America’s rural health care system is in crisis and has been for a long time. Hospitals are closing, doctors are leaving, and patients are driving hours just to get basic care. The $50 billion Rural Health Transformation Fund in the One Big Beautiful Bill is a rare and overdue opportunity to do something about it.
But we’ve seen too many government programs hijacked by well-connected interests or squandered through short-sighted implementation. If we’re not careful, this fund will become just another bailout—a temporary fix that fails to address the underlying problems. That would be a tragic waste.
We write as two lifelong conservatives who have led at both the national and state levels. We believe in limited government, fiscal responsibility, and the power of innovation. And we believe this fund can work, but only if the focus remains on real transformation, not short-term subsidies.
The biggest mistake Washington could make is treating this as a temporary band-aid for rural hospitals reacting to the bill’s Medicaid reforms. In fact, rural hospital employment declines faster in states that implement provider taxes compared to those who don’t. That’s because the challenge facing rural health care goes beyond coverage. The system itself is not built for areas with low population density.
Our payment model still rewards volume. The more patients you see, the more revenue you earn. That structure might work in cities, but it breaks down in rural communities where there simply aren’t enough people to support the traditional hospital-based model. Existing state and federal policies recognize the need to maintain critical rural services, to meet residents’ health care needs and to prevent the destabilization of communities, and additional payment reforms should be enacted as alternatives to a volume-only approach that will result in excessive geographic concentration of health care services.
Rather than use this fund to extend the life of unsustainable facilities, we should seize the opportunity to rebuild rural health care from the ground up. That starts with prevention and primary care. We should support models that keep people healthier and reduce the need for hospitalization, not models that depend on filling more beds.
This approach is consistent with the goals of Make America Healthy Again (MAHA), which focuses on shifting our health system away from reactive treatment and toward proactive wellness. Rural states can lead the way by using the fund to invest in early detection, chronic disease management, and community-based services that meet patients where they are. Mobile hospitals, microsites, and docs-in-a-box, for instance, can bring care to areas without easy access to a permanent facility.
If we are serious about improving care, the federal government must require more than vague promises or politically convenient metrics. “Jobs saved” or “hospitals kept open” may be easy to count, but they say nothing about whether people are healthier.
Each state should submit a clear transformation plan with measurable goals focused on patient outcomes—such as reducing maternal mortality, cutting diabetic complications, or expanding access to preventive and behavioral care. CMS should treat this as a national demonstration project. By Year Three, the agency should issue a midterm evaluation. After five years, it should report on which state strategies were most effective and scalable.
The same is true when it comes to health technology and access to rural broadband . There is plenty of excitement around artificial intelligence in medicine, and for good reason. AI can help doctors detect illness earlier, reduce avoidable complications, and streamline workflows that eat up staff time. For rural clinics operating on tight budgets, these tools can make a real difference. But this fund is not a tech subsidy. AI and similar technologies should be used to support broader reforms, not distract from them. No software upgrade can fix a broken care model on its own, but a onetime capital investment into rural broadband will do a great deal of help.
CMS should also use the fund to promote greater transparency and competition. Many hospitals still fall short of complying with federal price transparency rules, which are supposed to give patients clear information about the cost of care. Nonprofit hospitals often fail to tell low-income and uninsured patients they qualify for charity care. And anti-competitive contracts can block doctors from working in nearby areas, including rural communities that badly need them. These practices reduce access and drive up costs. CMS should require states to address these issues as a condition of receiving funds or offer bonuses to hospitals that meet reform benchmarks.
Done right, this fund could be one of the most important and informative investments in rural health care in our lifetime. But its success is not guaranteed. It depends on whether Congress, CMS, and the states treat this as a real opportunity to rethink how we deliver care—or fall back on the same habits that created the crisis in the first place.
As Albert Einstein is often credited with saying, “Insanity is doing the same thing over and over and expecting different results.” Let’s not spend $50 billion proving him right.
Newt Gingrich is the Former Speaker of the U.S. House of Representatives, and Bobby Jindal is the Former Governor of Louisiana.
