Recent reports identify rural public health interventions, some with potential to mitigate Medicaid cuts

U.S. Department of Public Health Building.
Image courtesy of Boston Public Library. 

Introduction 

Healthcare in rural America finds itself a topic of much discussion lately, with mainstream media coverage of the crisis unfolding after Medicaid cuts by the Trump administration's 2025 budget reconciliation bill, which was signed into law July 2025. By some estimates, the new law will increase the number of uninsured people by 10 million in 2034. Other coverage concerns the fate of a $50 billion rural health slush fund that is yet to pay out in the communities who need it most and the recent slew of hospital closures in rural communities.

While the new restrictions on Medicaid eligibility and reduced federal spending will be felt across the nation, rural communities will be hit especially hard, due to the higher rates of people on Medicaid in nonmetropolitan areas. Sarah Jane Tribble, reporting for KFF Health News, writes: "[p]eople who live in the nation’s rural expanses have more chronic diseases, 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." 

Hospital closures (online tool showing a map of recent closures) exacerbate the present struggle to meet rural healthcare needs, where people are generally more vulnerable and less likely to utilize primary care services due to structural barriers like cost and provider shortages. "Rural adults are less likely to be insured, less likely to use healthcare, and more likely to delay seeking care than urban residents," Caldwell et al., 2016. To put it plainly, access to acute care is bleak in much of rural America right now, and reductions in Medicaid spending and eligibility are poised to make things worse. 

Rural hospital closures, 2005-2010 (in blue) and 2010-present (in yellow).
Graphic courtesy of Sheps Center for Health Services Research, UNC. 

There is, however, another dimension of the rural health conversation that is gaining traction in public discourse – rural public health. Where the trends in healthcare are alarming, improvement in public health feels tractable. This post focuses on insights from two recent reports – this one from the Aspen Institute (Feb. 2026) and this one from California's Department of Public Health (Feb. 2026) – to highlight opportunities for high-impact rural public health intervention amid the ongoing healthcare crisis. 

Public Health: Rurality in Focus

In general, the healthcare industry aims to treat people who are sick or injured, whereas public health seeks to keep people from getting sick or injured in the first place. Healthcare focuses on individualized care; public health focuses on entire populations. Because a key responsibility of public health is to collect, analyze, and interpret health data to inform timely public health interventions, policies, and resource planning, it is more likely to analyze and include the axes of identity and experience that inform vulnerability. In fact, rurality has been an axis of analysis in public health research for decades. "Place," meaning where people live, work, and play, is widely understood by experts in the field as a fundamental social determinant of health.

In February 2026, the Aspen Institute and the California Department of Public Health each published reports that examine, in significant detail, the state of rural public health. The Aspen Institute Report is titled "Meeting the Health Needs of Rural America," and represents the tenth installment in the Aspen Health Strategy Group's mission to tackle a single health issue annually through year-long, in-depth study. The California Department of Public Health Report, the State's second-ever "California State of Public Health Report," ("Cal. DPH Report") carves out tens of pages devoted to risks, trends, and interventions specific to rural children, adolescents, and adults.

All-Cause Mortality Rate by Race and Ethnicity in Urban/Rural
Areas, California 2022-2024 (Cal. DPH Rep., p. 32)

This post focuses on one paper from the Aspen Institute Report titled Population Health in Rural America: Changes, Challenges, and Opportunities, authored by rural demographer Shannon M. Monnat and sociologist Tim Slack. Their paper tees up several useful policy proposals, which provide a path to remedying the so-called "rural mortality penalty" – the name for a widening disparity where rural U.S. residents experience higher age-adjusted mortality rates than urban counterparts. The authors suggest that the relative recency of the rural mortality penalty, which emerged in the data only four decades ago, "provides reason to believe it can be reversed." (Aspen Inst. Rep., p. 5). 

Systemic Risks and Opportunities 

Each report does a thorough inventory of factors driving mortality rates across the lifespan, from infants to working-age adults to the elderly. Unsurprisingly, barriers like lack of access to healthcare, transportation, healthy food, broadband internet, and other social services are central to their findings. But each goes a step further to do some accounting of recent social and economic trends driving the numbers: substance abuse and misuse; growing gaps in educational attainment; and persistent economic disinvestment that has hollowed out local institutions and workforce pipelines. Environmental risks (including climate change) and exposures also explain recent losses in resilience and increases in mortality rates. These overlapping stressors compound, reinforcing cycles of poor health outcomes that are difficult to interrupt through healthcare access alone. 

Adult Mortality Rates in Nonmetropolitan (Rural) Counties,
2000-2022 (Aspen Inst. Rep.)

Writing for the Aspen Institute, Monnat & Slack characterize "rural economic and human health" as "intertwined." The data in both studies bears this out. Lower income, wealth, and levels of educational attainment correlate strongly with shorter lifespans and fewer years lived in good health. Importantly, both reports frame these outcomes not as inevitable features of rural life, but as the product of policy choices and disinvestment patterns that can be changed. The California report, in particular, emphasizes that upstream interventions–those that target education, early childhood development, and economic stability–offer some of the highest returns for improving long-term health outcomes (Cal. DPH Report). 

The reports identify education policy reform as a major inroad for uplifting rural communities struggling with economic disinvestment and population decline. 

Education, particularly possessing a bachelor’s degree, has become an increasingly important determinant of health and longevity in the United States. Higher education confers economic, social, and lifestyle advantages that manifest as a “personal firewall” that protects health, even in the face of external and unpredictable threats, such as pandemics, recessions, and natural disasters.

(Aspen Inst. Rep., p. 76). Investments in vocational programs, community colleges, and early childhood education programs like Head Start not only improve education and employment outcomes, but also provide measurable health benefits over time. Many health outcomes and disparities in adulthood are rooted in childhood conditions such as family and community health, neighborhood safety, policies, and systems" (Cal. DPH Report, p. 58). By strengthening local economies and expanding opportunities, these interventions address root causes of poor health, rather than treating symptoms as they occur. In this way, rural public health policy begins to function as a cross-sector strategy for community resilience. 

Conclusion 

The current crisis in rural healthcare access underscores the need for action, but it also highlights the limits of a healthcare-only response. As the reports analyzed in this post make clear, improving rural public health outcomes requires sustained investment in the social and economic conditions that shape health, long before a person ever becomes a patient. Public health offers a framework for identifying upstream opportunities and making interventions where they can have the greatest impact. In the face of hospital closures and shrinking coverage, this broader approach might provide a path forward: one that treats rural health not only as a medical issue but as a function of place, policy, and long-term community investment.