For families caring for aging parents, managing chronic illnesses or preparing for the birth of a child, access to healthcare is about more than having an insurance card.
It is about knowing where to go when a loved one needs help — and whether that care will be available, affordable and close enough to reach in time.
Across rural America, those assurances are becoming increasingly uncertain as hospitals face financial difficulties, medical professionals become harder to recruit and patients struggle with rising healthcare costs.
During a Sept. 18 national news briefing hosted by American Community Media in partnership with the Robert Wood Johnson Foundation, healthcare experts warned that the pressures facing rural hospitals could affect entire communities, including residents who already have health insurance.
When distance becomes a health concern
Dr. Katherine Hempstead, senior policy adviser at the Robert Wood Johnson Foundation, described rural healthcare systems as financially vulnerable even before recent changes to federal healthcare policy.
Many rural communities have aging populations, higher rates of chronic illness and fewer healthcare providers than metropolitan areas.
Hospitals serving those communities face a difficult financial equation. They must maintain emergency departments, medical equipment and trained personnel even when the number of patients is relatively small.
When hospitals lose money, they may respond by reducing services rather than closing completely.
That can mean eliminating maternity care, chemotherapy or other specialized treatments, forcing residents to travel farther for medical attention.
For families caring for an older relative, a longer drive may require arranging transportation, taking time away from work or coordinating care across multiple households.
For someone managing diabetes, high blood pressure or heart disease, the added burden may make regular appointments more difficult to maintain.
Research from KFF underscores the challenges facing older rural residents. About 32% of Medicare beneficiaries living in the most rural areas had five or more chronic health conditions, compared with 25% of beneficiaries in urban areas.
The research also found that rural Medicare beneficiaries were more likely to have low incomes, making transportation and other healthcare-related expenses especially difficult to manage.
A caregiver who couldn’t afford her own care
Dr. Amy Gordon Bono, a Tennessee primary care physician, shared a patient experience that illustrated how quickly financial barriers can become medical emergencies.
The patient, a woman in her early 60s, worked as a caregiver helping others but lacked access to affordable employer-sponsored health insurance.
She had enrolled in coverage through the Affordable Care Act marketplace but eventually lost it because she could no longer afford the payments.
Without coverage, she went without medical appointments and necessary medications.
She later suffered a stroke that Bono described as preventable.
The woman required treatment at a rural hospital, creating both a life-changing health crisis for the patient and uncompensated medical costs for the facility.
Her experience highlights a difficult reality for many families: people responsible for caring for others may struggle to obtain the healthcare they need themselves.
It also illustrates the consequences of interrupted treatment for chronic conditions that often require ongoing monitoring and medication.
Why maternity care matters, too
The loss of rural healthcare services is especially concerning for expectant mothers.
Even when a hospital remains open, it may no longer provide labor and delivery services, leaving pregnant patients to travel to another community for prenatal appointments or childbirth.
KFF has documented persistent racial disparities in maternal and infant health, including substantially higher pregnancy-related mortality rates among Black women than White women.
Research cited by KFF also suggests that rural hospital and obstetric-unit closures can disproportionately harm Black infant health.
Those findings provide important context for Black families living in rural and medically underserved communities.
However, the underlying challenge is broader: when maternity services disappear, patients of all backgrounds can face longer travel distances and fewer options for care.
The September briefing did not focus specifically on racial disparities in maternal health, but its discussion of disappearing hospital services and workforce shortages helps explain why access to care remains a concern for families across the country.
Healthcare costs affect the whole household
Dr. Neale Mahoney, a Stanford University economics professor, emphasized that having insurance does not necessarily protect families from significant medical expenses.
Rising deductibles and out-of-pocket costs can leave patients struggling to afford treatment even when they maintain health coverage.
Those expenses can be particularly challenging for households supporting both children and older relatives.
A family may be paying insurance premiums while also helping a parent purchase medication, arranging transportation to appointments or covering expenses that insurance does not fully reimburse.
When nearby medical services disappear, those responsibilities can become more complicated.
The financial strain also affects hospitals. Patients who lose coverage may still require emergency treatment, leaving facilities with additional uncompensated costs.
Bono noted that inadequate payments from private insurers can also contribute to rural hospitals’ financial instability.
What happens next?
Federal policymakers have established a $50 billion Rural Health Transformation Program to support rural healthcare over five years, from 2026 through 2030.
The program includes investments in technology, workforce development and new models for delivering medical care.
But Hempstead questioned whether those initiatives would provide enough immediate financial assistance to hospitals already struggling to survive.
Healthcare experts say strengthening rural access will require attention to insurance affordability, hospital financing and shortages of medical professionals.
For families, the concern is more immediate.
Will a nearby emergency room remain open? Will an aging parent be able to see a doctor regularly? Will an expectant mother have access to maternity care without traveling hours from home?
Those questions affect more than rural hospitals’ financial statements.
They affect the ability of families to care for one another — and the future of the communities they call home.