83. Michelle's May Matters
Hello one and all, and welcome back to a brand-new episode of "The Rural Impact." I'm Michelle Rathman, and I mean it when I say thank you for joining us again for another conversation that works hard to connect the dots between policy and rural everything.
Well, today's conversation is just between me and you, because when you hear this, I will be at my last day at the National Rural Health Association Annual Meeting, and tonight I will be at, serving my last, I think it's one of my second-to-last policy Congress sessions. So, I'm on the road. But I wanted to bring you kind of Memorial Day, early summer message to kind of let you know what we're working on, because we do have a lot going on.
So, as you've heard me say earlier, in 2026, we launched a number of different series so that we could tackle so many subjects at the same time and just keep the series going. And of course, we are in the middle of our rural health transformation, or we're calling it Tracking Transformation series, and you're going to hear so much more about that because I'm having a lot of conversations this week, and we're gonna be unpacking states' plans state by state as the year goes on, and really understanding the impact of the $50 billion and what that actually looks like on the ground, and who's actually receiving the money, and how it's meeting the people where they are.
So, stay tuned for that. There's a lot going on where that is concerned. Now, we are also going to be continuing our conversations that focus on the impact on counties with respect to policy shifts at the federal level. Where I'm going with this one is I've been very curious to have conversations with county officials who are running their elections for their counties.
With so many states with ballot measures that have to do with voters' rights and redistricting, and we're gonna talk about that in just a moment, we know that county governments are impacted because they are the ones who manage their elections. And when you've got a staff of three, four, or five people, and the need for people to volunteer to do the, the voter polls and so forth, I just really think it's important for us to understand that the impact on everyday people's lives is significant. And so, we're gonna be talking with county officials about that and other matters to be sure.
We're going to be having conversations about the Farm Bill and the progress where that is concerned. I'm excited to have a couple of my phone-a friends come back. I'm not gonna reveal who they are. You're just gonna have to wait to see who they are.
But we're going to go deep into the Farm Bill and really kind of talk about the policy lifts and letdowns because that's important. There are a few silver linings, and at the same time, there are some thunderclouds to be sure. We are also continuing our series focused on rural education. You know, there is not a day that I don't get in my inbox some read that has to do with what's happening there.
And right now, you know, the Department of Education, as of today, the day I'm recording this, which is on the 17th, I'm working on a Sunday, as of today, it doesn't look to be enough votes to completely shutter the Department of Education. However, we are taking a look at what that means for rural schools and students and parents and teachers and resources going into the next school year.
Absolutely must follow that because things don't seem to be getting any better where funding and other policies are concerned on that front. Another subject we're going to be tackling, and honestly, I really wish that we didn't... I don't, I, I wish I didn't feel like we have to, but I really feel compelled that we have to.
You know, I'm recording this on technology, and so we rely on technology every single day. But I'm really struck by what I'm reading and what I'm hearing with respect to data centers and rural communities. These aren't popping up in the middle of urban centers. You know, I find it ironic, and maybe you do as well, where there's a lot of talk about, you know, not expanding alternative energy sources and wind farms and so forth, and yet we are seeing sprawling data centers popping up all across rural America.
And as a result, we are seeing, in particular, out in Georgia, and I saw another one in Idaho, that's on, on the verge of being launched, that is depleting local water sources, which I don't know about you, but in my book, that is not okay. So, we're gonna be talking about data centers and what some alternatives might be and, and how the two can coexist without, you know, deteriorating our public lands and making water sparce.
I mean, water? We have to be in a position where that is a priority for all policymakers to make sure that the people have clean water, uh, and that data centers are not, so to speak, sucking them dry. So, we're gonna be having conversations about that. Oh my gosh, we're also gonna be talking about the US Postal Service because that has not been settled.
As a matter of fact, we're really keeping an eye on that because we do know that so many rural communities, states, in fact, rely on vote by mail, and there is danger ahead. I think that's safe to say where this is concerned. Of course, you know we're gonna be talking about food policy, some pretty significant challenges coming on that front.
And so I also wanna just put out there for you, listen, if you have got a rural policy story that's a lift up, where you can see policies that are lifting up communities and people and places, I wanna hear about that too. I am, as I tell people, I'm a pretty optimistic person, and I really want to see some, some policy that is making shift happen on a positive measure for rural populations anywhere where it happens.
So before I close out, I did, I, I pulled a couple of things that I thought it would bring a little bit more context to kind of the shifts that we are experiencing right now in 2026 and moving into 2027. Back in early 2025, I believe, nearly 45 organizations contributed to the Rural Policy Action Report, and I'm going to make sure that I put that link up on our website 'cause I think you would be, well-advised, if you will, to read that policy report and kind of take a look at what was done last year.
The report, kind of in a nutshell, was designed as a roadmap to build momentum for policies that deliver for rural people. Now, those who contributed to the report represent, listen, a diverse geographic, areas, many areas of expertise, dozens of critical issues that they are well-versed on, and one of the goals of this report was to ensure that rural people be included in influencing decisions that directly impact their lives.
There is a favorite saying of mine that goes something to the effect of, "When you are not at the table, you're on the menu," and I think that's kind of the premise of that one. So such an example cited in the report was the 2024 Missouri voter victory at the time after organizing for a ballot initiative, that rose the minimum, state's minimum wage and established paid sick leave, and this is something that, you know, that again, the Missouri voters agreed on, and the majority, they put it on the ballot, they voted, and it was victorious.
But then came the legislative response, which was not, shall I say, a surprise. But despite the voter approval, the Republican-led Missouri legislature then passed HB 567 in May of 2025 to repeal this paid sick leave portion before it could take effect, citing business concerns, and this means the paid sick leave mandate was not in place as of August 28th, 2025, and the minimum wage tie to the consumer price index was also removed.
