December 9, 2025 • 40 mins
Impending Medicaid cuts, the One Big Beautiful Bill Act’s defunding of Planned Parenthood, and the freezing of Title X funding have fueled clinic closures across rural areas. Ashley Kurzweil, Senior Policy Analyst for Reproductive Health and Rights at the National Partnership for Women and Families and Sarah Coombs, Director for Health System Transformation at the National Partnership for Women and Families sit down to talk with us about the future of rural hospitals and clinics and the patients they care for.
Many Medicaid cuts will take effect in January of 2027. One of the most immediate impacts of the law is the failure to extend premium tax credits-- which helps those who do not have access to Medicaid or employer-sponsored health coverage-- afford marketplace coverage. Rural residents, who have higher rates of Medicaid coverage and benefits from enhanced ACA premium tax credits, will be disproportionately affected. Increased financial strain will be placed on these rural hospitals, and maternal health programs, labor and delivery units, and reproductive health care clinics will be dire in rural areas. This will disproportionality impact Black communities, indigenous communities, and Latina communities, as well as rural health workers.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Jennie (01:17):
Welcome to rePROs Fight Back, a podcast on all things
related to sexual andreproductive health, rights, and
justice.
Hey rePROs, how's everybodydoing?
I'm your host, Jennie Wetter,and my pronouns are she/her.
So, I have been trying to bereally good this year and not
(01:40):
buy a bunch of books and readthe ones I already have on my
e-reader.
It has gone okay.
I know.
I saw this great sticker that Ifeel like fits me perfectly.
It says, "I'm not a bookworm,I'm a book dragon." I mean, yes,
I hoard books.
(02:01):
It happens.
There, I feel like there areworse addictions I could have
and worse things I could do thanbuy all the books I want to
read.
But I've been really trying toput effort in into not buying,
but I feel like what has thathas turned into then is I have
like a wish list of books, andthen I'll get a like Barnes and
(02:24):
Noble.
We're having triple sticker or25% off all pre-orders or
whatever.
And then I will go on like aspree and make up for all of the
books that I read off of my TBRand generally more.
So, it's not going great.
But I'm I'm still putting theeffort in and trying and trying
(02:48):
to not uh be a book hoarder.
But I think that's just mything, y'all.
I think I'm just a bookhoarder.
It's not like I never readthem, it just takes me a while,
but my but my list on uh on mylittle iPad mini of books that
are on it right now is kind oflong and I really need to read
it down a little bit.
(03:09):
So, I'm still gonna work on it.
But that all being said, it'sholiday season and I love
nothing more around the holidaysthan to read cheesy Christmas
romances.
So, if y'all have anysuggestions for ones you like or
have found fun, send them myway, please.
(03:30):
I'm gonna get a couple to readover the holidays.
So if you have some you love,let me know.
You can email me atjennie@reprosfightback.org.
Or feel free to reach out to meon social media at @JennieInDC
on Bluesky.
I still have an account onTwitter, I'm just not there as
(03:53):
much.
But feel free to reach out tome at either place and let me
know of any fun, cheesy holidayromances that you uh feel like I
should read.
Yeah.
And maybe next year will bebetter about the book hoarding.
I doubt it.
But maybe.
I did just buy some again, andI know, I know.
(04:15):
But like I said, there areworse problems to have, and I
will read them all eventually,most likely.
It is my one one really badthing if I do book hoard.
But I love it.
Okay, let's see.
What else is exciting and new?
I don't know.
I am getting ready to head upto New York for a quick visit,
(04:39):
see an old roommate and go outfor dinner, have a couple things
that I need to do.
I'm hoping to maybe hit up uhthe holiday market at some point
in Bryan Park.
So, we'll hopefully hit that upat some point while I'm up
there.
But yeah, I so looking forwardto that.
(04:59):
Uh other than that, I just feellike work has been a little
wild.
I've had a lot of things anddeadlines and uh things to get
out.
Ooh, uh I should also messmention our Senior Fellow
Preston Mitchum released a brandnew brief that you all should
check out.
We'll make sure to include itin the show notes.
It is a great brief. Preston issuch a great writer, so make
(05:22):
sure to check it out.
It's up on our socials, butI'll make sure that we have the
link in the show notes as well.
With that, let's go to thisweek's episode.
This is one that is near anddear to my heart.
I mean, honestly, so many ofthem are, because I'm the host
and I pick our topics.
So, we get to talk about thingsI care about.
But this one hits very close tohome, literally.
(05:45):
We're gonna be talking aboutthe cuts to Medicaid and what
this is gonna mean to ruralhospitals.
As many of you know, I am fromrural Wisconsin.
The hospital that I grew upgoing to is considered a rural
hospital.
So, hearing about how all ofthese Medicaid cuts are gonna
impact rural hospitals reallydoes hit very near and dear.
