Access to healthcare supports climate resilience everywhere, but especially in rural America

Salinas River near Greenfield, CA
© Jillian Gronnerud (2018)

Human health and environmental health are undeniably interdependent. Clean air and water, limited exposure to pollutants, a preserved natural environment, and adequate protection from occupational health and safety hazards are a few of the ways that robust environmental protection can support human health. As the effects of climate change become more visible and more severe, so too do the effects on human health and well-being. 

The World Health Organization's overview on environmental health tells us that climate change is profoundly affecting human health: natural disasters, infectious diseases, heat-related illnesses and death, effects on food production, migration, and economic instability are among the direct and indirect impacts. According to the WHO, more than 13 million people worldwide die each year due to modifiable environmental conditions. 

Zooming in on food production, climate change is already having major impacts on agricultural operations around the world. In the United States, impacts manifest directly as higher average air temperatures, changing precipitation patterns, and rising concentrations of atmospheric carbon dioxide. Indirectly, productivity is harmed by changes in disease occurrence and insect and weed populations. According to one USDA report, "research has documented cases where elevated atmospheric levels favor the growth of weeds over the growth of the crop species with which they compete." 

Taking a more nuanced look at climate change effects on the economics of US agriculture, the same USDA report notes that agricultural production is chronically vulnerable to environmental stressors (dry spells, insect damage, disease outbreak), making the added unpredictability of climate impacts unwelcome. In some cases, climate change effects render agricultural operations economically non-viable. 

In a March 2026 piece for Inside Climate News, Jordan Gass-Pooré interviewed a family farmer from upstate New York who stopped growing vegetables because "they were afraid extreme weather events would ruin their crops." Reflecting on the decision, Samantha Kemnah told ICN: "'We really enjoyed growing vegetables [. . .] [b]ut we couldn’t continue to commit to people, to raise food, and then have a hailstorm wipe it all out.'"

Photo Credit: US Department of Agriculture (2016)

A lack of formal, institutional support for farmers like Kemnah complicates the picture further. Diversified farms and smaller family farms face a lack of governmental support, in part because subsidies remain geared toward commodity crops and often come with a minimum base acre requirement. The result? Small family farms are hemmed in by stiff financial conditions and unable to access capital needed to run their business. Recent USDA research reveals that "[m]any farmers face steep hurdles to diversify their crop rotations. More diverse rotations may make management more complex and may require new equipment. Farmers may also need to learn how to grow new crops."

When farms like the Kemnah's are forced away from diversified crops and toward subsidized commodities, they are also driven away from crop rotation and other environmentally beneficial practices that could serve as part of the farm's climate change mitigation strategy. 

Cows in field near Duncan Mills, CA
© Lisa Pruitt (2025)

With a clearer picture of the impacts of climate change on US agriculture in mind, the remainder of this post will focus on one key aspect of the nexus between the environmental and human health. The basic argument goes – and research supports – that access to high quality healthcare might be one of the best preventative measures we can implement to promote climate resilience for American farmers, farmworkers, and the lands they live and work on. 

The recent Inside Climate News article by Gass-Pooré paints a picture of the current relationship between healthcare and those with agricultural livelihoods:

In the U.S., nearly half of rural residents, including farmers, are uninsured or insured by government-funded programs such as Medicaid or Medicare. Nearly one in four people under the age of 65 [...] have Medicaid coverage [...] Now, even this system is in peril as millions of Americans are expected to lose coverage as a result of pending changes and cutbacks to Medicaid [...] As a result, some farmers risk losing their lifeline and becoming uninsured. It would leave them even less prepared to do farm work and to tackle the oncoming impact of climate change. 

These dynamics suggest that healthcare access is not merely a social service for farmers, but a critical component of resilience, both at the individual and systemic level. Rates of work-related death for farmers are seven times the national average. Working in the elements, with heavy equipment, and near chemicals mean that farmers face increased rates of occupational risks, injury, and chronic illness. Demanding work, economic instability, and isolation manifests in the form of mental health challenges at rates far higher than the general population (a 2021 CDC report shows a male suicide rate of 52.1 per 100,000 among farmers and ranchers, compared to 32.0 per 100,000 among male working-aged adults across all occupations).

Despite this risk profile, farmers routinely encounter barriers to care, including provider shortages, cost, and the associated prospect of medical debt.  In a 2022 study by Florence Becot & Shoshanah Imwood, researchers reported that 20.3% of American farm households had medical debt exceeding $1,000, and that 55 percent of these households were not confident they could cover the costs of a major illness or injury.

The concurrent loss of Affordable Care Act subsidies and challenging economic conditions means that health insurance will become outright unaffordable for many farmers. The decision then becomes whether to continue working and forgo coverage – a risky proposition in such a dangerous occupation – or to leave the industry altogether in search of a job that will provide health insurance.

By contrast, Gass-Pooré's article documents describes not-for-profit health plans in Germany, which are not tied to employment and strictly limit how much patients must pay out of pocket. These plans enable farmers to work full-time and "take advantage of reliable government support" as they implement farming practices meant to improve soil health and provide other climate mitigation benefits.

The situation in America is something else entirely. Gass-Pooré summarizes the current state of affairs: 

Climate change makes it harder to maintain a productive farm, health care cuts threaten farmers’ ability to work the land and cuts to the programs that could help with both mean their lives are more uncertain than ever. 

The connections between environmental health, agricultural viability, and human well-being are increasingly difficult to ignore. Climate change places growing strain on farmers and farmworkers, while structural barriers, from limited healthcare access to outdated and failing subsidy systems, compound their vulnerability. 

As this post has explored, improving healthcare access offers a tangible pathway to support both individual resilience and broader environmental outcomes. By treating healthcare as part of the infrastructure that sustains agriculture, policymakers can better equip rural communities to withstand climate pressures while preserving the systems that feed and sustain us all. 

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. 

