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A Rural Health Fund Band-Aid Will Not Staunch the Bleeding
The Trump administration’s rural hospital fund, meant to soften the impact of the brutal Medicaid cuts in HR1, will require a murky submission process and will not come close to closing the gap for rural communities.
Nov 04, 2025
Amid furious efforts to cover their tracks, Republicans included $50 billion in new funding to offset the disastrous cuts that rural hospitals will face as a result of President Donald Trump’s House Resolution 1. Trump’s new Centers for Medicare and Medicaid Services Director, Dr. Mehmet Oz, gave an explanation which would be laughable if this weren’t so serious. He stated that the Rural Health Fund “is part of a broader effort to modernize rural healthcare… [and that] innovation is the reigning theme” citing growing opportunities for rural providers to become more engaged in the healthcare system.
The “Rural Health Fund” was established by HR1 to soften the impact of the legislation, which cuts $911 billion in federal Medicaid spending over 10 years, due to start after 2030. The good news is that the distribution of the $50 billion will begin before the Medicaid cuts take effect (conveniently before the midterms). The bad news is that the temporary $50 billion in new funding will offset a little over one-third (37%) of the estimated $137 billion in permanent cuts to federal Medicaid spending in rural areas. People everywhere can do the math. Fifty is a whole lot less than 137.
On September 15, Centers for Medicare and Medicaid Services (CMS) released a Notice of Funding Opportunity for states to apply for the funds. Half of the funds, $25 billion, will be distributed by CMS equally across all states with approved applications, and the other half distributed based on four factors identified by CMS, including priorities that align with the Make America Healthy Again agenda. While some of the goals are welcome, such as expanding access to opioid-use and substance-use disorder treatment and mental healthcare and recruiting and retraining clinicians in rural areas, other priorities, such as supporting value-based care, alternative payment models, and other innovative delivery arrangements that shift risk to practitioners away from insurance companies and that have been demonstrated to increase costs in Medicare, are worrisome. Predictably, no funds can be used to pay for abortions for women living in rural areas.
Each state, regardless of the size of their rural population and needs, will receive the same amount from the first $25 billion tranche. States with few rural hospitals, such as Delaware, with three rural hospitals, will receive equal funding as California, with 66 rural hospitals, some of which have closed and many which are at risk of closing, and that assumes that both states are approved for funding.
We urge residents of rural communities to stand together and demand the right to excellent healthcare that our wealthy nation can and must provide.
Disbursement of the funds promises to be a cronyism gravy train requiring applications, murky decision criteria, no administrative or judicial review, and nonexistent information as to the amount a state will receive, how the funds will be distributed, or even if the funds will go only to rural hospitals. A merit review panel will review the state applications with final award decisions made by CMS. The program runs for five years, but because CMS will reevaluate state initiatives every year, CMS could withhold, reduce, or even recover funding from the state depending on a state’s progress or if continued funding is “in the government’s best interests.” The only thing that is clear is that hospitals and their administrators will spend countless hours and resources on evaluation, reports, and contractors hired to write these reports.
The stakes for rural hospitals couldn’t be higher. As a result of the Medicaid cuts, hundreds of rural hospitals are at risk of closing. But even before cuts, rural hospitals have been shuttering: From 2005 to 2024, 193 rural hospitals closed. In the wake of HR1Sen. Ed Markey (D-Mass.) and others asked the Sheps Center to identify rural hospitals at risk of closing because of the Medicaid cuts. The Sheps Center identified 338 hospitals which either experienced three consecutive years of negative total margins, serve the highest share of Medicaid patients, or both. These are the hospitals that, because of their heavy reliance on Medicaid funds, will likely shutter.
What will happen to the millions of people who live in these rural communities when these hospitals close? The median travel distance to the next hospital, emergency room, substance-use, or heart specialty care center will jump seven- to eightfold. This translates to higher mortality from many common conditions: heart disease, cancer, stroke, and unintentional injury.
In "The False Promises of VA Privatization", author Suzanne Gordon highlights the plight of healthcare access for veterans and Americans who live in rural communities, the majority of whom already live in so-called medical and mental health deserts. For example, 81% of rural communities do not have even one psychiatric nurse practitioner and 65% do not have a single psychiatrist. The shuttering of rural hospitals will also mean the loss of thousands of healthcare worker jobs and the ensuing negative economic impact on those communities.
