Congress set aside $50 billion to transform rural health care. Will it work?
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Hello, everyone. I'm Kimberly Adams. Welcome back to Make Me Smart, where none of us is as smart as all of us. Last summer, when negotiations were playing out over the GOP's big tax and spending bill, you'll know it and love it, is the one big beautiful bill act. States and health care advocates raised alarm over the roughly one trillion dollars in cuts to Medicaid that were in the legislation. Now, even though that total is over 10 years, according to the Congressional Budget Office, that's still a huge hit. And early data are showing that those cuts are going to hit particularly hard in rural communities. So in response to that, Congress pulled together a $50 billion pot of money for rural health care that's going out over the next five years.
It's called the Rural Health Transformation Program. And that made it into the final version of the bill. And some of that $50 billion in funding is finally starting to roll out. So to help make us smart about this, we are joined by Arielle Zients.
What funding has Congress allocated for rural health care?
She's a rural health care correspondent for KFF Health News and based in South Dakota. Arielle, welcome to the show.
Hi, thank you for having me.
Arielle, first walk us through how the Rural Health Transformation Program works.
Sure. So like you said, it's five years of funding and states submitted their applications for their first year of funding. And that has already been granted. Some received over $100 million. Others received a bit over $200 million. And they will be spending some of the funding through the states, like the states will be administering some programs, whereas others will be put out through grants that hospitals can apply for companies or other entities.
What determined how much money states were going to get, whether it be $100 million this year or $200 million or something in between?
That is a great question. It was a very complicated formula. So, OK, about half of it was like base money that every state got. And then the rest was based on a combination of various things. So one was pretty objective factors like your rural population, the amount of people on Medicaid. So, yeah, very like data heavy factors. trying to capture the rural population and also the financial needs of people. And then it was also based on states' willingness to adopt policies that align with the Make America Healthy Again movement.
That's really interesting, this aligning with the Make America Healthy Again movement, because there are some health care advocates that have raised concerns about some of these rules around the program and this political alignment. I mean, what kind of things are in that part of the criteria?
So some of the policies are pretty mainstream. They may still be divisive, but there's significant portions of the healthcare industry that supports them. Examples of that would be expanding scope of practice. So letting nurse practitioners or physician assistants act more independently or letting pharmacists do more things that they were trained to do. Another one would be interstate compacts. So if you have a license to practice in one state, letting you work in another state, so that way you can do telehealth in another state. The ones that are maybe more controversial are adopting the SNAP waiver to say that SNAP beneficiaries can't buy certain unhealthy foods or to adopt the presidential fitness test.
But some Democratic states did say they would do those things. But this is only a portion of how states were rated. And there was a lot of fear from some people that The money would be granted out in an unfair way, like favoring Republican states. But overall, that's not the case. It was pretty a mixed bag.
I mentioned at the top that, you know, the One Big Beautiful Bill Act included something close to a trillion dollars in cuts, according to the CBO. With those cuts in mind, how much of a difference can this rural health transformation funding really make?
That remains to be seen, of course. But overall, the feeling in the rural health care world is, of course, they're excited about this funding.
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