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: 

People 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. In 2016, Dr. Julia T. Caldwell et al. published a paper in the American Journal of Public Health, which states that "[r]ural adults are less likely to be insured, less likely to use healthcare, and more likely to delay seeking care than urban residents." 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. According to the American Public Health Association, 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, they 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.

A 2026 Farm Bill enters the House…

On February 13, 2026, the Farm, Food, and National Security Act of 2026, an updated version of the Farm Bill, was introduced in the House of Representatives. Shortly afterwards, on March 4th, the House Agriculture Committee voted 34-17 to advance the bill to the House floor, marking the first major legislative step in process likely to be long and contentious, given the recent extreme polarization on the U.S. Congress.

Supreme Court of the United States in 2023

It's high time for a new farm bill-- the last official version, the Agriculture Improvement Act of 2018, was authorized for 5 years, spanning from 2018 to 2023. Updates to the Farm Bill after 2023 were stalled by political gridlock. Instead of passing a new Farm Bill in 2023, Congress opted for two consecutive one-year extensions of the outdated 2018 framework.

At last, lawmakers are attempting to move forward with a new Farm Bill that will update how the federal government supports or defunds a range of programs affecting agriculture, food systems, conservation, and rural communities across America.

Farm bills have been introduced to Congress starting in 1933. The first one followed the catastrophic impact the Great Depression and the Dust Bowl had on American farmers. In response, the federal government created programs designed to stabilize farm income, conserve land, and ensure a stable food supply. You can read more about the history of the farm bill here or in this prior blog post. Indeed, many posts going back to this blog's inception in 2007 mention the Farm Bill.

Throughout the years, the Farm Bill has grown into one of the federal governments largest and most comprehensive policy packages, typically spanning hundreds or thousands of pages. Programs housed under the Farm Bill include SNAP funding, crop insurance, conservation programs, rural development programs, agricultural research, food distribution programs, and beyond. 

This Farm Bill claims to “expand investments in rural communities, bring science-backed management back to our national forests, and restore regulatory certainty in the interstate marketplace.”

Within the report, two sections specifically caught my eye—the MAHA section and the discussion surrounding California’s Proposition 12. Both sections highlight how the Farm Bill increasingly serves as a platform for broader political debates.

Somerset, El Dorado County, California

(c) Lisa R. Pruitt 2025

MAHA Section
The highlighted MAHA section references the Make America Healthy Again (MAHA) movement within the current administration led by Robert F. Kennedy. MAHA aims to address national health issues. As expressed in the one-pager released by the House Agriculture Committee on MAHA in this Farm Bill, the goals of MAHA are to “renew our lands, reforming dietary guidelines to focus on sound nutrition science, ensuring that rural America has access to quality healthcare, and making whole foods such as fruits and vegetables more affordable and accessible for everyday Americans.”

This Farm Bill codifies recent reforms to the Dietary Guidelines for Americans (DGAs) which include prioritizing whole, high-quality protein and full-fat fluid milk and hard cheeses. This Farm Bill also proposes the incorporation of these guidelines into SNAP which may impact which foods are promoted within federal nutrition assistance programs. 

Sign in Sonoma County

(c) Lisa R. Pruitt 2024

Another initiative highlighted in this one-pager is the establishment of a “local procurement program” that will in theory strengthen partnerships between local producers and the “food distribution community” in effort to ease fresh food distribution.

On paper, the idea sounds promising. Strengthening local food systems could support farmers while improving access to healthier foods. However, the proposal remains vague-- it is not clear (at least to me) who, how, or where these programs will take place.

Another major component of the MAHA section focuses on rural healthcare, an issue that has become increasingly urgent as rural hospitals close and rural healthcare systems become increasingly stressed, as I discussed in this prior blog post.

Clinic in McCloud, California

(c) Lisa R. Pruitt 2018

This bill proposes expanding programs affecting rural healthcare including the Distance Learning and Telemedicine Program, the Community Facilities Program, and the Rural Hospital Technical Assistance Program (RHTAP). RHTAP is codified within the bill with the goal of “improv[ing] the financial and operational sustainability of rural healthcare facilities, bolstering essential health services for rural residents and preventing hospital closures in their hometowns.” This program originally received funding through the Rural Development Hospital Technical Assistance Program Act of 2025, which appropriated up to $2 million per year from 2025-2029. The proposed Farm Bill extends that funding window, restating the maximum funding for the fiscal years 2027-2031. As I mentioned in this blog post, politicians use policy packages such as this to signal their support of rural farms, families, systems, etc.. Yet the monetary value proposed in each case is insignificant to the cause. Here, $2 million spread among the countless rural healthcare systems that are in serious need is negligible.

Proposition 12 Section
Another section highlighted by the House Committee on Agriculture focuses on California’s Proposition 12 (Prop 12), one of the most controversial livestock welfare laws in the United States. Passed by 63% of California voters in 2018, Prop 12 prohibits the sale of certain pork, veal, and egg products in California unless they are produced according to certain animal welfare standards. These standards focus on enclosure size compliance. 

Chickens in transportation truck in Northwest Arkansas

(c) Lisa R. Pruitt 2017

Corporations like the National Pork Producers Council (NPPC) advocate for repealing Prop 12 to allow for the sale of animal products from animals raised in smaller and confined spaces. The American Farm Bureau Federation and the National Pork Producers Council brought suit against the California Department of Food and Agriculture asserting that Prop 12 violated the Dormant Commerce Clause. The Supreme Court upheld Prop 12, yet the current administration and House Republicans have attempted to overturn the decision and influence public opinion or legislatures not to support it anymore—for example, through this one-pager. In this one-pager, the House Committee on Agriculture calls Prop 12 “arbitrary and unscientific.” They state that “retail pork prices in California have increased 18.7% compared to a 6.3% increase nationwide. They then state that “[c]ompliance costs disproportionately affect small and mid-sized producers, who face tighter margins and less access to capital.” While small or mid-sized facilities may be affected more than large ones, Prop 12 has been fully in effect since 2022. I support Prop 12 and find that since the majority of California voters supported it, the NPPC and the MAHA movement should reassess their priorities.