The $50 billion rural health fund earmarked by the Trump administration will not transform these rural medical deserts, will not protect the livelihood of workers and their families, nor will it safeguard their communities. The piddly funds will not staunch the bleeding the brutal cuts to Medicaid will cause.
National Single Payer has launched a “Save Our Rural Hospitals with National Single Payer” campaign. We believe that a national, improved Medicare for All, free from profit in the financing and the delivery of care, would provide the reliable, equitable funding needed to help hospitals and physicians not only survive, but thrive in rural areas. The funding from global budgets would be based on community healthcare needs and not on industry interests.
We urge individuals who live in districts where the at-risk hospitals are located to contact their representatives and ask them to cosponsor HR3069, the Medicare for All Act. If your representative is already a cosponsor, tell them to do more to put national single payer on the nation’s agenda.
People can also pass a resolution in their local organization or city council going on record in favor of saving and sustaining their rural hospitals by calling on Congress to pass national, improved Medicare for All, free from profit.
We urge residents of rural communities to stand together and demand the right to excellent healthcare that our wealthy nation can and must provide. The 46 million people living in America’s rural communities don’t need a temporary Band-Aid—they deserve what everyone deserves, no matter where they live—healthcare as a human right, free from profit.
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Dems Decry GOP's $15 Billion Rural Hospital Fund as Sick Joke Compared to $800 Billion in Medicaid Cuts
Instead of offering a "disaster fund" for rural hospitals that would lose crucial funding due to Medicaid cuts, one Democratic senator said Republicans should not "create the problem in the first place."
Jun 26, 2025
"That ought to do it."
That was Democratic Senator Ron Wyden's sardonic response Wednesday to a new proposal put forward by Senate Finance Committee Republicans whose proposed solution to the devastating impacts of the $800 billion in Medicaid cuts they want to impose is a so-called $15 billion "stabilization fund" for rural hospitals that rely on Medicaid to operate.
Wyden was among several Democrats who appeared fed up this week with Republicans' attempts to paper over the devastation hundreds of billions of dollars in Medicaid cuts would cause in communities across the United States.
While several Republicans in the House have acknowledged that cutting Medicaid to help fund tax cuts for corporations and the wealthiest Americans would harm "vulnerable constituents"—echoing warnings that Democrats and progressive advocates have been shouting for months—Senate GOP lawmakers have also evidently looked at the party's budget reconciliation bill and its Medicaid provider tax decrease, which would slash state funding for Medicaid, and come to terms with the suffering the proposal would inflict on their own voters.
"The devastation to healthcare in the United States will be red and blue," Sen. Richard Blumenthal (D-Conn.) told the news outlet NOTUS. "Red, white, and blue, across the country, and I think they're hearing from constituents."
According to a report released last week by the AFL-CIO, with states losing Medicaid funding from the provider tax decrease, more than 330 rural hospitals are expected to go out of business if the Republicans manage to pass the reconciliation bill as written.
"This is literal life-and-death for folks who will have to travel even farther to access the healthcare they need," said Groundwork Collaborative, a progressive think tank and advocacy group.
Democrats suggested the apparent panic created by public outrage over the proposed cuts led Republicans on the Senate Finance Committee to circulate a memo Wednesday proposing a $15 billion fund for rural hospitals—but not facilities in urban areas, which also serve many Medicaid recipients but lie in largely Democratic areas.
About half the money in the fund would be made available for rural hospitals across the country and the other half would go to specific hospitals chosen by the Centers for Medicare and Medicaid Services, a Republican senator told The Hill.
Sen. Chris Murphy (D-Conn.) denounced the proposal as "a slush fund" that exemplified "the corruption" behind the GOP's megabill.
Republicans including Sens. Susan Collins (R-Maine) and Josh Hawley (R-Mo.) have proposed a larger $100 billion fund for hospitals—a number Senate Majority Leader John Thune (R-S.D.) scoffed at Wednesday—but Democrats were quick to point out that a bigger fund wouldn't reverse the impact of $800 billion in Medicaid cuts.
