When Almost Every Member of Congress Represents Rural Americans, Improving Access to Health Care Demands Bipartisanship
by MEG KABAT
Maeve and her husband, Steven, live just outside of Egg Harbor, in one of the most rural parts of New Jersey. It’s an hour and a half drive to Wilmington, DE, the closest VA Medical Center — and that’s on a good day. Steven served in the United States Marine Corps, with multiple deployments to both Iraq and Afghanistan. His service impacted him both physically and emotionally, and now Maeve serves as his family caregiver, assisting him with many activities of daily living and coordinating all his medical care. While Steven receives occupational and physical therapy close to home, specialty care — such as neurology — is not only harder to find, but even if they have found a provider, that provider does not have the expertise that Steven needs.
Maeve and her family are not alone. While the United States Federal Government has multiple definitions of “rural,” the most frequently cited number of people living in rural America is 59 million (approximately 28 million women), which accounts for approximately 19% of the population, including 2.7 million veterans enrolled in health care with the U.S. Department of Veterans Affairs. Specialized care, like clinicians with expertise in veterans’ health, women’s health, pediatrics, and cancer, can be almost impossible to find. In very rural or frontier areas of states like Montana and Alaska, access to primary care is often close to impossible.
The impact on the health of people living in rural areas is not a new topic for Congress — almost every member of Congress represents rural Americans. The bipartisan Supporting and Improving Rural EMS Needs Reauthorization (SIREN) Act, sponsored by Senators Susan Collins (R-ME) and Dick Durbin (D-IL), was signed into law in 2024. The SIREN Act is an example of recently passed rural health legislation and extends grants to rural fire and EMS agencies nationwide. With many competing priorities in Congress, legislation to address the rural health needs in varying regions across the United States continues to advance with bipartisan support because young and old, male and female, pregnant or seeking cancer treatment, rural health limitations are an American problem.
With fewer doctors and even fewer hospitals, there is less access to specialized care. The life expectancy of rural Americans is 2.5 years less than that of those living in urban areas, according to research published in the International Journal of Epidemiology. The CDC reports that rural Americans are more likely to die from heart disease and stroke. According to an analysis of literature published in Women’s Health Reports, rural women are diagnosed with cancer at a later stage, limiting treatment options and increasing morbidity. Rural women who are pregnant face barriers to prenatal care and delivery, resulting in poorer outcomes for both women and their newborns, according to the CDC. These outcomes can impact children well into adulthood.
In July, Senators Tim Scott (R-SC), Tina Smith (D-MN), Cynthia Lummis (R-WY), and Tim Kaine (D-VA) introduced the bipartisan Improving Care in Rural America Reauthorization Act (S. 2301). A similar version (HR 2493) was introduced in the House by Congressmen Earl Carter (R-GA), Shomari Figures (D-AL), Michael Rulli (R-OH), and Kim Schrier (D-WA).
The bill, which was approved by the Senate Committee on Health, Education, Labor, and Pensions in September and is now pending for consideration by the full Senate, would reauthorize a provision in the Coronavirus Aid, Relief, and Economic Security Act (CARES), the economic stimulus bill signed into law by President Trump in March 2020. Currently set to expire in 2025, the bill would continue to fund three crucial, impactful programs through 2030.
“Cancer patients living in rural areas of the United States are diagnosed at later stages, have a higher proportion of their cases unstaged at diagnosis, and are often in a more advanced stage of illness…”
In 2020, the then President of the American Society of Clinical Oncology (ASCO), Howard A. “Skip” Burris III, MD, FACP, FASCO, wrote in a letter to the House Ways and Means Committee when seeking topics that affect the health states and outcomes for rural communities.
The provision for reauthorization includes Rural Health Care Services Outreach Grants to improve the delivery of health care services through community engagement. One Pennsylvania Hospital used this funding in the past to transition its chronic disease program to an online format, allowing patients to access chronic disease management resources without leaving their homes. The Rural Health Network Development Grants help to integrate health care networks, create collaborations, and improve efficiencies and therefore outcomes for patients in rural settings, and the Small Healthcare Provider Quality Improvement Grants help to improve access to critical care access hospitals and rural health clinics and create networks of providers who work together. A frontier town in Northeast Oregon used the funds to place master’s-level health counselors in primary care settings to support lifestyle changes for patients with chronic disease.
Programs funded through the Care in Rural America Reauthorization Act
- Rural Health Care Services Outreach Grants: Originally funded in the late 1980s to improve the delivery of health care services through community engagement and the expansion of evidence-based models, the U.S. Department of Health and Human Services (HHS) provided $15 million to 58 awardees in FY25. For patients with chronic diseases, such as heart failure, diabetes, ischemic heart disease, chronic obstructive pulmonary disease (COPD), hypertension, and obesity, these grants help patients overcome many of the obstacles they face in accessing health care in rural America.
- Rural Health Network Development Grants: Developed in 1997, HHS provided $30 million to 30 grantees in FY24 to integrate healthcare networks, create collaborations, and improve efficiencies and therefore outcomes for patients in rural settings. One program in rural Arizona utilizes this grant to access care coordination and mobile telehealth units, thereby increasing access to quality specialty care.
- Small Healthcare Provider Quality Improvement Grants: Implemented in 2006, HHS provided $2.9 million 3-year grants in FY22 to 15 awardees to improve access to rural health clinics and critical care access hospitals and to create networks of providers who work together.
While none of these programs alone will mitigate the impacts felt by the 1 in 5 Americans who live in rural communities, together they weave a tapestry designed to improve access, increase preventive care — including screening for chronic diseases and prenatal care — and establish provider networks. The bipartisan work required to improve health care in rural America is not yet complete, but it continues to be a prominent example of our leaders leaning in and working together.
PL 119-21, often referred to as the Big Beautiful Bill, signed into Law by President Trump on July 2, 2025, established a $50 billion rural health transformation program, or the Rural Health Fund. Half of the fund will be distributed equally among all states with an approved application. HHS has significant discretion regarding the second half of the fund. The fund will be distributed directly to states. It can be utilized in various ways, including paying for health care services, expanding the workforce in rural communities, and providing technical assistance to transform rural health care. The fund will be available for five years, through 2030. All 50 states have applied for funding.
Meg Kabat is a licensed clinical social worker, former Chief of Staff at the U.S. Department of Veterans Affairs, and former National Director of VA’s Caregiver Support Program.