Ultimately, the Farm Bill has increasingly incorporated broader policy debates, but the 2026 rendition highlights how influential national debates and administrations can be on this hallmark legislation. Programs initially intended to support farmers, rural communities, and ecological conservation are now debated at length in an effort to gain an inch of power or influence. However, a new Farm Bill was desperately needed to address the everchanging landscape—especially post-COVID and entering a likely recession.

The importance of pharmacies in rural areas

Pictured is Newfane Pharmacy, a rural pharmacy in Newfane, New York my family owns

Newfane has a population of roughly 3,400

When discussing access to healthcare in rural communities, the focus often centers on hospitals and physicians’ offices but rarely on pharmacies. Yet pharmacies are critical healthcare access points: they provide not only prescription and over-the-counter medications, but also direct access to highly trained healthcare professionals. Pharmacists counsel patients on medications, diagnoses, and general health concerns while serving as trusted, familiar faces in their communities. They answer questions about immunizations, referrals to medical services, common colds, heart attack symptoms, and even pet medications. Pharmacists have a uniquely valuable position in their community-- they possess specialized medical and pharmacological knowledge while maintaining close personal relationships with their patients. 

At the same time, rural hospitals are increasingly at risk of closure due to systemic challenges such as funding reductions, high operational costs, and insurance provider reimbursement inadequacies. An article written in November, 2025 from Boston University School of Public Health stated that over 100 rural hospitals have closed in the United States over the past decade. The article also reported that 700 rural hospitals are currently at risk of closing, with 300 of them being at immediate risk of closing. Rural healthcare systems are already strained, and hospital closures further restrict access to care and shift additional pressure onto remaining providers, including pharmacies, critical access hospitals and small clinics, all of which are already few and far between. 

As hospitals close and medical services shrink, rural pharmacies absorb much of the strain. They face growing patient volumes, inadequate reimbursement from insurers—sometimes resulting in financial losses on certain prescriptions—and increasing pressure to expand services such as compounding and immunizations. An analysis by the Rural Policy Research Institute found that 80% of rural independent pharmacies recieved reimbursement less than the cost of acquiring and dispensing medications. Some states, like New York, provide additional reimbursement rates for state medical programs in rural areas to bolster healthcare assess. Additionally, unlike chain pharmacies, independent pharmacies often have the flexibility to adapt. Many provide delivery services for patients without reliable transportation and they expand clinical offerings to fill gaps left by other providers.

Despite funding challenges and cuts, there are signs of support for rural healthcare infrastructure. On December 30, 2025, the New York State Department of Health announced that the state will receive $212 million in 2026 under the federal Rural Health Transformation Program to improve health care access and delivery in New York communities. While the announcement states that "to ensure the funding directly benefits rural residents across the state... [p]rogram implementation will be supported by ongoing stakeholder engagement, including feedback from providers, tribal and faith-based organizations, local leaders and community members to target resources where they will have the greatest impact," it remains unclear if the funds will truly reach rural areas in need. Nevertheless, programs like this are essential to sustaining healthcare infrastructure and providers in rural areas.

(An model antique pharmacy in upstate New York)

Some may argue that funding rural pharmacies is secondary to hospitals due to mail-order prescriptions or outsourcing of prescription services. Access to prescriptions has increasingly shifted to mail-order pharmacy services. While mail delivery can be convenient, particularly for maintenance medications, it presents its own set of challenges. Delays, incorrect dosages, stolen packages, or temperature-sensitive drugs compromised during transit can place patients at serious risk. Additionally, mail-order services do not offer the same in-person consultation and real-time problem-solving that community pharmacists provide. Although mail services play a role in rural healthcare delivery, policy efforts should prioritize sustaining brick-and mortar pharmacies that provide direct support. 

Recent retail pharmacy closures have further intensified the strain. The closure of all Rite Aid stores and numerous CVS locations has increased patient volume at independent pharmacies. With a large proportion of rural patients relying on government-funded insurance programs, reimbursement pressures can make profitability difficult. Independent pharmacists must balance delivering high-quality healthcare with managing the financial realities of running a small business. The dual responsibility of being a pharmacist and a business owner adds stress but many remain committed because of the meaningful and tangible impact they make in their communities.

With healthcare in rural areas experiencing increased strain, policymakers should consider how to strengthen pharmacies’ roles. Perhaps independent pharmacies should have the ability to prescribe some drugs in rural areas. Perhaps federal and state governments should allocate greater support to rural healthcare infrastructure compared to urban ones? Rural pharmacies are pillars of community healthcare—the question is whether policy will evolve to recognize, and adequately support, that reality.

Rural women face a decline in access to necessary reproductive health care

Women's rural health clinic in Bishop, California.

Credit: California Health Report

Maternal Health

The United States has the highest rates of maternal death among high-income countries, three-times higher than comparably wealthy nations. Maternal health disparities impact certain populations more severely than others. For example, the maternal death rate for black women is 49.5 deaths per 100,000 live births, compared to the US average of 22.3 deaths per 100,000. 

Rural populations face maternal death disparities too. "Noncore" areas (areas outside metropolitan and micropolitan statistical areas defined by the Census) have a maternal mortality rate of 26.8 deaths per 100,000 live births compared to 19.5 deaths per 100,000 for large central metro areas. Further, the situation for rural women is likely to get worse.

Maternal health access has been declining in recent years. In 2024, the National Rural Health Association shared that 36% of U.S. counties, a majority of which are rural, are maternity care deserts. A maternity care desert is any county without a hospital or birth center offering obstetric services. In 2022, more than half of rural counties (58.8%) had no hospital-based obstetrics unit, up from 51% in 2010.

Katy Backes Kozhimannil, a professor at the University of Minnesota School of Public Health, told The Daily Yonder that closures of obstetric units are due to "not having enough revenue to keep the units open, as well as not having enough births and specialized skills to care for obstetric patients and not having enough trained clinicians to keep the unit operating." 