"The rural hospital fund is a fig leaf that will let them pretend that they can take away hundreds of billions of dollars in healthcare reimbursements," Sen. Elizabeth Warren (D-Mass.) told NOTUS.
Several Democrats and advocates said Republicans were desperately "trying to solve a problem they're creating" by slashing a healthcare program used by more than 71 million Americans.
"The obvious question is, don't create the problem in the first place," Wyden told NOTUS. "Don't create the need for things like disaster funds."
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Neither Snow, Nor Rain, Nor Sleet, Nor DOGE
Help family farmers and other rural folks defend a strong public U.S. Postal Service from the Trump administration’s attacks.
Mar 22, 2025
Since 1775 when Benjamin Franklin became the very first postmaster general, the United States Postal Service has faithfully fulfilled the many lofty goals that are now inscribed outside the entrance of the U.S. Postal Museum in Washington D.C.: “Bond of the Scattered Family; Enlarger of the Common Life; Carrier of News and Knowledge; Instrument of Trade and Commerce.”
Affordable universal reliable communication is not something many people can take for granted. In fact, the USPS was such a great American idea (like our national park system) that it has since been replicated across the globe. Under the pretense that the USPS is “bankrupt,” though, President Donald Trump and other neoliberal free marketeers are hellbent on imposing an austerity program and ultimately privatizing this vital public service.
During Trump’s last stint in the White House, USPS was forced to shutter half of its mail processing centers, leading to longer delivery times, and 10% of the nation’s post offices, mostly in rural towns, were put on the auction block. Despite such, the USPS continues to have some of the highest public approval ratings of any federal government agency. After all, who else can you trust to make sure you get your seed orders or drug prescriptions in a timely fashion?
Now is the time to speak up and insure the proud iconic eagle of the USPS is not replaced by some anemic vulture version.
How did this quite preventable (and orchestrated) mugging of the USPS come about? Well, one needs to go back a few decades when the government first opened the door for corporate competitors to undermine the viability of the USPS. At just 73 cents to deliver a first class letter, USPS rates remain among the lowest in the industrialized world. Given the surge in packages, accelerated by the pandemic, private outfits like Fedex and Amazon are now allowed to mooch off the USPS’ amazing efficiency to help deliver their own packages (saving themselves up to 75%). Contrary to some naysayers, the USPS does not get a dime from U.S. taxpayers—it provides a valuable public service at cost to consumers. So attacks on the USPS claiming it is “horribly wasteful” are just flat out wrong.
The USPS is also hamstrung from taking advantage of other ways to expand its services that many people, especially rural folks, desperately need. For example, the USPS still offers money orders, but many other countries’ postal systems offer a much wider range of popular financial services such as checking and savings accounts, even low-interest loans. One recent study found that the USPS could earn an extra $8-9 billion per year just by providing basic banking options to the millions of Americans who now subsist on the fringes of the financial system. It is no surprise that Wells Fargo is drooling over the possible demise of USPS (as revealed in a recently leaked internal memo), since they hardly want any other option for those now subject to their predatory lending practices.
Now is the time to speak up and insure the proud iconic eagle of the USPS is not replaced by some anemic vulture version. Family Farm Defenders is among dozens of organizations that have joined the Grand Alliance to Save Our Public Postal Service. And just like many family farmers rely upon cooperatives for their collective bargaining against agribusiness, postal workers also deserve to have their labor rights respected as fully unionized federal employees. Please contact your elected officials to insure the future of USPS as a vital public good, and next time you are at the post office thank the workers for their essential service! As the unofficial motto of the USPS goes: “Neither snow, nor rain, nor heat, nor gloom of night stays these couriers from the swift completion of their appointed rounds.” Neither should DOGE!
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Why Guaranteed Income Is the GOAT
Minnesota's three-year-old Guaranteed Income for Artists pilot program offers a small yet mighty payment that has unlocked creative freedom and opened new opportunities that ripple through our communities.
Nov 21, 2024
If you were driving by a remote stretch of Minnesota County Highway 210—connecting Wahpeton, North Dakota and Fergus Falls—you would see a massive billboard depicting a painting of three goats. It looks out of place—colorful and vibrant on a desolate stretch of highway mostly used by westbound truckers and locals. On the top left-hand corner of the billboard rests a stark reminder to anyone looking up: "In rural we tend to the herd."
