Unsteady Ground and Policy Shifts
Oct 13, 2025
It’s been a minute since you received an update from us, but don’t think for one second that the break was because we’d forgotten about you!
Hardly! Instead of a summer vacation, we’ve been busy producing new episodes that we hope have exceeded your expectations for connecting the dots between policy and rural quality of life.
If you’re following along, you know there is no shortage of seismic policy shifts rocking America’s rural world, and at the top of the list is health care and cuts that experts warn, will shutter hospitals and leave millions of people, including children, without coverage.
In step with Medicaid cuts come devastating reductions in the USDA’s Supplemental Nutrition Assistance Program (SNAP), which will hit rural populations particularly hard, because of major structural changes to how SNAP is financed and changes to work requirements for adults. The Congressional Budget Office (CBO) estimates that these statutory changes would remove more than 3 million Americans from the program in an average month, reducing spending by more than $92 billion over 10 years.
Here’s a few of the top rural health and other policy issues we’re tracking:
- The Rural Health Transformation Fund (RHTF), which is a $50 billion stipend for state grants, (DC and the U.S. territories excluded) providing a little over one-third (37%) of the estimated loss of federal Medicaid funding in rural areas. While the media and politicians alike have referred to the RHTF as a “rural hospital fund,” it is not.
- ACA Marketplace Premium Payments if Enhanced Premium Tax Credits Expire – As a part of the Biden Administration Inflation Reduction Act, enhanced tax credits were extended through the end of 2025. In a nutshell, ACA provisions capped how much subsidized enrollees pay for their health insurance premiums, calculated on a sliding scale and based on a percentage of income, with the federal government covering the remainder in the form of a tax credit. This keeps plan costs lower for enrollees. If the enhanced tax credits expire, premiums will rise by hundreds or even thousands per year for individuals and families.
Check our resource page for curated articles and references for more details.
In case you’ve yet to download and listen to the following episode, here’s a recap of Michelle’s conversations focused on the rural health care policy front.
Episode #66
HRSA's Dwindling Rural Health Commitments with Carole Johnson, Toniann Richard, and Alexa McKinley Abel
Rural health policy is one of many conversations we brought to you over the summer. In August, Michelle sat down with Dr. Jeff Strohl, Research Professor and Director of the Georgetown University Center on Education and Workforce (CEW), to discuss Bridging the Middle-Skills Gap in rural America, followed by a conversation about the impact of tariffs on rural households with Gbenga Ajilore, Chief Economist at the Center on Budget and Policy Priorities.
Another summer special included a conversation about Rural Prosperity and its Connection to Policies: Past, Present & Future with Tony Pipa, Senior Fellow in the Center for Sustainable Development at the Brookings Institution, and Brent Orrell, a Senior Fellow at the American Enterprise Institute. Together, they explore their combined efforts to garner bipartisan support for rural economic transformation, workforce development in the era of AI, the importance of infrastructure, climate change resilience, enhancing health outcomes, and the need for effective governance and policy coordination. We conclude this episode by hearing from Matt Hildreth, Executive Director of RuralOrganizing and RuralProgress, a nationwide network of nearly one million advocates and civic leaders in small towns and rural communities that have successfully advocated for over $1 billion in new economic prosperity programs for economically disadvantaged communities.
UP NEXT…
COMING October 9, 2025, our guests answer the question,
“Are States Ready to Implement HR 1 and Medicaid Work Reporting Requirements?”
We’ll also hear from The Rural Urban Bridge Initiative about their “Community Works” mission, which is to build relationships and trust across political differences by working together to address local needs, and coming soon, we’re covering the childcare crisisand policy solutions, aging in place with dignity, resources and grace and the roadblocks that policy either place or remove for rural seniors, and stay tuned for a critical conversation focused on the impact of unprecedented threats to nonprofits, their freedom to give and the direct effect on rural philanthropy.