Closure of rural hospitals exacerbates the maternal health crisis in these rural communities. Since 2005, 110 rural hospitals have closed, and almost 800 are currently at risk of closure due to financial distress. A previous blog post discussed the rural "slush fund" included in Trump's "Big Beautiful Bill," which included a $50 billion program to support rural health. The fund, named the Rural Health Transformation Program, is overshadowed by the fact that the bill cuts Medicaid funding by almost $1 trillion, estimated to be $137 billion in rural areas.

Credit: Allie Kelly, Business Insider

A study by Georgetown University Center for Families and Children showed that 47% of children and 18% of adults in rural and small towns rely on Medicaid (numbers that the study predicts underestimate the true values). Also, nearly half of all births in rural hospitals are covered by Medicaid. While the rural "slush fund" may provide some funding for rural health care infrastructure, its only one-third of what rural communities expect to lose from the cuts. 

The fund will be distributed over five years, $10 billion each year starting in 2026. The amount each state will receive this year averages $20 million. Half of the fund is distributed equally across states, with only a quarter of the fund being distributed based on need, meaning that states with significantly larger rural populations may receive similar amounts of funding to states with lower rural populations. Additionally, the fund is broadly available to aupport health care systems, with initiatives not directly tied to rural health, such as Make America Healthy Again (MAHA), posted by Centers for Medicare & Medicaid Services (CMS) as an example of what may receive funding.

Abortion Access

On another reproductive healthcare front, access to abortion clinics from rural areas is limited. In California, about 40% of counties do not have an abortion clinic, and most of these counties are rural. In Inyo County, CA, most residents live over 200 miles from the nearest abortion provider. The lack of abortion care is shocking in light of California's support for abortion access. But residing in a state that recognizes the right to abortion does not mean its residents automatically enjoy easy access to abortion providers. Avery Van De Berg previously wrote on this blog about the severely limited abortion access in Missouri, despite their amendment to protect abortion rights.

Rural residents in states that have enacted post-Roe bans on abortion face even greater barriers to care. Many residents now have to travel significantly farther to find abortion providers. Sarah Melotte of The Daily Yonder analyzed abortion care data and found that after Roe was overturned, rural travel to abortion providers increased from 103 miles on average to 159 miles on average. This distance can be significantly farther in some rural areas. Travel to an abortion provider is as far as 800 miles of travel from parts of rural Texas and 492 miles of travel for the average rural Louisiana resident.

What's the Solution?

Policy-makers have proposed solutions to the reproductive health care crisis facing rural residents experience. Similar to solutions posed to prevent legal deserts, a solution for maternity care deserts includes recruiting, training, and retaining physicians who provide maternal care. To improve access to care, Telehealth policies have been proposed to bridge the gap between physicians in rural area and maternal care needs. 

Undoubtedly, many of these solutions come down to investment in rural health care. We've yet to see whether laws like the "Big Beautiful Bill" will fulfill promises of affordable and available healthcare in rural communities.

For more academic analysis of these issues read more here and here.

Rural health "slush fund" distributions announced

Fall River Mills, California
(c) Lisa R. Pruitt 2018

The Centers for Medicare and Medicaid Services announced this week the establishment of the Rural Health Transformation Program in relation to Trump's "One Big Beautiful Bill" passed in July--and the so called "rural slush fund" that was a last-minute addition to that law.  An earlier post about that late addition to the law is here, also noting that it was added in part to secure the vote of U.S. Senator Lisa Muskowski's (Alaska) support for the law.  

The Rural Health Transformation Program website touts it as 

empower[ing] states to strengthen rural communities across America by improving healthcare access, quality, and outcomes by transforming the healthcare delivery ecosystem. Through innovative system-wide change, the RHT Program invests in the rural healthcare delivery ecosystem for future generations.

Its stated goals are: 

• make rural America healthy again
• sustainable access
• workforce development
• innovative care
• tech innovation

At the end of this post, I cut and pasted from this website more information about the structure and requirements.  For now, however, I want to focus on details of the distribution.  First, all states got a share of the distribution,  and the states that fared best were Texas, Alaska, California, Oklahoma and Montana.  That said, the award amounts to the states did not vary dramatically.  The average amount awarded to each state was $200 million, with the range from $147 million (New Jersey) to $281 million (Texas).  Here's an excerpt from the CMS announcement of the awards, which went to all 50 states.  

This unprecedented federal investment will help states expand access to care in rural communities, strengthen the rural health workforce, modernize rural facilities and technology, and support innovative models that bring high-quality, dependable care closer to home.

It includes this long quote from Health and Human Services Secretary Robert F. Kennedy, Jr.:  

More than 60 million Americans living in rural areas have the right to equal access to quality care.  This historic investment puts local hospitals, clinics, and health workers in control of their communities’ healthcare. Thanks to President Trump’s leadership, rural Americans will now have affordable healthcare close to home, free from bureaucratic obstacles.

It also features this direct quote from Dr. Mehmet Oz, the CMS administrator:  

Today marks an extraordinary milestone for rural health in America. Thanks to Congress establishing this investment and President Trump for his leadership, states are stepping forward with bold, creative plans to expand rural access, strengthen their workforces, modernize care, and support the communities that keep our nation running. CMS is proud to partner with every state to turn their ideas into lasting improvements for rural families.

Roll call covered the matter, with a focus on Texas.  Some key excerpts follow: 

Twenty percent of [a state's] score [on the application for the competitive part] was determined by a state’s policy actions, including vows to pursue waivers to ban SNAP users from buying certain items like soda and candy, reinstating the presidential fitness test for schoolchildren and requiring that medical schools teach students about nutrition, among other things. States could lose money in future years through a “rescoring” process if they don’t follow through on those initiatives, Oz said.

The remaining 30 percent is based on the strength of the ideas that states proposed in their applications.

Projects highlighted by CMS on Monday include ones that aim to expand access to preventative, primary, maternal and behavioral health care. States also are pursuing “food as medicine” initiatives, models to address chronic disease prevention and programs to shore up their health care workforce.

