Last year, Republicans in Congress slashed Medicaid funding and let Affordable Care Act subsidies lapse—moves that hit rural America hard, a core GOP constituency. To soften the blow, they tucked $50 billion into the One Big Beautiful Bill Act for rural health initiatives. But experts warn the money alone won’t reverse a grim trend: rural areas are hemorrhaging doctors, hospitals, and even pharmacies, and neither party has a credible plan to stop it.
A Crisis of Access and Innovation
There is a silver lining: more than 96% of Americans live within 90 minutes of a full-service hospital—the critical window for treating heart attacks. In Canada, only 71% do. Yet the U.S. lags in deploying tools that could transform rural care. Specialists at the Mayo Clinic already treat thousands of rural stroke victims annually via telemedicine, often within minutes of arrival at an ER. Drones deliver blood, vaccines, and emergency medicines—including clot-busting drugs for strokes and antivenom—in several African countries, but not here. As some states score high on health emergency readiness, others remain stuck in what analysts call the technological Dark Ages.
Legal Hurdles Block Lifesaving Tech
To fully use telemedicine, drones, alternative providers, and new payment models, dozens of state and federal laws must change. Take telemedicine: a doctor licensed in one state generally cannot treat patients in another without a second license. During COVID, most states waived these restrictions, but most have since reimposed them. Even where exceptions exist, legal hurdles are costly and burdensome. In an ideal world, a doctor licensed anywhere could practice via telehealth anywhere. That remains a distant goal, especially as legal battles over telehealth abortion access underscore the regulatory patchwork.
Drone delivery faces similar headwinds. In a large rural state like Texas, one might expect drones to shuttle blood and drugs to remote hospitals. Instead, medical centers must navigate a tangle of federal aviation rules, state regulations, and even local city ordinances. Compare that to Rwanda, Ghana, Nigeria, and Kenya, where robust drone programs are routine. The U.S. is falling behind.
Unleashing Nurse Practitioners and New Payment Models
Only 27 states and Washington, D.C., allow nurse practitioners to practice independently to the full extent of their training. Texas is one of 11 states that require physician supervision for nearly everything, forcing nurses who want autonomy to move to big cities—exactly where doctors already cluster. The cost of that supervision can run thousands of dollars a year, a drain on small rural practices.
Payment reform is another frontier. Direct primary care—once called concierge care for the wealthy—offers a flat monthly fee for all primary care, avoiding the administrative nightmare of 10,000 billing codes. Atlas MD in Wichita, Kansas, charges $50 a month for adults 20-44 and $10 for a child, with unlimited access to doctors. The One Big Beautiful Bill Act now allows Health Savings Accounts to pay these monthly fees, and employers can contribute. But to give rural patients real options—both on-site and via telehealth—Congress should extend HSAs and direct primary care access to Medicare and Medicaid enrollees.
John C. Goodman, president of the Goodman Institute for Public Policy Research, argues these changes are essential. Without them, rural healthcare will continue its decline, regardless of how much money is thrown at the problem. As health costs top voters' concerns, the pressure on lawmakers to modernize the system will only grow.