My wife and I share a farm with Edith, Willa, and Milagro—our three goats and the willing subjects of the billboard—and 10 laying chickens, two inside dogs, and three outside cats. As a recipient of Minnesota's three-year-old Guaranteed Income for Artists pilot program, I was inspired to create the billboard as a tribute to the state's guaranteed income pilot, which tends to the community and is changing the lives of artists like myself.
Since moving to Otter Tail County in 2017, I've deepened my connection to the land and the rhythms of rural life. I am attuned to the changing of the seasons, and the serene landscape outside my windows becomes inspiration for paintings in my home studio. Living in a rural setting provides the space I need to get into the creative flow. And the quiet, slower pace of life has unlocked the creative freedom to make my large-scale narrative paintings.
As policymakers and community leaders consider implementing guaranteed income programs, I hope they look to Minnesota's example.
But making a living as an artist in rural Minnesota is no easy feat. It often requires having many different income streams to stay on top of student loans, car payments, and grocery bills. So, when I received an email telling me I had been chosen by lottery to participate in a new pilot providing guaranteed income for rural artists, I breathed a sigh of relief.
The program is set to expand, soon providing no-strings-attached $500 monthly payments to 100 artists for five years—far exceeding typical 12-18-month pilots. This growth cements its position as the nation's longest-running guaranteed income pilot focusing on both urban and rural creators. For me and my fellow artists, this small yet mighty payment has unlocked creative freedom and opened new opportunities that ripple through our communities.
As Minnesota finds itself in the national spotlight following Gov. Tim Walz's candidacy for Vice President, our state's innovative approaches to social and economic policy are garnering renewed attention. As of 2024, 10 states have introduced legislation attempting to ban guaranteed income programs. The misplaced fear stems from ideological and economic concerns about the effects of guaranteed income even though more than a dozen studies have shown that it leads to higher employment rates, housing and food security, and more family time.
When artists have the freedom to create and engage, we become catalysts for positive change that benefits entire communities. Take Jess Torgerson, a multidisciplinary artist and community organizer in Fergus Falls, Minnesota. Before the guaranteed income program, Jess was working 60 hours a week. Now, she has partnered with another artist to create sculptures from found materials, simultaneously making art and ridding her community of unwanted waste. Then there's Torri Hanna, a fiber artist. The program helped Torri and her daughter improve their living situation and stabilize her yarn store business. Torri, too, has expanded her community involvement, working with the local senior center to create art for downtown storefront windows.
Recent data from the program shows its remarkable impacts. Participants reported a decrease in financial stress, an increase in their ability to pay for basic needs, and an increase in their ability to take on creative and community projects they wouldn't have otherwise pursued. The success of Minnesota's program is part of a larger movement, with over 100 pilot programs across the United States testing the impact for different groups of people. Programs like the Works Projects Administration coming out of the New Deal made it possible for artists to make a living and beautified our nation's infrastructure. We have a history to look back on in guiding public investments in artists—we already know that investing in artists pays back manifold.
In my community, we understand the value of tending to the herd—and we've all taken an important lesson from Edith, Willa, and Milagro, who sit in formation with their backs to each other so that they can share body heat, and each can observe a different direction to keep an eye out for threats. Our communities are strengthened when we tend to each other with the same dedication. This, to me, is what guaranteed income does for artists. It says, "We've got your back."
As policymakers and community leaders consider implementing guaranteed income programs, I hope they look to Minnesota's example. Include artists in your pilots. Recognize the unique value they bring to your communities. Understand that by supporting artists, you're nurturing the creativity, resilience, and interconnectedness that make our communities thrive. In Minnesota, we know that the strength of the herd depends on how well we tend to each individual. We know our rural parts of the state enable our strong urban centers to thrive. As you consider the future of your own communities, look out for each other. Share your warmth. Face different directions, but always stay close and connected.
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The Progressive Populism of Tim Walz
Walz is making an argument for Harris and the party that is rooted in the rural values of regions where Democrats have struggled to compete in recent years.