Critics had argued the amount of funding available is nowhere near large enough to offset reductions in federal Medicaid spending made by the reconciliation law, which amounts to $911 billion over 10 years. Sen. Susan Collins, R-Maine, who voted against the bill, had pushed for at least $100 billion in rural health funding.

The $50 billion would offset only about 37 percent of the estimated loss of federal Medicaid funding in rural areas, according to KFF, a health policy research organization.

But Dr. Mehmet Ozi is quoted as saying the funding is not intended to offset the reductions:  

The purpose of this $50 billion investment in rural health care is not to pay off bills.  The purpose of this $50 billion investment is to allow us to right-size the system and to deal with the fundamental hindrances of improvement in rural health care.

This excerpt from PBS Newshour coverage hits more squarely at the politics of the matter and what the Trump administration's CMS is trying to accomplish with these awards in relation to its wider "Make America Healthy Again" agenda: 

Several Republican-led states — including Arkansas, Iowa, Louisiana, Nebraska, Oklahoma and Texas — have already adopted rules banning the purchase of foods like candy and soda with SNAP benefits.

The money that the states get will be recalculated annually, Oz said, allowing the administration to "claw back" funds if, for example, state leaders don't pass promised policies. Oz said the clawbacks are not punishments, but leverage governors can use to push policies by pointing to the potential loss of millions.

"I've already heard governors express that sentiment that this is not a threat, that this is actually an empowering element of the One Big Beautiful Bill," he said.

Carrie Cochran-McClain, chief policy officer with the National Rural Health Association, said she's heard from a number of Democratic-led states that refused to include such restrictions on SNAP benefits even though it could hurt their chance to get more money from the fund.

"It's not where their state leadership is," she said.

Next, I quote from the analysis of a rural health care consultant working out of Texas, which came across my LinkedIn feed: 

Just reviewed the state allocations from CMS’s landmark $50B Rural Health Transformation Program, and the per‑rural‑person math is fascinating. I'm a CPA and I love excel...so you know I had to create my end of year fun facts related to the CMS awards for RHTP.

If you missed the announcement, here is a link to the full article. 

For context, the average award across all states is $1,957 per rural person.
Texas received $329 per rural person — a solid, meaningful investment in our rural communities. 

N.B.   It is not clear how this consultant is defining "rural" for purposes of these calculations.  

To put that in perspective:
Rhode Island: $31,525 per rural person
Just above Texas: Ohio ($345), NC ($360), PA ($390), MI ($413)
Next tier below RI: NJ ($5,343), AK ($4,949), MA ($3,332), DE ($3,231)

Texas’s total award is $1.4 billion over five years — the largest in the country. While we weren’t guaranteed the top spot, the hard work by the Texas team at HHSC on the application positioned us to lead in rural innovation.

I was personally hoping for closer to $2.1B, but we’ll take this $1.4B and put it to work transforming the rural health landscape across Texas. Huge congratulations to the HHSC team and all our partners who made this possible.

Here’s to an innovative, data‑driven 2026 and beyond for rural Texas! 🌟

Finally, I'm pasting here the details on the program (as promised above), which is essentially the call for applications: 

Program Structure

RHT Program funding is $50 billion to be allocated to approved States over five fiscal years, with $10 billion of funding available each fiscal year, beginning in fiscal year 2026 and ending in fiscal year 2030.

• 50% to be distributed equally amongst all approved States
• 50% will be allocated by CMS based on a variety of factors including rural population, the proportion of rural health facilities in the State, the situation of certain hospitals in the State, and other factors to be specified by CMS in the NOFO

Uses of Funds

States must use RHT Program funds for three or more of the approved uses of funds:Promoting evidence-based, measurable interventions to improve prevention and chronic disease management.

• Providing payments to health care providers for the provision of health care items or services, as specified by the Administrator.
• Promoting consumer-facing, technology-driven solutions for the prevention and management of chronic diseases.
• Providing training and technical assistance for the development and adoption of technology-enabled solutions that improve care delivery in rural hospitals, including remote monitoring, robotics, artificial intelligence, and other advanced technologies.
• Recruiting and retaining clinical workforce talent to rural areas, with commitments to serve rural communities for a minimum of 5 years.
• Providing technical assistance, software, and hardware for significant information technology advances designed to improve efficiency, enhance cybersecurity capability development, and improve patient health outcomes.
• Assisting rural communities to right size their health care delivery systems by identifying needed preventative, ambulatory, pre-hospital, emergency, acute inpatient care, outpatient care, and post-acute care service lines.
• Supporting access to opioid use disorder treatment services (as defined in section 1861(jjj)(1)), other substance use disorder treatment services, and mental health services.
• Developing projects that support innovative models of care that include value-based care arrangements and alternative payment models, as appropriate.
• Additional uses designed to promote sustainable access to high quality rural health care services, as determined by the Administrator.

This KFF Health News site tracked the states' applications for these funds.  

Farm Bureau skirts Obamacare (ACA) requirements on health plans

The Washington Post story is here, under the headline, "More states are offering cheap health plans to farmers, with a catch."  The lede follows:  

For years, Indiana farmer Corina Brant found herself squeezed on health care. Unable to qualify for Affordable Care Act subsidies, she worked an extra job that took her away from her farm duties.

That all changed in 2021, when she bought a policy for herself and her family under the Indiana Farm Bureau. It’s one of the growing number of states that allow these agencies — which lobby on behalf of farmers — to sell policies underwritten by large insurers such as UnitedHealthcare. The laws are modeled after a decades-old Tennessee statute that allows a state farm bureau to sell health coverage to farmers.

The catch: While these policies are inexpensive, they come with major restrictions. The plans cover checkups and most medical procedures, but they aren’t required to cover applicants with preexisting conditions or maintain coverage for someone who becomes seriously ill. In that sense, they resemble the cheap short-term plans that the Trump administration has pushed as a private-market alternative to the ACA. Critics call them “junk plans,” while proponents say they expand affordable options to an underserved group.

