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June 10, 2026
Bad News in the Back Woods: Rural Americans Losing Access to Medical Care

Bad News in the Back Woods: Rural Americans Losing Access to Medical Care

For many, the lakes and creeks, hills and hollows, of the American countryside represent paradise on Earth. This is where some of our citizens choose to set up housekeeping and raise their family. You won’t catch them very often in an urban setting as they strictly avoid and sharply eschew city living. Of course, there are a few downsides to residing in the more rural areas of our country. There’s the limitation of stores, restaurants, services and the like. There’s often a lack of job opportunities. But, perhaps most importantly, there is an increasing scarcity of nearby healthcare facilities for these folks to easily access.

Bad News in the Back Woods: Rural Americans Losing Access to Medical Care

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A Concerning Trend

The Center for Healthcare Quality and Payment Reform (hereinafter, “the Center”) recently put out their 2026 report on the state of rural hospitals in America. Here is their opening statement on the current crisis being faced by many of our citizens:

Over the past decade, more than 100 rural hospitals have closed. As a result, more than 3 million Americans who live in those communities no longer have access to an emergency room, inpatient care and many other hospital services that citizens in most of the rest of the country take for granted. In addition, 52 hospitals have eliminated inpatient services since the beginning of 2023 in order to qualify for federal grants that are only available for Rural Emergency Hospitals (REHs). More than 13,000 rural residents had received inpatient care in those hospitals each year, but now seriously ill individuals in their communities will have to be transferred to a hospital far from home in order to receive the services they need.

So, the bottom line is that millions of our fellow Americans have already lost easy, or at least more convenient, access to nearby hospitals. And this is not inconsequential. Lack of quick care—especially in emergency situations—can quite conceivably lead to detrimental outcomes, including the possibility of death in some cases.

A Bleaker Future

The Center’s report goes on to warn that the situation could become more dire in the near future. “More than 700 rural hospitals—representing one-third of all rural hospitals in the country—are at risk of closing because of the serious financial problems they are experiencing.” The report notes that almost 300 of these rural hospitals are at immediate risk of closing because of the severity of their financial problems. Some of the details underlying the current crisis for our rural hospitals include the following, per the report:

  • Losses on Patient Services. Over 40% of the rural hospitals in the country lose money delivering patient services. It costs more to deliver healthcare in small rural communities than in urban areas, and many health insurance plans do not pay enough to cover these costs.
  • Insufficient Revenues From Other Sources to Offset Losses. Many hospitals have managed to remain open despite losses on patient services because they receive local tax revenues or government grants. However, there is no guarantee that these funds will continue to be available in the future or that they will be sufficient to cover higher costs. The special federal assistance many hospitals received during the COVID-19 event has now ended. As a result, almost one-third of rural hospitals lost money overall in 2024-25.
  • Low Financial Reserves.The hospitals at greatest risk of closing have more debts than assets, or they do not have adequate net assets (i.e., assets other than buildings and equipment, minus debt) to offset their losses on patient services for more than a few years.

Rural hospitals are at risk of closing in almost every state. In the majority of states, over 25% of rural hospitals are at risk of closing; and, in 10 states, 50% or more are at risk.

According to the Center, “The primary reason hundreds of rural hospitals are at risk of closing is that private insurance plans are paying them less than what it costs to deliver services to patients.” So, commercial insurance is the primary culprit in the estimation of the authors of this report. They point out that, although the at-risk hospitals are losing money on uninsured patients and Medicaid patients, losses on private insurance patients are the biggest cause of overall losses. However, they qualify this indictment of commercial carriers by acknowledging that many rural hospitals are not at risk of closing because they do receive sufficient payments from private health plans. These payments not only cover the costs of delivering services to the patients but also offset the hospitals’ losses on services delivered to uninsured and Medicaid patients. In other words, while commercial insurance is identified as the main problem where rural hospitals struggle, there are some rural hospitals that are—strangely enough—being helped by commercial insurance.

The Center concludes by providing several recommendations on how to correct the current tragic trajectory of hospitals in rural America. To review those recommendations, as well as the full report—which includes a state-by-state status report—you are encouraged to go to the following link: Rural_Hospitals_at_Risk_of_Closing.pdf.