Rural Health at a Crossroads: How Policymakers Have Failed Rural America and What Can Be Done for a Healthier Tomorrow

Context: Rural and urban areas have diverged significantly in health care access and health outcomes over the last four decades. Federal and state policies have played important roles in shaping these trends.

Methods: I qualitatively review previous and existing federal and state policies that have shaped contemporary rural-urban health disparities. I review academic literature on recent policy enactments that have shown promise for alleviating some rural health struggles as well as scholarship on how the politics of rural health have stymied better policymaking.

Findings: Large scale federal investments (e.g., the Hill-Burton Act) were required to bring modern health care to rural communities in the first place, but inadequate and nonuniversal policies enacted since the 1970s and the increasing corporatization of health care over the last decades have led to withering rural health care access. The recent “One Big Beautiful Bill Act” will likely make these matters worse. Policies that have expanded telehealth and mobile health access, as well as subsidized rural transportation services and changes to public payer reimbursement policies, have provided some optimism. However, the broader politics of rural health limit policy opportunities.

Conclusion: Rural health has suffered, in part, due to state and federal policy failures. While some incremental changes have certainly shown evidence of potential improvements, a more radical policy agenda may be needed to maintain or improve health care access in rural communities. There is mixed-to-negative evidence regarding whether the political environment will allow for sufficient policy improvements.