So with that, let's turn tothis week's interview.
(06:09):
I have two wonderful guestsfrom the National Partnership
for Women and Families,Ashley Kurzweil and Sarah
Coombs.
And with that, let's go to myinterview with Ashley and Sarah.
Hi, Ashley and Sarah.
Thank you so much for beinghere today.
Thanks so much for having us,Jennie.
Thank you so much for havingus.
(06:30):
Before we get started, wouldyou like to take a minute and
introduce yourselves?
Um, let's go alphabetical.
Ashley, go first.
Ashley (06:38):
Thanks so much, Jennie.
Hi, everyone.
Ashley Kurzweil, I use she/herpronouns, and I'm the Senior
Policy Analyst for ReproductiveHealth and Rights at the
National Partnership for Womenand Families.
Sarah (06:50):
Hey, y'all.
I'm Sarah Coombs.
I use she/her pronouns.
I'm the Director for HealthSystem Transformation also at
the National Partnership.
Jennie (06:58):
I am so excited to talk to y'all, particularly about
rural hospitals.
I think that's something that alot of people don't necessarily
think about a lot, but um thehospital where I'm from would be
considered a is considered arural hospital.
So it is something that isdefinitely near and dear to my
heart.
I still have family that goesto that hospital.
(07:19):
So, it is something that Ialways kind of keep a close eye
on.
So, let's talk about it.
Tell us a little bit aboutrural hospitals and why this is
such an important issue rightnow.
Sarah (07:31):
Yeah, first, I think we should step back and talk about
the big looming Medicaid cutsthat we are expecting to see.
I think we all know by now thatin July, President Trump um
signed into law over onetrillion cuts in Medicaid, also
known as or HR one, also knownas the "One Big Beautiful Bill
(07:54):
Act." And this is considered oneof the most harmful uh pieces
of health legislation in UShistory.
It's the largest rollbag offederal support for health care.
Many of the Medicaid provisionsdon't take effect until January
2027, which of course wasintentional.
And those include, you know,things that we all know about,
you know, Medicaid workreporting requirements, freezes
(08:16):
and provider taxes, you know,which most states use to help
finance their Medicaid costs.
But I would say the mostimmediate impact of the law is
that President Trump andcongressional Republicans failed
to extend what are called theAffordable Care Acts enhanced
premium tax credits that are setto expire at the end of this
(08:37):
year.
Um and these premium taxcredits are so essential uh in
helping people who don't qualifyfor Medicaid or have access to
employer-sponsor coverage,whether because they work
part-time or they are a smallbusiness owner, it helps them
afford individual marketplacecoverage.
And in 2025, nine in 10 ACAmarketplace enrollees had or
(09:02):
received premium tax credits.
That's about 22 million people.
So taking, you know, theMedicaid cuts, the ACA
provisions in the law, CBOestimates, as the Congressional
Budget Office, estimates thatthis law will result in 10
million more people becominguninsured by 2034.
And this willdisproportionately affect rural
(09:25):
residents who have higher ratesof Medicaid coverage and who
disproportionately benefit fromthe enhanced ACA previous tax
credits.
The estimated loss of coveragewill lead to increased
compensated care for ruralhospitals and will also place
increased financial strain onthose hospitals.
And as you probably know,Jennie, I know that you said
you're from Wisconsin, the ruralhospitals are already
(09:48):
struggling with over 100 thathave closed already in the last
decade.
So faced with additionalfinancial loss, many rural
hospitals may be forced to stopproviding certain services or
close altogether, leaving adevastating impact on access to
essential health services inrural communities.
So, I think that really gets usthinking about how this bill
(10:11):
will really impact rural healthin ways that I don't think a lot
of people really understand.
Jennie (10:17):
And I also think the other thing I've been thinking
about too is people may not knowthat their hospital is a
considered a rural hospital,right?
So uh the I live uh outside oftown, but the the city where the
hospital is located, Beloit,Wisconsin, is like, I don't
know, it's been a while sinceI've seen the population number.
It was like 35,000, 40,000people.
(10:38):
So like they may not think thatthat hospital is considered a
rural hospital.
So I think there's a lot ofpeople across the country who
may not know that this is goingto impact their hospital.
Sarah (10:49):
Absolutely.
And I think a lot of peopledon't realize that, you know,
whether you have Medicaidinsurance, private coverage,
employer-sponsored coverage, itdoes not matter what type of
insurance coverage you have,everyone will be impacted by
these cuts.
Everyone who can access or hasaccess to those hospitals that
(11:10):
are at risk of closing, they arealso at risk of losing their
hospital access.
And I think this also what ismost striking to us is the
impact on what this means foraccess to maternal health.
And so, of course, the NationalPartnership for Women and
Families, one of our biggestissue areas is maternal health.
(11:30):
And we know that Medicaid is alifeline for maternity care in
rural communities.
