Getting to the bottom of the rural health "slush fund"

When the U.S. Senate passed Trump's "Big Beautiful Bill" a few weeks ago, considerable attention was paid to the sweetheart deal the administration had made with Alaska Senator Lisa Murkowski.  Initially skeptical and critical of the bill because of the impact it would have on rural Alaska (read more here), Murkowski eventually signed on to support the act after the Trump administration made concession to Alaska, including a $50 billion program for rural health.  

On Marketplace (American Public Media), Sarah Jane Tribble of Kaiser Health News breaks down how this so-called "slush fund" would work.  Here are some key excerpts about the so-called Rural Health Transformation Program: 

The Rural Health Transformation Program calls for federal regulators to hand states $10 billion a year for five years starting in fiscal year 2026.

But the “devil’s in the details in terms of implementing,” said Sarah Hohman, director of government affairs at the National Association of Rural Health Clinics.

“An investment of this amount and this style into rural — hopefully it goes to rural — is the type of investment that we and other advocates have been working on for a long time,” said Hohman, whose organization represents 5,600 rural health clinics.

People who live in the nation’s rural expanses have more chronic disease, die younger, and make less money. Those compounding factors have financially pummeled rural health infrastructure, triggering hospital closures and widespread discontinuation of critical health services like obstetrics and mental health care.

Nearly 1 in 4 people in rural America use Medicaid, the state and federal program for low-income and disabled people. So, as Senate Republicans heatedly debated Medicaid spending reductions, lawmakers added the $50 billion program to quell opposition. But health advocates and researchers doubt it will be enough to offset expected cuts in federal funding.

Senate Majority Leader John Thune, a Republican from South Dakota, which has one of the largest percentages of rural residents in the nation, led the push to pass the budget bill. His website touts support for strengthening access to care in rural areas. But his office declined to respond on the record to questions about the rural health program included in the bill.

The story also notes Tribble's efforts to get comments from Senator Susan Collins of Maine, another state with a significant rural population.  Senator Josh Hawley of Missouri, having voted for the "big beautiful bill" is pushing for a reversal of its cuts to Medicaid and an increase in the "rural program," which presumably refers to the $50 billion fund. 

From the think tank, libertarian sector, Tribble gives us this note of skepticism: 

Michael Cannon, director of health policy studies at the Cato Institute, a libertarian think tank headquartered in Washington, D.C., said the money was set aside because of politics and not necessarily for rural patients.

Here is a further quote from Cannon:   

As long as it’s a government slush fund where politics decides where the money goes, then there’s going to be a mismatch between where those funds go and what it is consumers need.

I can't help wonder by what factors and with what algorithm Cannon determines "mismatch."