And I say this, I'm bringing this up today because of current events. You have heard me say again over and over on this podcast, all roads to quality of life are paved by policy, and right now, where this is concerned in places like Virginia, where the will of the voters were just recently overturned on the matters of redistricting, and of course in dozens of states, again, right now, citizen-initiated ballot measures are pending, and they have focused on access to reproductive healthcare as an example, as well as dozens of legislatively referred ballot measures that seek to further diminish voters' rights and access to healthcare, Just to name a few.
So just Google that and see what you come up with, and then put in the word rural and see what you come up with. I think you might be, maybe, maybe not surprised. Now, in addition to the rollercoaster ride that is the ballot measure mania that we're seeing right now, we're also facing, frankly, a tsunami of difficult changes, coming at every state with respect to Medicaid work requirement reporting.
Why does this matter? Well, you may already know that on May 1st, this just a few weeks ago, Nebraska became the first state in the country to enforce Medicaid work requirements under HR1, that is, the Federal Reconciliation Law. At its core, the rule is that able-bodied adults ages 19 to 64 on Medicaid expansion must now document at least 80 hours per month of qualifying activity, including paid work, school, job training, or volunteering.
Now, if they cannot prove it, they risk dis-enrollment, and as many experts following this have reported, including my go-to source, and it might be one of yours as well, KFF, most of these adults already qualify, and it is estimated that roughly 65%, that is more than half of the expansion adults without dependent children already work 80 or more hours per month.
And you know, you might be thinking, "Well, great. What's the problem? Who cares then? What, what's it matter?" Well, without going into, kind of the fine print, here is the harsh reality. Coverage losses are not going to come from people who do not work. They are going to come from people who cannot navigate the paperwork, or in many places, cannot navigate a system that has yet to be built to ensure they are reporting.
Make that make sense. It is truly, in many places, building the plane while it's flying, and so we are really, I... There's a phrase I think of, like jumping through fire hoops to comply. So, we need, need to be paying attention to this because we only need to take a look at Arkansas for a preview of what's to come.
And if you don't recall what happened in Arkansas, that's when tens of thousands of individuals lost their coverage, and of those who were dis-enrolled were actually working. However, documentation proved to be the real problem. So, through no fault of their own, a fault of the system, they lost their coverage.
Taking a deep breath. Now on top of these devastating impacts, and of course ACA tax credits expirations and coverage loss, KFF is projecting Medicaid work requirements nationally, rolling out state by state through 2027 could leave 7.5 million more, that's additional, Americans uninsured by 2034, and of that, 5.3 million would be directly attributable to work requirement disenrollments.
Don't even get me started on how many children. I'm going to bring back one of my, very soon, hopefully Joan Alker,from Georgetown Center on Children and Families. If you're hearing me, Joan, the invitation is open to you because I am really following your work, and I think it's important for us to make sure that we keep an eye on that.
Because connecting more dots, because that's what we do here, for safety net providers operating like rural critical access hospitals in rural, places and of course FQHCs or community health centers as they're called, these policy decisions will and are already fundamentally threatening their existence.
So, I want you to look around. If you live anywhere in a rural place where you've got a critical access hospital or a community health center right now operating, they are really making, having to make some really challenging decisions because patients who lose their Medicaid do not automatically no longer need healthcare.
And when they do lose their insurance, you can absolutely expect them to present as uninsured with less of an ability to pay at an urgent care clinic if one exists in your rural community and the emergency room, which of course as we know, is the most expensive level of care. And I'm looking at it even further because I'm also taking a look at how challenging it is right now for EMS in rural communities as well.
And I'm gonna say there's no magic wand, there's no $50 billion fund, no $50 billion fund that's going to transform this. So, we have some significant challenges before us, okay? And healthcare, I'm gonna say this before we close out, it is political. I wish it were not the case, but it is, and the proof is in the policies.
And the more we acknowledge this fact, perhaps the more informed our decisions can be as to who we elect to serve and make these crucial decisions for us. This, my friends, if I can call you that, should not be a lightning rod subject or a taboo topic for us to talk about when the truth is that when we see millions, multi-millions of people, of Americans lose their access to healthcare, to the nutrition services, to life supports, and then putting safety net health providers in financial peril.
As I said to somebody on LinkedIn, you know who you are, I like to dance, and people who know me know I do, but I do not dance around these issues. So, with that, I'm gonna close out today, and I'm just gonna remind you that, we do appreciate that you have subscribed to "The Rural Impact." We encourage you, I encourage you to follow me on social.
I really do welcome your comments. I hope that you'll leave some, you'll rate us. Subscribe on any channel that you like. And before you leave, go to our website, theruralimpact.com. Go to our resource page, where you're gonna find past episodes, of course, and all the resources, and the papers that we're documenting, and the great reports that we're finding, and all the great information, and really enlightening information that our guests provide us to be able to share with you very easily without having to click all over the internet.
You can find rural-focused policy and issues and matters of that on our website. And that is also where you can get your merch. I just ordered myself another water bottle 'cause I wanted to have one for the road. So again, visit theruralimpact.com. When you make a purchase, you are supporting our work to bring you these dot-connecting conversations.
We know they are not light subjects, but as always, our goal is to enlighten. Until the next time we are together, I'm gonna do it every time, I'm gonna invite you to take the best possible care of yourself, and to the best of your ability, all those around you. I want you to stay tuned because we've got some news coming up just after this.
Don't leave us yet, about a wonderful event that we are hosting here on "The Rural Impact" on June 22nd. So, stay tuned for that. We'll see you soon.
