Across rural America, the health care crisis is no longer looming—it is here. Hospitals are closing. Pharmacies are disappearing. 911 calls are going unanswered. Home care workers are stretched thin and underpaid. Patients drive hours for basic services, while communities lose jobs, trust, and the sense that their futures and their health are secure in their rural communities.
For decades, the dominant response has been to search for a single silver bullet: a new reimbursement model, a hospital merger, a telehealth platform. But rural health challenges are not isolated problems. They are systemic—and they require a system-level solution.
One solution already exists: expanding the proven role of cooperatives.
Cooperatives offer rural communities something direct and proven that the market alone has failed to deliver: Locally rooted, democratically governed health infrastructure that aligns health care delivery, workforce stability, and cost control directly and personally tailored to meet community needs rather than shareholder returns. When applied across the health ecosystem—home care, purchasing, and clinical services along with the ability to reach millions with healthcare messages—co-ops don’t just patch holes. They can transform how rural health works.
Start Where Care Actually Happens: At Home
In rural communities, health care often does not begin in hospitals. It usually begins in homes—supporting older adults, people with disabilities, families managing chronic illness and behavior/diet changes that can prevent many healthcare needs. Yet home care workers are among the most undervalued in the health system, facing low wages and unstable hours, with little voice in their industry.
Home care cooperatives flip that model. As worker-owned enterprises, they give caregivers ownership, living wages, training, and a say in how care is delivered. The results are powerful: lower turnover, higher quality care, and stronger relationships between caregivers and patients. The difference is significant: turnover in the home care industry is as high as 80%; meanwhile, home care cooperatives report turnover rates between 15 and 30%.
Lower Costs Without Sacrificing Care Through Purchasing Co-ops
As another example, rural providers often pay more for supplies, pharmaceuticals, insurance, and administrative services simply because they lack scale. Purchasing cooperatives solve this by allowing independent clinics, pharmacies, hospitals, and home care providers to pool demand, negotiate better prices, and share back-office services.
Importantly, purchasing co-ops free up scarce resources—resources that can be reinvested in patient care, workforce development, and expanded services rather than absorbed by rising overhead costs.
For example, Independent Pharmacy Cooperative (IPC) in Wisconsin is a unique group purchasing organization and secondary pharmaceutical wholesaler dedicated solely to supporting independent pharmacies—the member-owners of the co-op. With over 2,000 cooperative members, IPC’s group purchasing model demonstrates how independent pharmacies can thrive and care for their communities.
Care Pharmacies in Maryland is another co-op of 130+ independent community and specialty pharmacies across 23 U.S. states who retain their unique identity while leveraging group purchasing power, operational support, and competitive advantages. These co-op benefits translate into quality care for communities that has continued for over 60 years.
People can have ownership over their health plans and health care, too. Group Health Cooperative of South-Central Wisconsin is a non-profit, member-owned health plan providing health care to 70,000 members in south central Wisconsin.
The New Rural Health Transformation Program
The $50 billion/five-year Rural Health Transformation (RHT) Program, from which states now have major new funding, is a once in a generation opportunity to truly transform healthcare. This is the moment, before the first dollar is spent, to consider how to effect real and lasting change. Policymakers, philanthropy, and health system leaders have a choice. They can continue funding fragmented fixes that treat symptoms—or they can invest in cooperative infrastructure at scale to address root causes.
Rural health will not be saved by one institution acting alone. It will be saved when communities are empowered to cooperate—across services, across sectors, and across the full continuum of care.
The future of rural health depends not on doing more of the same, but on doing something fundamentally different: owning our health systems together.
The nation’s governors will gather at the Winter Meeting of the National Governors Association in Washington at the end of February, and they will look to each other for the best ideas and best practices they can apply in their own states – the “laboratories of democracy.” We hope they will highlight one of America’s greatest hidden assets – cooperatives – that can be taken to scale in a relatively short period of time, and their work goes to the heart of bringing health care directly and consistently to the people of rural America, with a range of cooperatives focused on health care—from medical providers who personally deliver services to those who work in purchasing to lower costs and ensure critically important medications are available. There is also an opportunity to harness the power of the cooperative ecosystem across rural America. Electric and other utility co-ops, farmer co-ops and many other co-ops could deliver health information on diet, exercise and important screenings and check-ups directly to the millions of rural Americans who are their members.
The good news is that these cooperative sectors already have a legacy of community impact across America and broad networks they can leverage. They stand ready to support other cooperatives in all 50 states, or create new ones, supported by the National Cooperative Business Association and the Cooperative Development Foundation, who have served as a major means of enhancing existing cooperatives and building new ones for many years.
Cooperation Is Not a Niche Model—It’s a Scalable Strategy
What makes cooperatives particularly suited to rural health transformation is their ability to do four things at once:
- Stabilize essential services like access to personal healthcare without requiring extraction or consolidation
- Expand healthcare access from the home and in the community
- Build prosperity by keeping ownership and profits local
- Strengthen democratic participation in decisions that directly affect people’s lives
This is not just about improving health outcomes. It is also about rebuilding the social and economic fabric of rural communities.
Doug O’Brien is the CEO of the National Cooperative Business Association.