Aug 09, 2024
Kamala Harris set up a virtual primary for the Democrats who wanted to join the party’s 2024 ticket as her vice-presidential running mate. She offered them all—governors and senators, progressives and centrists, East Coasters and Midwesterners, Southerners and Westerners—an opportunity to secure the nomination. And they all gave it their best.
So how did Minnesota Gov. Tim Walz, arguably the least well-known and least politically connected of the finalists, come from the back of the field to win Harris’ confidence?
Democratic Party insiders and the political pundits who listen to them are struggling to figure out what just happened. But there is nothing complicated about the Walz surge.
“Their idea of freedom is to be in your exam room, your bedroom. You know, banning books, we’re banning hunger. These are Democratic policies.”
What Walz recognized—to a far greater extent than more centrist and cautious VP prospects such as Arizona Sen. Mark Kelly and Pennsylvania Gov. Josh Shapiro—was that Democrats wanted to add a happy warrior on the ticket with Harris, whose replacement of President Joe Biden as the party’s presidential nominee has given the Democrat’s 2024 prospects a significant boost in morale and in the polls.
Walz had no problem fitting the bill. His record and political instincts positioned him as a candidate who is capable of winning where Democrats need to prevail in the race against Republican presidential nominee Donald Trump and vice-presidential nominee J.D. Vance.
As a Democrat who had won six races in a rural, Republican-leaning congressional district in southern Minnesota and then two terms as the governor of a politically competitive Midwestern state, Walz knew exactly how to rally the party base and to reach out to the progressive-leaning independents who must be mobilized to defeat the Republican right.
Where other Democratic candidates and party strategists had struggled for years to figure out how to characterize Trump and the MAGA cabal that has taken over the Grand Old Party, Walz got to the point in his first interviews as a VP contender. “You know there's something wrong with people when they talk about freedom: freedom to be in your bedroom, freedom to be in your exam room, freedom to tell your kids what they can read,” Walz told MSNBC’s Jen Psaki. “That stuff is weird.”
The “weird” line went viral, as Democrats from across the ideological spectrum embraced what turned out to be a highly effective critique of Trump and Vance.
But there was much more to Walz’s appeal.
In a remarkable series of cable TV appearances in late July, at a point when the former teacher and National Guard master sergeant was still in the back of the pack of Democratic vice-presidential prospects, Walz made an argument for Harris and the party that was rooted in the rural values of regions where Democrats have struggled to compete in recent years.
“I grew up in a small town of 400 people. I have said I had 24 kids in my class—12 were cousins—graduating. That’s small-town America,” began Walz in one of his first MSNBC appearances during the VP race, turning the tables on Trump and Vance. “I said the thing that most irritates me and baffles me... is a failed real-estate guy from New York City that knows nothing about small towns and a guy who wrote a book that denigrates my neighbors and tells them that this is some type of cultural thing. I think the real message here is that the reason that rural America is struggling more—[with challenges such as the] outsourcing of jobs—is because of Republican policies and people like Donald Trump and J.D. Vance, a venture capitalist who cares nothing about those institutions there.”
Then he dug into the issues that actually matter to the rural regions, small towns, and small cities where Democrats need to do better—areas where, if the party can hold its own in the way that it did when Barack Obama was its nominee in 2008 and 2012, it will win nearly every swing state. And, perhaps, a few states that weren’t thought to be competitive.
“If you’re in a town of 400, there are two institutions that are the most important to your town. That is the public school and a hospital or a clinic, if you have it,” Walz said to MSNBC. “Both of those things are being gutted by the Republicans. They’ve been telling us for six-and-a-half years they have a plan on healthcare, and that means taking away Medicare and Medicaid and reducing [Affordable Care Act] access. And they talk about privatizing public schools.”
Rejecting the tired, and massively disproven, Republican talking point that says the private sector will invariably do a better job than the public sector, Walz mocked the GOP line that says, “Oh, we’re gonna privatize this and take the money out of our public schools.” Then he said, “Let me be very clear: When you talk about private education, that means you gut the public schools, you send [public money] to people [who are] already sending their kids to those schools, and you got it. So I think the condemnation of these people [is that] they don’t know middle America. They don’t know who we are.”