Bipartisan effort to re-open rural California hospital

I blogged this summer about the impending closure of the Glenn County Hospital in northern California, a closure attributable to a change in interpretation of a federal regulation regarding what counts as a "critical access" hospital.  Because of that changed interpretation, the hospital lost a critical funding stream and closed in early October, as reported here.  Now, however, U.S. Senator Adam Schiff and U.S. Congressman Doug LaMalfa, both from California, have introduced legislation that would restore the funding stream, leading to the possibility of the facility again opening.  Here is some detail of how that might work:

Schiff teamed up with Republican Sen. Cindy Hyde-Smith of Mississippi to introduce legislation that would amend the Medicare Rural Hospital Flexibility Program, which helps fund critical access hospitals. Their bill would allow hospitals designated critical access as of Jan. 1, 2024 – including Glenn Medical Center – to keep that status.

 Ana Ibara reports for CalMatters on why the effort is unlikely to be successful.  Here's an excerpt:  

Each proposal would restore the hospital’s “critical access” status, a designation that brings increased Medicare reimbursement and regulatory flexibilities that help small hospitals.

* * *

Changing federal policy to restore the hospital’s critical access status, however, would not enable Glenn Medical to reopen immediately. Even if Congress approves Schiff’s or LaMalfa’s bill, the hospital is still left with another problem: reopening a closed facility requires cash, and lots of it.

“Having the critical access designation reinstated, which is my understanding of what the bill would do, that at least makes [reopening] a possibility,” said Matthew Beehler, a spokesperson for American Advanced Management, the for-profit company that owns Glenn Medical Center and several other rural hospitals in California.

But, he said, “the reality is once the employees have left, you’re starting from scratch. We need to see this be successful first and then work with electeds to help identify potential funding sources,” he said.

Beehler did not have an exact figure, but reopening Glenn Medical, he said, would cost in the tens of millions of dollars.

Catching up on rural healthcare stories

I wrote several posts about rural healthcare this summer, mostly prompted by the consideration and passage of Trump's One Big Beautiful Bill, which was widely discussed as undermining rural health care and rural hospitals.  Since then, I've neglected the issues except to address some of them in this forthcoming law review article, which focuses on the challenge of maternal mortality for rural women.  

In this post, my plan is just to provide links to the stories I've seen about rural health care since the summer, making this something of a repository of resources to study how rural health care is faring in the Trump administration's first year and likely further degradation of services as a consequence of recent Republican policies.

First off, the Trump administration is withholding support to tsunami proof this hospital.  Katia Riddle reports from Astoria, Oregon.   One interesting aspect of this story is how local Republicans who supported Trump are flummoxed--or worse--about his administration's failure to support a rural hospital that has saved many local lives.  Here's some context:   

The Trump administration has canceled billions of dollars in federal grants across multiple agencies, and one of those grants is for a program that was designed to help local governments fortify places that are vulnerable to natural disasters.

* * *  

[The hospital in Astoria], called Columbia Memorial, was built decades ago. Now that we know more about earthquakes, it's hard to imagine a worse spot to build a hospital. Not only is the whole town in a major subduction zone, the building is just a few blocks from the water, on top of dangerously unstable ground.

And here's a key quote from a former mayor of Astoria, Willis Van Dusen, a Republican who voted for Trump but now is frustrated by the recent turn of events regarding the needed hospital work: 

Van Dusen: What is more important than a hospital in a rural community like Astoria? Now, it saved my life.

Riddle: Van Dusen points to a framed photocopy of a piece of paper - the EKG reading when he had a heart attack some years ago. At one point, he flatlined.

Van Dusen: All these are (imitating electric current), and they're hitting the paddles. And I had actually died.

Riddle: It was doctors at Columbia Memorial that brought him back. Van Dusen says he and many other people in Astoria wouldn't be here without this hospital. Making sure that it can keep providing care during an earthquake and a tsunami, he says, is the opposite of waste, fraud and abuse.

Van Dusen: And just to jerk that money away from us, I can't just say it makes - it's frustrating. It makes me livid. It makes me angry.

Riddle: Van Dusen says he's not the only one in this town who's mad.

Van Dusen: I know every single Republican that I have talked to is livid over what's happening.

This is a rare instance when I've seen a Trump voter whose mind has been changed by Trump's spending priorities--and how those priorities have played out in the voter's own community.  It shows that Trump voters can be swayed when Trump's spending priorities impact them, something rarely illustrated.  

Regarding the $50 billion "rural health fund," sometimes referred to as the rural slush fund, Sarah Jane Tribble of Kaiser Health News reported about ten days ago on how states are competing for these funds.  It hardly seems like a fair fight.   Tribble provides details on how and why substantial chunks of the funds might not even wind up in rural places:  

Nationwide, states are racing to win their share of a new $50 billion rural health fund. But helping rural hospitals, as originally envisioned, is quickly becoming a quaint idea.

Rather, states should submit applications that "rebuild and reshape" how health care is delivered in rural communities, Centers for Medicare & Medicaid Services official Abe Sutton said late last month during a daylong meeting at D.C.'s Watergate Hotel. Simply changing the way government pays hospitals has been tried and has failed, Sutton told the audience of more than 40 governors' office staffers and state health agency leaders — some from as far away as Hawaii.

"This isn't a backfill of operating budgets," said Sutton, CMS' innovation director. "We've been really clear on that."

Rural hospitals and clinics nationwide face a looming financial catastrophe, with President Trump's massive tax-and-spending law expected to slash federal Medicaid spending on health care in rural areas by $137 billion over 10 years. Congressional Republicans added the one-time, five-year Rural Health Transformation Program as a last-minute sweetener to win the support of conservative holdouts who worried about the bill's financial fallout for rural hospitals.

Yet, the words used by CMS Administrator Mehmet Oz and his agency's leaders to describe the new pot of cash are generating tension between legacy hospital and clinic providers and new technology-focused companies stepping in to offer new ways to deliver health care.

It's "what I would call incumbents versus insurgents in the rural space," said Kody Kinsley, a senior policy adviser at the Institute for Policy Solutions at the Johns Hopkins School of Nursing.

