Rural health challenges demand attention | ViVE 2026

Los Angeles – Dr. Brian Hoerneman acknowledges the plight of rural hospitals and health systems isn’t exactly new.

Hoerneman is the president and CEO of Sanford Health Marshfield, overseeing the system’s 11 hospitals in Wisconsin and Michigan’s upper peninsula. (Sanford acquired the Marshfield Clinic Health System last year.) Sanford serves scores of rural communities across the upper Midwest, and Hoerneman, an emergency physician, is well attuned to those problems.

Workforce challenges are a problem for most systems, but they are especially difficult for providers in rural communities. Rural hospitals say inadequate reimbursements are particularly painful to organizations struggling mightily to break even.

During a panel at the ViVE conference focusing on rural healthcare, Hoerneman says he wonders if the message is resonating.

“We've heard about this in the rural health space for really a long time,” he says. “What I worry about a little bit is it's maybe starting to get to be white noise for some of our policymakers that have heard it for a long time.”

Necessary, but insufficient

Hoerneman says he’s seen hospitals close in the region.

Other health systems have also had to shut down labor and delivery units, which exacerbates troubling problems with access in rural areas. Some in rural communities already face the prospect of driving an hour or two to a hospital, and maternity care deserts are all too common in rural areas.

Rural health systems are also worried about the impact of cuts to Medicaid as part of the sweeping HR 1 tax package President Trump signed last year. Analysts project Medicaid spending will be cut by about $1 trillion over the next 10 years, with over 10 million Americans losing coverage. Hospital leaders warned the added financial pressures from the Medicaid cuts could sink rural hospitals.

If more lose coverage due to Medicaid cuts and the expiration of tax credits for the Affordable Care Act, more Americans in rural communities are going to go without regular visits to doctors and could end up in hospitals with more advanced conditions.

“We’re trying to prevent chronic disease and having that continuity of care is really important,” Hoerneman said. “And so when that's interrupted, they kind of fall off the radar. Maybe they get coverage later. They're coming in sicker.” And those patients will end up having longer and more expensive hospital stays.

Aiming to ease those concerns Congress and the White House created the Rural Health Transformation Program, which directs $50 billion over the next five years to improve health in rural communities.

Rural health leaders welcome the influx of money and say it could be used to help improve access, but they also say it’s not likely to offset the steeper losses from the Medicaid cuts.

“I think it is exciting,” Hoerneman said of the new federal program. “I think it's an opportunity. I don't think it's going to be wasted dollars, but it doesn't completely fix the fire problem.”

Gulshan Mehta, chief digital and information officer of the Blanchard Valley Health System, also offered a similar assessment. The system operates two hospitals and a host of clinics in northwest Ohio.

“It's necessary, but likely to be insufficient in order to go out and offset some of the headwinds,” Mehta said.

The health system is uncertain about how much money will be coming, and the program is temporary.

“We're not going to bank on the fact that we're getting a tremendous amount of dollars, or an infusion, if you would, from the fund. When that arrives, you know, we'll take a look at it,” Mehta said.

But he said Blanchard Valley is focused on finding a way to ensure long-term sustainability, regardless of what may be coming from the federal rural health program.

During the session, Mehta also pointed to the challenge for rural health systems to plan thoughtfully when federal healthcare policy continues to change.

“We see regulation as, we know that it's going to be there. We just want it to be more predictable,” he said.

Other types of providers in rural communities continue to face a hard road. Joe Dunn, chief policy officer of the National Association of Community Health Clinics, points out about 40% of those clinics are based in rural America. Rural Americans have lower survival rates of cancer, according to the American Cancer Society.

And about 70% of the nation’s rural areas are classified as areas of a shortage of healthcare professionals. As Dunn says, it’s simply harder to draw doctors and nurses to rural communities and it’s more difficult to keep them.

“It something that really demands national attention,” Dunn said.

Dunn sees the potential to do some good with funding from the new federal program to improve rural health. But given the five-year lifespan of the program, Dunn said it’s wiser to use the money on one-time investments, as opposed to building programs that require ongoing support.

“You cannot count on Congress to come back again and replenish this fund,” Dunn said.

But he said the funds could be used to help bolster partnerships with hospitals and other organizations. Such collaborative efforts could lead to longer success.

Reasons for hope

Even with the formidable obstacles they face, the leaders on the rural health panel still expressed a great deal of optimism.

They see the possibilities in telehealth offering more access to patients in remote areas.

“We look at technology how it does enable us to extend our reach and be in more spots and improve patient outcomes,” Hoerneman said.

“I think we are in a new chapter for rural health care and an inflection point based on a lot of technology coming out,” Hoerneman added. “So I'm looking forward to it.”

Mehta also pointed to the use of technology to help patients and ease some of the work on staff, which could help rural providers keep top talent.

“I do feel very optimistic about as far as the use of it is concerned going forward, especially not only in terms of access of care, which is important, but also in terms of the health of the workforce, and being able to retain the workforce going forward,” Mehta said.

Healthcare providers in rural communities have adapted constantly for generations, Dunn noted, and that is why he is optimism they can overcome the hurdles they face.

“Rural America has a really strong history about being resilient and having creativity and that sense of community, and so that is what gives me hope,” Dunn said.