That is a progressive populist message that’s rooted in the rhetoric of Democrats such as Franklin Delano Roosevelt and Harry Truman, who won rural Americans, and of Jimmy Carter, Bill Clinton, and Barack Obama, who won enough rural, small town, and small city votes to tip the balance to their party in the elections of 1976, 1992, 1996, 2008, and 2012.
It also reflects the record of a congressman from rural Minnesota who continuously won volatile elections from 2006 to 2016, and of the Democratic governor of a frequent battleground state who won big in 2018 and 2022.
Recalling his congressional wins, Walz now says, “I represented a district that Trump won by 18 points, but that got tougher and tougher.” But, instead of giving up, Walz says, “I think we need to take this populist message—the economy, the freedoms—[and say that]: These guys aren’t for freedoms. Their idea of freedom is to be in your exam room, your bedroom. You know, banning books, we’re banning hunger. These are Democratic policies. And I think the people in Missouri, [and] I would argue, the people in Montana, doing those types of things make a big difference. What is Donald Trump offering? You go to these rallies, he’s talking about Hannibal Lecter.”
And that, as Tim Walz put it, is weird.
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Raging Against White Rural Rage
In their new book, Tom Schaller and Paul Waldman write as if economic class no longer exists or matters.
Apr 17, 2024
I don’t like to slam books, especially those ahead of mine on the best seller list. It might seem like petty jealousy. But one recent release, White Rural Rage by Tom Schaller and Paul Waldman, is seriously flawed.
For starters, the authors write as if economic class no longer exists or matters. According to this book, all rural white people, or at least most of them, share similar racist attitudes. Class distinctions between bosses and workers, rich and poor, are meaningless.
Because Schaller and Waldman view the world through their anti-class, whiteness lens, they don’t consider the possibility that working-class voters share common attitudes across geographies. Contrary to their thesis, the research for my book found no discernable differences in attitudes on hot-button social issues between urban, suburban, and rural white working-class voters.
When Democrats, like Sherrod Brown, show the courage to fight against Wall Street’s war on workers they gain working-class support.
As Democratic Party pollster Mike Lux reports, “These voters wouldn’t care all that much about the cultural difference and the woke thing if the Democrats gave more of a damn about the economic challenges they face deeply and daily.”
Where’s the Beef?
Schaller put his cards on the table during an interview on MSNBC, during which he called rural Americans “the most racist, xenophobic, anti-immigrant, anti-gay geo-demographic group in the country.”
The authors also claim it is getting worse. In defending themselves in The New Republic, they write that “as the rest of the country moved away from Donald Trump [in 2020] rural whites lurched toward him by nine points, from 62% to 71%.”
But voting for Trump is not the same as being a bigot. In fact, the data in my book shows that white working-class voters, rural and otherwise, are growing more liberal, not illiberal on key social issues.
Anti-Immigrant?
“Are you in favor of granting ‘legal status to all illegal immigrants who have held jobs and paid taxes for at least three years and not been convicted of any felony crimes?’” (Cooperative Election Study)
White working-class in favor:
2010: 32.1%
2020: 61.8%
Anti-Gay?
“Should gay or lesbian couples be legally permitted to adopt children?” (American National Elections Study)
White working-class in favor:
2000: 38.2%
2020: 76.7%
Increasing Racism?
“Agree that most Blacks just don’t have the motivation or willpower to pull themselves out of poverty.” (General Social Survey)
1996: 56.8%
2021: 32.8%
Furthermore, our data, which is derived from three large multi-year voter surveys, shows that from 20-50% of white working-class non-Democrats are liberal on social issues.
What About Sherrod Brown?
If white rural racism is the key to all politics, then why do significant numbers of rural voters in Ohio support Sen. Sherrod Brown, who in 2018 ran about 12% ahead of President Joe Biden in 2020? In fact, Brown, who votes liberal on social issues up and down the line, ran significantly ahead of Biden in every rural county.
Brown’s connection to working-class voters might have something to do with his willingness to take on Wall Street for ripping off workers again and again. It works politically because enough of those supposedly bigoted white workers care a lot more about never-ending job instability than they do about wokeness.
