Pictured is Rural Minds founder Jeff Winton, who recently discussed why Medicaid and the Affordable Care Act are important for Rural America. Submitted photo

As the United States’s current administration continues to try and drastically reduce the federal deficit, a local non-profit organization is worried those cuts will harm many in rural America – including here in Chautauqua County.

Rural Minds founder Jeff Winton noted that while the recently passed Continuing Resolution keeps Medicaid and Medicare at current levels, it is only guaranteed for the next six months. At the same time, the enhanced premium tax credits in the Affordable Care Act marketplace – which increase the affordability of marketplace health insurance coverage – will expire at the end of 2025 unless Congress extends them.

“While proposed Medicaid cuts could be widespread, the 46 million people who live in rural America would likely face the most dramatic impact, and doubly so without the ACA tax credits,” Winton said. “Medicaid and the ACA marketplace play a disproportionately important role in rural communities’ financially fragile healthcare systems; in rural America, incomes are lower, and fewer people have employer-sponsored insurance than in other parts of the country.”

Winton said making these cuts would severely impact the ongoing mental health emergency in America today, specifically in rural areas, adding that some of the numbers should be alarming to everyone. Compared with their urban counterparts, people in rural America have higher rates of depression and suicide, but are less likely to access mental healthcare services.

Depression, anxiety, and behavioral conditions are more prevalent among rural children compared to urban children. In 2020, an estimated 12.7 million rural adults suffered from a behavioral health issue, such as a mental illness, substance use disorder, or other psychiatric conditions. According to the latest statistics from the Centers for Disease Control and Prevention, suicide rates among people living in rural areas are 64% to 68% higher compared to people living in large urban areas. Farmers and ranchers are nearly twice as likely to die by suicide compared to other occupations; the suicide rate among farmers is more than three times the general population.

“Any cutting of Medicaid or the ACA tax credits will only make support for mental health and substance abuse disorder in rural America more dire,” Winton said. “Retaining Medicaid and Affordable Care Act marketplace tax credits for the people in rural America is crucial for many reasons. Rural areas face unique healthcare challenges that make these programs even more essential. Rural America tends to have a higher proportion of older adults, people with chronic conditions, and individuals living with disabilities. These populations often have more significant healthcare needs, but may have difficulty affording necessary care. Medicaid and ACA tax credits help these vulnerable groups access health services without risking financial devastation.”

Winton cited a recent report done by Georgetown University’s Center on Children and Families, which says at least half of rural children in six states are covered by Medicaid. In comparison, Medicaid covers more than one third of non-elderly adults living in rural areas in fifteen states. The ACA marketplace has also become an essential source of coverage for people in rural America, where many are self-employed or work for small employers that don’t offer coverage. In addition, farmers rely on the ACA premium tax credits. A Robert Wood Johnson Foundation report on insurance coverage in the 10 states where farmers are the largest labor force showed a significant combined impact of the ACA marketplace and Medicaid, with more than 25% of the population enrolled in one of these two programs.

“Rural communities often have fewer healthcare facilities, specialists, and primary care doctors – for example, rural communities have 20% fewer primary care providers than in cities,” Winton said. “This is particularly acute for mental health services: there is a lack of psychiatrists in 65% of rural counties; a lack of psychiatric nurse practitioners in 81% of rural counties; and 47% of rural counties lack a psychologist.”

Additionally, Winton said in 2020 there were 2,176 acute care hospitals in rural areas of the US, a number that has since decreased to 1,796 in 2025, a statistic that Winton said reflects a significant decline in the availability of healthcare services in rural communities, with many hospitals closing or converting to other models, such as rural emergency hospitals, which do not provide inpatient care. 432 rural hospitals are currently considered vulnerable to closure.

Winton added that rural hospitals and healthcare providers will often operate with lower profit margins and fewer resources, making it harder for them to maintain their services, and something that is helped by Medicaid and ACA tax credits, which bolster financial stability of rural health care providers. They also provide consistent funding streams that help ensure healthcare providers can continue to operate and serve their communities and that people living in rural areas can continue to receive necessary care.

Winton said rural Americans are also more likely to be uninsured than those in urban areas, and another aspect provided by Medicaid and ACA tax credits is financial assistance to help low- and moderate-income individuals afford health insurance.

“Many rural areas have high healthcare costs, so the enhanced subsidies make a big difference,” Winton said. “If the enhanced credits are allowed to expire, it is estimated that areas described as rural would expect a nearly 60% increase in premiums, compared to 28% in urban areas.”

Winton added that health insurance plays a critical role in financial stability for rural area families, and without Medicaid and ACA tax credits medical debt or the inability to afford insurance can have “devastating economic consequences.”

“Health insurance coverage can help people stay healthier, leading to increased productivity and fewer missed workdays, ultimately benefiting the local economy,” Winton said. “While maintaining the Federal subsidies for Medicaid and the ACA tax credits are essential to sustain any progress in healthcare for rural America, there is more that can and should be done given the importance of rural America to the country’s economy.”

Winton outlined some ideas to help improve these healthcare problems for people in rural America, such as limited access to healthcare providers, lower income levels, and geographic isolation. Telehealth access is one way that can help, he said, adding that telemedicine offers a convenient and cost-effective way to connect rural residents with healthcare providers, especially for those in remote areas where there may not be nearby specialists or even primary care doctors.

“Currently, however, rural communities are underserved: nearly 30% of rural homes lack access to broadband internet,” Winton said. “This situation needs to be remedied, and making good on high-speed internet to those without, expanding telehealth infrastructure, and reimbursing telehealth visits through Medicare, Medicaid, and private insurance can make healthcare more accessible and should be a significant priority.”

Telehealth is something Winton said is also important for mental health services, increasing access to those services as well. Another suggestion from Winton was making it so pharmacies can be brought under Medicaid and reimbursed as providers, therefore expanding the services they are able to provide, as pharmacies are easily accessible in most communities. This could include diagnostics, labs, testing, and, in some cases, prescribing treatments. Winton also touched on rural health clinics, saying that when linked to larger hospitals they should be provided with financial incentives to continue providing services like emergency care, maternity care, and chronic disease management. He added that a telehealth-enabled rural health clinic would increase coverage for those individuals whose geography significantly impedes healthcare. Winton then looked at shortages in the workforce.

“Workforce shortages are a significant reason for healthcare being underserved in rural America,” Winton said. “There is no single solution for these shortages. Still, if we are going to make good on the obligation to provide healthcare throughout the country, we need to consider incentives to improve this situation.”

Winton suggested things such as offering loan forgiveness to healthcare professionals who choose to work in rural communities for a set period of time, or incentives for medical schools to create rural-specific residency programs and for healthcare professionals to undergo training in rural health may also increase the number of providers willing to practice in these areas.

Winton encouraged everyone to reach out to their representatives and Senators and urge them to keep Medicaid and the ACA tax benefits as they are.

“At the very least, it’s clear we must maintain the status of Medicaid and ACA Tax Benefits for rural America,” Winton said. “As budget discussions go on in Congress pending the Continuing Resolution expiration at the end of September, contact your senators and members of Congress to urge them not to sacrifice the people in rural America and their needed healthcare for short-term thinking on budget reductions.”