Report Calls for Transparent Rural Health Impact Net Standard to Fairly Evaluate Cuts to Rural Health Care State-by-State

MEXICO, MO  — Farm Action Fund today released a new report warning that rural America needs to see the whole ledger when Washington claims it is investing in rural health care after passage of the 2025 Big Beautiful Reconciliation Bill. 

The report, The Rural Health Ledger: What Washington Is Giving Rural America May Not Add Up to What It Is Taking Away, examines the federal government’s new rural health investments alongside the sweeping Medicaid reductions enacted in the Big, Beautiful Bill reconciliation law. 

The conclusion is straightforward: federal grants touted by the Trump Administration do not tell rural Americans whether Washington’s overall health-care policies are strengthening or weakening their communities.

“Rural Americans deserve more than a press release announcing another pot of money,” said Joe Maxwell, co-author of the report and a leader of Farm Action Fund’s Rural Independence Initiative. “They deserve to know what Washington is putting into their communities, what Washington is taking away, and what the bottom line will be for their families, their hospitals and their local economies as hospitals and clinics continue to decline in our rural communities. I now have to travel over 50 miles in rural Missouri to get an appointment.”

The federal government recently announced nearly $25 million in direct assistance to 132 small rural hospitals across 13 states, while the $50 billion Rural Health Transformation Program provides $10 billion annually through 2030. Farm Action Fund says those investments are meaningful and should be welcomed.

But they must be viewed alongside the much larger Medicaid reductions.

The Congressional Budget Office estimates the 2025 reconciliation law will reduce federal Medicaid spending by approximately $911 billion over ten years. KFF estimates approximately $137 billion of those reductions will fall on rural areas. The Rural Health Transformation Program, by comparison, provides $50 billion over five years.

And the two funding streams are not interchangeable.

The stakes are high. Rural hospitals have been enduring years of financial stress. Between 2010 and 2025, 152 rural hospitals closed, including 52 Critical Access Hospitals. Today, 700 rural hospitals, 31% of the nation’s operating rural inpatient hospitals, are classified as at risk of closing, including 264 at immediate risk.

The report highlights just how dramatically the impact could vary from state to state.

According to a 2026 RAND analysis, Iowa received approximately $209 million in first-year Rural Health Transformation funding. Yet RAND projects that Iowa’s Medicaid fund will be $12.8 billion lower by 2034 — a 16.01% reduction from the modeled baseline.

Florida received nearly the same amount of rural transformation funding — approximately $209.9 million — but RAND projects its Medicaid fund will be 0.14% higher by 2034.

Wyoming, meanwhile, received approximately $205 million and is projected to see its Medicaid fund increase by 9.77%, or approximately $1.04 billion.

“Two states can receive virtually the same rural health grant and end up with completely different health-care futures,” Maxwell said. “That is why rural Americans need to see the whole ledger — not just the side of the ledger Washington wants to advertise.”

Farm Action Fund has endorsed Harriet Hageman for U.S. Senate and Rep. Anna Paulina Luna (FL-13) for re-election as they have proven to be rural champions looking out for their constituent’s best interests. Rep. Ashley Hinson’s vote for the 2025 Reconciliation bill will reduce Iowa’s Medicaid fund, leading Farm Action Fund to endorse her opponent Josh Turek.

Farm Action Fund calls for a Rural Health Net-Impact Standard

Farm Action Fund is calling on Congress and the Administration to establish a transparent, nonpartisan Rural Health Net-Impact Standard for major federal health policies.

The standard should provide a state-by-state accounting of:

• Changes in federal Medicaid funding;
• Medicaid enrollment and coverage;
• Rural Health Transformation funding;
• Provider reimbursement and uncompensated care;
• The number and financial condition of rural hospitals;
• Access to emergency, inpatient, maternity and other essential services; and
• Rural health-care employment and economic impacts.

“Washington should be judged by outcomes, not announcements,” Maxwell said. “If federal policy is making rural communities healthier and more economically resilient, show us the numbers. If it is leaving rural families with fewer hospitals, fewer providers and less access to care, rural Americans deserve to know that too.”

Read the full report: The Rural Health Ledger: What Washington Is Giving Rural America May Not Add Up to What It Is Taking Away.