Senate prepares to vote on a budget reconciliation bill that would have devastating impacts on healthcare access in Oklahoma, hospital administrators will share how Medicaid cuts would impact their communities. When: 12 p.m., Friday, June 27, 2025 Where: Virtual: Link: Webinar ID: 867 6513 9648 Passcode: 022980 Why: The cuts to Medicaid and Oklahoma's directed payment program now being considered would result in an $8 billion loss over 10 years to Oklahoma hospitals, as well as job losses, hospital closures, and reduction in healthcare services to communities across the state. Who: Rich Rasmussen, president and CEO, Oklahoma Hospital Association Bennett Geister, president, Oklahoma City Communities, Mercy Denise Webber, president and CEO, Stillwater Medical Jay Johnson, president and CEO, DRH Health, Duncan Trent Bourland, vice president, rural development, SSM Health Oklahoma Additional Interviews: Jay Johnson, Denise Webber, and Bennett Geister will be available for one-on-one, on-camera interviews in Oklahoma City beginning at 1:30 p.m. Please schedule in advance. View source version on Contacts Media Contact: Susie WallaceVice President of Strategic CommunicationsOklahoma Hospital Association(405) 427-9537swallace@ Error in retrieving data Sign in to access your portfolio Error in retrieving data Error in retrieving data Error in retrieving data Error in retrieving data
