Twenty percent of the US population – about 66.3 million Americans – live in rural areas across the country, and around one in five of those Americans – over 12 million – are enrolled in Medicaid, including 47 percent of children in rural areas. Medicaid is a vital source of coverage for people across rural America, who are more likely to lack insurance, experience negative health outcomes, and encounter more barriers to accessing care. Rural communities generally also have lower rates of employer-sponsored coverage. Medicaid has built a foundation for resilience and remains vital for the growth and prosperity of rural families and their communities.
But Republicans are leaving rural Americans behind. By passing a budget that cuts nearly $1 trillion dollars from Medicaid to fund tax breaks for billionaires and the ultra-wealthy, Republicans are putting profits over people.
Protect Our Care is continuing its “Hands Off Medicaid” campaign with theme weeks to underscore the importance of Medicaid across the country. Alongside partners, lawmakers, and other advocates, Protect Our Care is working to defend Medicaid from the Republican-led plan to slash funding to pay for another round of tax cuts for the wealthy and big corporations. This week’s focus is the importance of Medicaid for rural Americans. Read more here.
If Republican Plans Succeed
- Millions Of Rural Americans Depend On Medicaid. Over 12 million people on Medicaid reside in rural communities across the country.
- Medicaid Helps To Maintain And Strengthen Rural Economies. Hospitals employ 10 percent of all employees in rural counties that report having any hospital employment. When rural hospitals close, communities can lose a staggering number of jobs, both within and outside of the health care sector. The closure of one rural hospital can eliminate 220 jobs immediately with ripple effects impacting thousands more.
- Rural Americans Are Increasingly Isolated From Quality And Affordable Care. A 2023 NICHM study found that around 80 percent of rural Americans are medically underserved and that 12 percent of rural residents have to drive 60 minutes or more to the nearest hospital. Between 1999 and 2015, the rate of accidental death was almost 50 percent higher in rural areas than in urban areas with the CDC citing the distance between hospital facilities in rural areas.
- Medicaid Is A Lifeline For Moms in Rural Communities. Medicaid covers 41 percent of births in the United States and pays for a greater share of births in rural areas than any other source of coverage. A majority of all births in several Republican-controlled states including Louisiana, Mississippi, and Oklahoma – which all have disproportionately larger rural populations, are covered by Medicaid.
- Rural States Rely On Medicaid To Provide Affordable Health Care. Uninsurance rates in rural America are 2 to 3 percentage points higher than in urban areas. States that expanded Medicaid experienced a 7-point increase in insured rates after the passage of the Affordable Care Act.
- Medicaid Keeps Rural Hospitals Open, Republicans Want Them Closed. Between 2010 and 2022, over 130 rural hospitals closed. Since 2020, 36 rural hospitals have closed and as of 2025 around 768 rural hospitals were found to be at risk of closing in the near future. A 2016 analysis that identified 673 rural hospitals at risk of closing estimated that if those hospitals shut down, 99,000 health care jobs in rural communities would be lost.
Rural Hospital Closures by State
Rural hospitals have consistently seen higher rates of uncompensated care, especially in states that have refused to expand Medicaid where uncompensated care is nearly 2.5 times higher than in expansion states. Across the board, states that have refused to expand Medicaid have seen worse rural hospital outcomes, more hospital closures, and worse overall care than in states that have expanded Medicaid. This disparity of access to care for rural Americans can be seen at all levels of the rural hospital closure crisis, and studies continue to suggest that expanding Medicaid in all 50 states could be the largest driver in slowing down emergency closures.
Data as of April 2024.
State
Hospital Closures Since 2005
Hospitals At Risk of Closing*
Hospitals at Immediate Risk of Closing**
Number of Rural Hospitals Left
Has This State Expanded Medicaid?
Alabama
7
30
23
52
No
Alaska
1
3
2
17
Yes (2015)
Arizona
4
3
1
27
Yes (2014)
Arkansas
2
26
14
49
Yes (2014)
California
9
18
10
56
Yes (2014)
Colorado
0
9
5
42
Yes (2014)
Connecticut
0
2
1
3
Yes (2014)
Delaware
0
0
0
2
Yes (2014)
Florida
8
8
5
21
No
Georgia
9
22
10
68
No
Hawaii
0
8
0
12
Yes (2014)
Idaho
0
7
1
29
Yes (2020)
Illinois
4
12
7
71
Yes (2014)
Indiana
4
5
4
52
Yes (2015)
Iowa
1
28
10
92
Yes (2014)
Kansas
10
57
26
101
No
Kentucky
4
16
6
72
Yes (2014)
Louisiana
2
23
9
52
Yes (2016)
Maine
3
11
7
25
Yes (2019)
Maryland
1
0
0
4
Yes (2014)
Massachusetts
1
2
1
5
Yes (2014)
Michigan
3
16
7
63
Yes (2014)
Minnesota
6
18
7
95
Yes (2014)
Mississippi
6
38
25
73
No
Missouri
10
21
9
56
Yes (2021)
Montana
0
17
5
55
Yes (2016)
Nebraska
2
5
2
72
Yes (2020)
Nevada
2
5
3
13
Yes (2014)
New Hampshire
0
2
0
17
Yes (2014)
New Jersey
1
0
0
0
Yes (2014)
New Mexico
1
7
6
28
Yes (2014)
New York
6
29
23
51
Yes (2014)
North Carolina
12
7
5
53
Yes (2023)
North Dakota
1
12
4
39
Yes (2014)
Ohio
2
6
4
70
Yes (2014)
Oklahoma
8
34
23
79
Yes (2021)
Oregon
0
7
2
32
Yes (2014)
Pennsylvania
6
13
7
41
Yes (2015)
Rhode Island
0
0
0
0
Yes (2014)
South Carolina
4
10
5
25
No
South Dakota
3
9
4
48
Yes (2023)
Tennessee
15
19
17
54
No
Texas
25
77
29
159
No
Utah
0
0
0
21
Yes (2020)
Vermont
0
8
4
13
Yes (2014)
Virginia
2
9
8
30
Yes (2019)
Washington
1
14
2
40
Yes (2014)
West Virginia
5
10
6
28
Yes (2014)
Wisconsin
1
7
1
75
No
Wyoming
0
6
2
25
No
*These hospitals do not have adequate net assets to offset their losses on patient services for more than 6-7 years
**These hospitals do not have adequate net assets to offset their losses on patient services for more than 2-3 years