And so we're really taking aclose look at how this bill will
impact maternal health asMedicaid pays for nearly nearly
half of all births in ruralareas.
Jennie (11:44):
Perfect transition.
Let's turn to (11:46):
what is the impact going to be around
maternal health?
Sarah (11:50):
Yeah, sure.
I, so, typically, you know,maternity care services are the
first to be sacrificed when ahealth system is struggling
financially because, well, one,Medicaid reimbursement rates are
subpar for maternity care.
And there are also seriousworkforce shortages and high
operational costs as well.
So, we looked at data that wasreleased from the University of
(12:14):
North Carolina SHEP Center overthe summer that identified 338
rural hospitals that were atrisk or are at risk of closing
due to the potential Medicaidcuts.
So we wanted to take a deeperlook into how these potential
cuts, for closures rather, wouldimpact maternal health in rural
(12:35):
communities.
Because after all, we areliving um in a maternal health
crisis where the US is the mostdangerous place to give birth,
especially for Black,Indigenous, and rural women.
So based off of UNC'sfoundational research, we found
that there are 131 ruralhospitals with Labor and
Delivery units that are at riskof closing due to anticipated
(12:57):
cuts under HR 1.
And this is actually a prettyconservative number given the
narrow financial criteria thatthe researchers used.
But the number of potentialclosures represents a total of
126 counties across 39 statesthat may be impacted.
And what's striking is that 96of these counties are at risk of
(13:19):
losing their only source ofhospital-based obstetric care or
birthing services in hospitals.
So, we found that the stateswith the highest number of
at-risk Labor and Delivery unitswere Kentucky, California, New
Mexico, Louisiana, Indiana, andWashington State.
And that's not so surprisingbecause those states have the
(13:42):
highest percentage of Medicaidenrollees in their states.
But again, our analysis doesnot really paint the complete
picture.
States that we identified withfew or no at-risk hospitals,
like states like Georgia orWisconsin, for example, could
reflect that these states arealready have limited access to
(14:03):
maternal health care.
So I think, you know, I thinkit's also just to take into
account when you see thesenumbers, is to contextualize it
that some of these states arealready, you know, facing or
undergoing um maternity carecrisis.
And it's also really criticalto discuss how these attacks on
healthcare access also intactprotective health care.
Jennie (14:25):
Yeah, I was definitely when I was looking through the
report y'all put out, uh wasshocked at some of the states
that uh that weren't at risk.
And you explained it perfectlybecause I was like, oh, that's
surprising that some of thesearen't at risk.
But when you're like, no,because they've probably already
closed a lot of those Labor andDelivery units, then it was
(14:47):
like, oh, that would be why.
Okay, so let's turn toreproductive health care because
this is also gonna impact that.
Ashley (14:55):
Yeah, thanks so much, Jennie.
So for many, the link betweenMedicaid cuts, hospital
closures, and abortion accessisn't obvious.
But it's so important that weelevate how these attacks that
Sarah described on ourhealthcare systems also harm
(15:16):
reproductive healthcare becausethe impacts on access are
already immense.
And the situation is likely toonly grow more dire, especially
for people in rural areas.
The bottom line here when itcomes to repro is that health
care cuts and the dismantling ofhealth systems impact all
(15:39):
pregnancy care, includingabortion care.
So when hospitals are forced toreduce the maternity care
services that they offer, or cutstaff, or shut down operations
entirely, that affects theavailability of a range of
obstetric and gynecologicalservices.
(16:00):
And in addition to thepotential lever and delivery
unit closures that Sarahmentioned, we're seeing dozens
of hospitals close all togethersince the passage of these
Medicaid cuts a few months ago.
The national partnershipactually put together a hospital
hit list to really track thisdevastation.
(16:20):
And all these closures erodeaccess to full spectrum
reproductive and pregnancy carefrom emergency abortion care
that patients get in hospitalsto services for a high-risk
pregnancy that they get in Laborand Delivery units to family
(16:41):
planning services that they getfrom their OBGYN.
So you have to consider thefull picture.
And if OBGYNs are forced toshift the services that they
(17:03):
provide or relocate becausetheir unit or their hospital
closes, patients can't access arange of reproductive health
services that OBGYNs offer, fromabortion care to childbirth
services to cancer screenings.
And rural areas already facesteep shortages of OBGYNs who
(17:27):
are essential in providingpreventive services that rural
folks depend on, likecontraceptive counseling and STI
screening and testing.
Especially in the wake of theDobbs decision, many OBGYNs have
been forced not to practice ortrain in states with abortion
(17:48):
bans, which has really worsenedprovider shortages in many rural
areas.
And I have to go here nextbecause it's so crucial to put
the shuttering of hospitals andLabor and Delivery units in full
context.