In his excellent review (and evisceration) of White Rural Wage, Nicholas Jacobs, a political scientist, points out that:
Democrats who give in to the simplistic rage thesis are essentially letting themselves off the hook on the politics, suggesting that rural Americans are irrational and beyond any effort to engage them.
It’s not white rural rage. It’s not irrational rage either. Rather it’s very clear-eyed working-class anger as insatiable corporate greed tears up their lives.
When Democrats, like Sherrod Brown, show the courage to fight against Wall Street’s war on workers they gain working-class support.
Maybe it’s time for a little more Democratic Party rage?
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Idaho Hospital Ends All Labor and Delivery Care, Citing Abortion Ban
"Consequences for Idaho physicians providing the standard of care may include civil litigation and criminal prosecution, leading to jail time or fines," said Bonner General Health as it closed its obstetrics unit.
Mar 22, 2023
Rural areas in the U.S. have faced a decline in hospitals that provide obstetric services for years, and the fate of one hospital in northern Idaho suggests that abortion bans could worsen the trend.
As The Washington Post reported reported Tuesday, Bonner General Health in Sandpoint, Idaho has been forced to announce the impending closure of its labor and delivery department, citing staffing issues as well as the state's punitive abortion ban—one of the strictest in the nation—and threats from state Republicans to make the law even more stringent.
The state's ban criminalizes abortion cases in almost all cases and threatens doctors who provide care with felony charges, suspension or termination of their medical license, and up to five years in prison. It includes potential exceptions for people whose pregnancies result from rape or incest and people who doctors determine face life-threatening pregnancy complications—but as Common Dreams has reported, such exceptions have led medical providers to withhold care until a patient is sufficiently ill, placing them in danger.
The threat of prosecution and pressure to withhold medical care from people who need it has contributed to the hospital's staffing shortage, said Bonner General Health in a statement late last week.
"Idaho's political and legal climate does pose as a barrier specific to recruitment and retention for OB-GYNs."
"Highly respected, talented physicians are leaving. Recruiting replacements will be extraordinarily difficult," said the hospital. "In addition, the Idaho Legislature continues to introduce and pass bills that criminalize physicians for medical care nationally recognized as the standard of care. Consequences for Idaho physicians providing the standard of care may include civil litigation and criminal prosecution, leading to jail time or fines."
Idaho Republicans have proposed classifying abortion as "murder from the moment of fertilization" and have called for bans that extend to people whose pregnancies result from incest and rape.
"Idaho's political and legal climate does pose as a barrier specific to recruitment and retention for OB-GYNs," hospital spokesperson Erin Binnall told the Post.
Patients in Sandpoint will now have to travel to Coeur d'Alene, about 45 miles south, to deliver their babies. The city now has the northernmost labor and delivery department in the state, and people living near the state's northern border may have to travel two hours to reach the hospitals there.
Bonner General Health announced its decision days after the podcast "This American Life" featured an interview with an obstetrician who has worked for several years at Bonner General Health but has considered leaving the state since Idaho's ban went into effect last June, after the U.S. Supreme Court overturned Roe v. Wade.
"I was looking at social media and somebody was talking about a person who is completing their OB-GYN residency and was looking to come to the Pacific Northwest," said Dr. Amelia Huntsberger. "And I'm like, hey, there's all sorts of openings in Idaho. And then I'm laughing out loud because I'm like, who is going to be finishing their residency training and being like, I definitely want to go to the state with the super strict abortion laws that criminalize healthcare?"
The Journal of the American Medical Association published a report in 2018 showing that a lack of obstetric care in rural hospitals is associated with a rise in preterm births and more people giving birth in facilities where medical staff lack the proper training to assist with labor and delivery, such as emergency departments. High rates of maternal mortality are also associated with "maternity care deserts," which include nearly half of rural U.S. counties, according to the Commonwealth Fund.
Nearly 90 rural obstetrics units closed their doors between 2015 and 2019, with hospitals citing financial losses associated with high numbers of patients who use Medicaid as well as difficulty in recruiting and retaining doctors.
"This will be the beginning of a trend, I fear," said behavioral scientist Caroline Orr Bueno of Bonner General Health's decision. "We already have a maternal mortality crisis in the U.S.—we're the only country in the developed world where maternal mortality rates are increasing—and abortion bans are going to make it worse."
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