I further detail possible non-rural uses of the fund in my forthcoming law review article, which relies on Tribble's reporting. 

Finally, Abigail Ruhman reported for the Texas Tribune a few weeks ago on how Texas' rural hospitals are competing for a piece of that "rural slush fund."  

As Texas develops its application for a new rural health funding program, rural hospital leaders say the priority should be financial stabilization for their facilities.

The recent sweeping tax and spending plan includes a $50 billion appropriation for the Rural Health Transformation program. States will receive funding based on applications they submit in early November.

During an hours-long public hearing Monday to discuss the program, several hospital leaders raised concerns that without direct funding, the state may experience more rural hospital closures.

Erin Clevenger, CEO of Memorial Medical Center in Port Lavaca, southeast of Victoria, said her hospital is high on the list of Texas hospitals at risk of closure.

“Every day is a battle to make sure we don’t become one of those statistics,” Clevenger said.

In the last decade, Texas has lost 14 rural hospitals. Of the 156 rural hospitals currently in the state, about 70% have lost services, and more than half are at risk of closing, according to a report from the Center for Healthcare Quality and Payment Reform.

Memorial Medical Center is in the southern part of the state, but it provides critical services that benefit people across Texas – even patients in Dallas.

“When even large urban hospitals could not take on more patients, we opened a COVID care unit and accepted their transfers, even flying patients in from Houston and Dallas,” Clevenger said.

Keep an eye out for more news about whether rural hospitals are getting the benefit of the "Big Beautiful Bill" and its rural slush fund--and whether any funds they receive are sufficient to keep them open.  It'll also be interesting to see if the anticipated closure of rural hospitals will turn rural Trump supporters against him--if those closures happen during his presidency.  

Meanwhile, the reduction and reinterpretation of other federal funding streams, along with other strains,  have been threatening--and in one instance, closing--hospitals in rural California.  Read more here (Inyo County in the eastern Sierra) and here (Imperial/Riverside County).  

Planned Parenthood closes five California clinics, two of them rural(ish)

This story in the San Francisco Chronicle by Sara DiNatale reports that recent budget cuts in the so-called "Big, Beautiful Bill" have led to the closure of five Planned Parenthood health care centers in California, including two in places that are rural by some measure, Gilroy (Santa Clara County) and Madera (Madera County).  Other closures were in South San Fancisco, San Mateo, and Santa Cruz.  

Mar Monte is the largest Planned Parenthood affiliate in the United States.  As DiNatale reports, "The GOP-led federal spending bill that Trump signed into law earlier this month eliminated federal Medicaid funding for any type of medical care to organizations that perform abortions."  

National and regional media have paid a great deal of attention to the consequences Trump's budget cuts will have for rural health care.   

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." 

Here's a full report from KFF on the so-called rural health slush fund.  

Cutbacks to public media likely to hurt rural communities the most

The disporportionate impact that federal funding cuts to public media will have on rural communities has been a theme of several publications in recent weeks, all in the run up Congress' vote to do just that--take back $1.1 billion previously allocated in support of public media.  

The first item I want to highlight is this July 11, 2025 episode of The Daily (New York Times audio), "Is Congress about to Kill this Local Radio Station?"  It discusses the likely impact of the proposed cuts on a public radio station, KFSK, in Petersburg, Alaska, population 3,000, in the southeast part of the state.  Jessica Cheung of The Daily sets up the interview with KFSK Station Manager Tom Abbott:    

Small rural stations, like KFSK, rely on federal funding to exist. And in a town like Petersburg, that is conservative, a town that voted for Trump by almost two to one in the last election, people are grappling with the Republican Party that is now trying to defund an important resource within the community — a radio station that a lot of people love. So I wanted to talk to Tom about what that’s been like, what’s at stake, and just what a station like KFSK offers people.

They start with a discussion of the place, including its beauty, economy, wildlife, and remoteness. 

Tom Abbott:  We also don’t have any chain stores here. Everything is mom and pop. Even though if you go to the post office, you’ll see a lot of Amazon boxes coming across the counter, because on occasion, there are things that can’t be found here, just because it’s a small market and it’s a small community. And that’s what brings us back around. radio. That’s why there’s only public radio here.

Jessica Cheung:  And if you turn the dial in Petersburg, can you hear any other radio station out there?

Tom Abbott:  Yeah, you can catch 88.5, which is the Lutheran Church.

Jessica Cheung:  And that’s it?

Tom Abbott:  Yeah, they broadcast for the shut ins that can’t make it to their service on Sunday. And that’s the only other service that’s on the FM dial. And there’s nothing on the AM dial.

What follows in the interview is a description of a service that reminds me of the "party line" feature on the local radio station I listened to while growing up in the Arkansas Ozarks.  On KFSK, it is called Tradio.  Here's an excerpt: 

Tom Abbott:  Where the caller calls in to the radio station. We put them on the air. And they either make an announcement about an event coming up. Maybe they’re having a garage sale on Saturday.

Archived Recording:  And we have tons of stuff — chairs, dozens of hand tools, fishing poles, sporting goods. There’s books and movies. And you name it, we got it.

Tom Abbott:  Well, this week, we’ve got a lot of fishing poles. Or this week, we’ve got a lot of baby clothes, something, whatever it may be.

Archived Recording:  Yes, good morning. This is Earl. I got a 2012 Nissan red vehicle with low mileage.

As Cheung expresses it, 

This is basically Facebook Marketplace on the radio.

At some point, Abbott starts talking about how the station ceased live broadcasts of some meetings during the pandemic because what some residents were saying at the meetings constituted misinformation, as locals stated their opinions about public health measures.

Cheung then turns to the likely effect of the proposed federal budget cuts on KFSK. 

Tom Abbott:  Our service would be drastically altered. The CPB funding that we receive is 30 percent of our budget. As public radio does, we rely on membership donations. And that is our largest single source. Our second largest single source funding is CPB funds.

