The Health Care Crisis in Rural America

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By Dwight Vick
August 1, 2025

As I traveled by car from Texas to Iowa to attend a family member’s funeral, I searched for reliable programming to remain alert and thought about upcoming topics for PA Times while driving through “flyover country.” I focus my contributions on supporting, to use Michael Lipsky’s phrase, “street-level bureaucrats” and examining the impact policies have on their careers. I listened to several of ASPA’s podcasts that covered a variety of topics. Later, I tuned into a CSPAN panel featuring 15 experts discussing the health care impact of both climate change and President Trump’s policies on Black, Brown and poor communities.

Moderated by Tavis Smiley, the panel discussed maternal health care, environmental health, Medicaid, Social Security and the current state of health care access for people living in rural America. The conversation, especially about rural health care access, resonated with my experiences living in the Texas Panhandle and with what I observed on my drive along I-40 from Amarillo to Oklahoma City and northward on the Oklahoma and Kansas Turnpikes into eastern Nebraska and finally into western Iowa.

I saw few hospital signs and even fewer primary care physicians’ offices in the picturesque Midwestern towns along I-35, I-335, State Highway 75 and I-29 until I drove through larger cities like Oklahoma City, Topeka, Omaha and Sioux City. This absence underscored the concerns raised during the CSPAN panel and reminded me of the crisis at home and the growing national emergency.

Texas currently has the highest number of hospital closures in the nation. Primary care providers are either moving away from towns like Texline or retiring. Their absence leaves large health care gaps and negatively affects local economies. How can small towns grow if basic health care needs are unmet? Amarillo-area hospitals, like other major urban facilities, are overwhelmed with emergency room visits for acute conditions that could have been managed as chronic ones if primary care were more accessible.

Various news agencies have reported that the Panhandle is a “maternal health care desert.” About four years ago, I attended a League of Women Voters presentation on maternal and women’s health care in our region. Presenters described the care available to women of color and poor or working-class women as equivalent to that found in “third-world countries.” Currently, only two Panhandle cities—Amarillo and Hereford—offer OB-GYN services. While a coalition exists to provide maternal and child health services, a pregnant woman living in a larger town like Dumas must choose between driving over an hour to a hospital to deliver or staying with family or in a hotel until labor is far enough along to be admitted. If she relies on Medicaid, even in Amarillo, a city of over 250,000 people, wait times for a prenatal appointment often extend past the first trimester, posing serious risks to both mother and child.

According to the Center for Health Quality and Payment Reform (CHQPR), Kansas and Oklahoma have the highest number of rural hospitals at immediate risk of closure. Without emergency rooms or inpatient care, physicians, nurses and other providers lack the infrastructure to treat chronic or acute conditions locally. The reasons for closure include low patient volumes, shrinking populations, rising health care costs, inadequate Medicaid reimbursement and recruitment challenges. Many rural hospitals survive on government grants more than on insurance reimbursements.

In a July 9, 2025 article titled “What Experts Think of the $50 Billion Rural Health Fund in Trump’s Big Bill,” PBS health reporter Laura Santhanam quoted CHQPR CEO Alan Morgan, who warned that 300 rural hospitals are at immediate risk of closing. The bill proposes $50 billion for rural health programs while cutting $1 trillion from Medicaid, with projected rural Medicaid cuts totaling $155 billion over the next decade. The new Rural Health Transformation Program invites all 50 states to compete for funds by submitting five-year plans. Still, this funding could fall short. Ultimately, lawmakers face a stark choice: adequately fund health care, education and infrastructure at current tax levels or impose tax increases to support these systems.

So I ask three questions:

1. What can we do as ASPA members to remain alert to the needs of our street-level health care providers?

2. How can we positively impact the health care climate?

3. What can we do to support not only rural providers but also those in urban areas who are overwhelmed by an influx of rural residents with acute, preventable ailments?

ASPA members—especially those in the Health and Human Services section—can serve on local and state health committees, continue conducting and publishing research and use our newsletters and publications to raise awareness. Through community service and professional networks, we can advocate for more sustainable rural health systems. Just as I drove through “flyover country” with my hands on the wheel, we must keep our hands on the wheel of progress—because the road ahead requires attention, purpose and coordinated action.

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Author: A graduate of Arizona State University, Dr. Dwight Vick has been as ASPA member for 30 years.  He is an instructor with Texas A&M International University and Thomas Edison State University as well as works with Texas area high schools teaching government, economics, political science, and English.

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