Rural health care in America faces a host of chronic challenges: high costs, limited access, and aging infrastructure. For millions of families across the heartland, these problems aren’t abstract—they determine whether patients can see a doctor, reach a hospital, or receive timely care close to home.
More than 60 million Americans—nearly one in five—live in rural areas where patients routinely travel long distances only to find fewer doctors, hospitals, and clinics available to serve them.
Under-resourced communities face over-sized health challenges. Nowhere is this more evident than in rural America, where higher rates of chronic disease, premature mortality, and alcohol and drug addiction persist compared to the rest of the country.
In recent months, the Trump administration and Congress have advanced a set of reforms—largely overlooked in the national debate—that directly address long-standing disparities and structural weaknesses in rural health care, and could meaningfully strengthen care delivery in these communities, improve health, and save lives.
The most significant of these efforts is the Rural Health Transformation Program, created last year in President Trump and the Republican Congress’s signature “One Big Beautiful Bill Act” (Public Law 119-21). This $50 billion program represents the largest investment ever dedicated specifically to rural health, far exceeding the scale of prior grant programs. States that receive awards can use these resources to modernize and stabilize its rural health systems.
The program allows states to invest in innovative care models tailored to rural realities—whether expanding outpatient capacity, strengthening the health care workforce, or upgrading aging facilities. Instead of imposing a one-size-fits-all approach, the program gives states the flexibility to design reforms that reflect local needs and constraints.
Although media attention has shifted elsewhere, the White House and congressional leaders should continue to emphasize the long-term importance of this investment. The program addresses a foundational weakness in America’s health system and delivers tangible support to rural communities that have too often been left behind.
As part of the recently enacted FY 2026 appropriations legislation, Congress also extended Medicare telehealth flexibilities through December 31, 2027, delaying a return to statutory barriers that once limited access to telehealth services. Telehealth allows patients to connect with specialists, receive mental health services, and manage chronic diseases without traveling hours for an appointment. In communities facing persistent provider shortages, telehealth has become not a convenience but a lifeline—a bridge over miles of empty road, connecting rural patients to care that would otherwise remain out of reach.
The FY 2026 appropriations legislation also reauthorized the Acute Hospital Care at Home initiative, which allows eligible patients to receive hospital-level care safely in their own homes. This approach reduces costs, eases pressure on rural hospitals with limited capacity and improves patient satisfaction. For small hospitals struggling to keep beds staffed and doors open, Acute Hospital Care at Home offers a practical way to deliver high-quality care while preserving local access.
Finally, although Congress has not yet enacted it into law, lawmakers are working to reauthorize the Rural Health Care Services Outreach Program (H.R. 2493, S. 2301). This program supports community-based efforts to expand access to care, strengthen coordination among providers, and address persistent service gaps. Its grants help rural health systems collaborate across institutions and tailor solutions for populations that too often fall through the cracks.
Taken together, these reforms do not promise a quick cure—but they do offer a realistic treatment plan. They don’t strengthen rural health care because it’s easy; they make it easier because rural health care must be strong. While these efforts will not eliminate every challenge rural communities face, they are designed to deliver tangible improvements that deserve recognition.
By expanding flexibility, encouraging innovation, and meeting rural communities where they are, policymakers have begun to confront the unique realities of rural health care. Yet as the news cycle moves on, these achievements risk being overlooked. Policymakers in both Congress and the Executive Branch should resist the urge to rush to the next challenge and instead highlight the significance of these steps in the right direction.
Gary Andres is Assistant Secretary for Legislation at the Department of Health and Human Services.