Jessica Cheung:  And without that 30 percent you get from the federal government, what are you contemplating?

Tom Abbott:  As far as the expenses go, personnel expenses are 65 percent of our budget.

Jessica Cheung:  And how many personnel do you have on staff right now?

Tom Abbott:  Five, and there’s two high school kids that help us out when we’re doing live broadcasts in the evenings. And going forward, I foresee KFSK eliminating all staff except for two. And both of those I would like to see it remain two reporters. If you were to go down to one reporter, you’re on an endless cycle of burnout.

Jessica Cheung:  And is it my understanding that with 30 percent cut, you could still survive? Or is taking KFSK off the air an option you’re contemplating?

Tom Abbott:  I don’t think you’d ever have to go off the air, because the infrastructure is here, the antenna is here. But it wouldn’t be locally run anymore. It just couldn’t be. 

Right now, we have 27 individual public radio stations in the state of Alaska. I think that’s going to go down to two, maybe three if this rescission goes through. It’s not going to happen immediately, but it’s going to go that route. And that’s what’s under threat here.

Then Abbott discusses how some NPR reporting has been received by locals. There's a lot here, and I'm just going to include a very brief excerpt:

Tom Abbott:  [W]hat we have control over is local. I have no control over the editorial content of NPR. I have no control over that whatsoever.

In fact, I have, myself, as a station manager, contacted them many times over the years with complaints. I think there are certain subject matters that are covered heavily that are not necessarily representative. They’re certainly not representative of the audience that I serve.

Jessica Cheung:  Is there a specific story that you’re thinking about, maybe one that you wrote to NPR about?

Tom Abbott:  I don’t know. What comes to mind is the propensity for the LGBTQ+ stories. I don’t believe that the percentage of the stories that that subject matter has is equivalent to certainly the service area that I have. And I’m not saying that people are not caring about others. I’m not saying that at all.

I get the editorial decision on it. It’s under threat. But I’m just saying, what is pertinent in your personal life? And I think this holds for Kansas, Nebraska, Oklahoma, wherever you are. Small town, rural areas, to me, it sounds like the editorial decisions are being made for the audiences that are in New York, Chicago, Philadelphia, the big metro areas.

And on occasion, there is a great story that NPR does that covers small-town America or relates to small-town America plenty of times. I’m not saying that they totally have a blind eye towards it. I just think the target audience that NPR has is metro areas.

Jessica Cheung:  And what would you rather hear get coverage by NPR?

Tom Abbott:  Well, what’s the effect of the tariffs on the farmers of America, the seafood industry of America? That would really resonate here locally.

Following on this excellent and very comprehensive podcast focused on KFSK in Alaska, the New York Times editorial board published on July 16, "This is Why America Needs Public Media." Here, I'm just going to excerpt the part that mentions rural places, as well as an acknowledgement that NPR's programming (as distinct from local programming) may not reflect "the citizenry that is subsidizing them": 

When the private sector doesn’t provide an important service, the government often steps in. That is why the framers established the U.S. Postal Service; they believed no one else would deliver the mail to the entire country. Many places in America, especially in rural communities, would not have a library without public funding. Police departments, the military, Medicare, Social Security and public education offer other examples.

* * *

Republicans complain, not always wrongly, that public media reflects left-leaning assumptions and biases. And they can fairly tell NPR and PBS to do a better job of reflecting the citizenry that is subsidizing them.

* * *  

We are reminded of the excesses of the “defund the police” and “abolish ICE” movements on the other side of the ideological spectrum. They adopted a fatalistic view of vital government services, suggesting that their imperfections justified their elimination. They were wrong, and so are the conservatives who want to defund public media.

* * *

Public media, like every other major institution, is imperfect. But it improves the lives of millions of Americans, and it strengthens American interests. 

I earlier commented on NPR's political bias here.  To be clear, I completely trust NPR's reporting on factual matters, such as whether the 2020 Presidential election was stolen.  It was not.  I simply think that the entity's editorial slant is often far enough to the left of middle America to fuel distrust by many--as suggested by some of the patrons of KFSK.

Finally, today, NPR's Frank Langfitt reported from Dunmore, West Virginia, under the headline, "Cuts to public media will smash budgets of some local radio stations."  I'll just include some key excerpts here:  

[S]ome of those hardest hit by Congress' decision last week to clawback $1.1 billion in federal funds are small radio operations that provide local news and information to rural communities.

One is Allegheny Mountain Radio, a cooperative of three stations which cover Pocahontas County, West Virginia as well as Bath and Highland counties in Virginia. Allegheny Mountain is not an NPR member station, but it does run NPR's daily newscast, a quick run down of top stories.

* * * 

Allegheny Mountain's mix of programming includes local news and information as well as gospel, country and blues shows. A recent episode of the Noon Hour Magazine reported on a $5,000 signing bonus to attract new teachers and how the energy demands from data centers could eventually affect this remote region where people sometimes have to drive 60 miles to reach the nearest shopping center.

Allegheny Mountain relies on funding from the Corporation for Public Broadcasting (CPB) for up to 65 percent of its annual budget of about half a million dollars. Smith says his stations do have financial reserves, but the hole in their budget could become existential.

Langfitt quotes station's general manager:

There is only so long that you can continue to exist when you are operating in the red. ... At some point that well runs dry.

One bottom line, this quoting the NYT editorial:

[T]he “national” part of NPR (or National Public Radio, as it used to call itself) that chafes conservatives may well be just fine without federal funds.   

It is local stations, trying to provide local programming, that will suffer most from these cuts, along with their listeners.  

One other detail worth noting on the Congressional vote to claw back the public media funding:  Senator Mike Rounds (R) of South Dakota had previously indicated that he would oppose the cuts but decided to support the package after "top Trump administration officials" said they would steer unspent funds 'to continue grants to tribal radio stations without interruption' for next year."  Yet, Loris Taylor of Native Public Media commented: 

There is currently no clear path for redirecting these funds to tribal broadcasters without significant legislative and administrative changes.