The Medicaid cuts that Sarahtalked about not only led to the
(18:10):
closure of these facilities,but also to reproductive health
clinic closures, as you know alltoo well, Jennie.
Anti-abortion extremistpoliticians used the budget bill
to not only attack marginalizedpeople's access to health care,
but also to ram through abackdoor ban on abortion care by
(18:35):
defunding Planned Parenthood.
So the budget bill prohibitsMedicaid reimbursements to
Planned Parenthood healthcenters.
And the majority of clinicsthat have been at risk of
closure because of thisfinancial loss are in rural
areas, medically underservedareas and areas with provider
(18:56):
shortages.
And it's really outrageous thatthese closures are taking away
health care for patients thatare most in need, like folks in
rural and low-income communitiesand people of color who already
face the most barriers toaccess.
So now patients are in asituation where they are having
(19:17):
to go without reproductivehealth care or they're having to
contend with long wait times ordelays or travel super far to
find any affordable services.
So the logistical and financialobstacles that then come with
the need to travel greaterdistances for care can be
(19:39):
prohibitive for patients thatwant abortion care or need
abortion care.
And having to take often unpaidtime off of work to travel far
to go to a provider and incurexpenses for lodging and
transportation and child careand the cost of the procedural
(20:02):
itself really add up.
So when you look at everythingall together, the Republican
budget bill is waging waragainst women and birthing
people on multiple fronts.
It's closing reproductivehealth care clinics and making
family planning and abortioncare completely unattainable
(20:23):
while at the same time cruellyshuttering hospitals and Labor
and Delivery units that make itharder for people to get the
maternal health care that theyneed.
That is just, like, so much allin like one terrible, terrible
bill attacking access to preventpregnancy, access for maternal
(20:46):
health care.
This is so much.
And I think there are somedistinct challenges that are
faced by people in rural areas.
So, what are some of thedistinct challenges that we are
going to see people in ruralareas encountering?
It's such a good question to really highlight
these uh unique strugglesbecause rural women's access to
(21:10):
reproductive care has alreadybeen fraught for a Long time
with legal barriers, logisticalobstacles, financial challenges,
but it's only gotten worseunder Trump in particular,
especially taken togetherMedicaid cuts, Planned
(21:31):
Parenthood defund[ing], and thefreezing of Title X family
planning program funding that,you know, that fuels more clinic
closures, add-on abortion bans,and add on so many other
restrictive anti-abortionpolicies, and you have a mess.
It essentially delivers a deathby a thousand cuts to rural
(21:55):
reproductive health care access.
And the national partnershipback in June released research
on the impacts of abortion bansand criminalization three years
post-Dobbs.
And we focused in on a varietyof marginalized communities and
how they are really impacted bythose restrictive policies.
(22:17):
So we found that women who livein rural areas are especially
likely to live in the 22 stateswhere abortion is banned or
under threat.
Specifically, we found that 2.6million women of reproductive
age, or 50% of all rural womenof reproductive age, live in
(22:41):
these states without abortionaccess.
And systemic underinvestment inrural areas and structural
inequities and health care makereproductive care even less
accessible for many Black,Indigenous and people in rural
(23:02):
communities.
Plus, research shows that ruralworkers have less access to
paid sick days and paid leavethat are really essential when
you have to travel what could behundreds of miles or across
state lines to get abortioncare.
And nobody should ever have torisk losing their job or their
(23:26):
paycheck because they have totake this time off to travel for
essential health care.
But a lot of pregnant peopleare being put in this impossible
bind when navigating theever-mounting barriers to
reproductive health care.
What this means in practice ishorrifying.
People living in states andrural areas with limited access
(23:50):
to abortion because of bans andprovider shortages and hospital
closures face health risks andeven forced pregnancy.
We've seen countless stories ofjust harrowing delays in
emergency abortion provision andfatal denials of care, in
(24:12):
particular since the Dobbsdecision.
Many people have been forced tocontinue pregnancies that are
nonviable or that put their ownlives in jeopardy.
And the irony is also not loston me that the same extremists
who pushed Medicaid and Title Xcuts that are forcing all these
(24:36):
reproductive health clinics toclose across the country are
bankrolling crisis pregnancycenters.
And for folks that reallyaren't aware of what these
anti-abortion fake clinics areup to and where they're located,
I want to just provide a littlebit more information because
(24:56):
anti-abortion "crisis pregnancycenters" are super prevalent in
rural communities by design.
It's all on purpose.
They exploit gaps in access tocare to target rural women with
misleading and coerciveanti-abortion propaganda.
(25:17):
They try to pass themselves offas you know viable alternatives
to reproductive care, butthey're typically run by
individuals with little to nomedical experience and they
misinform people about theirreproductive health options and
try to dissuade them fromseeking reproductive care and
abortion care.
So ultimately, this is howanti-abortion extremists take
(25:43):
away reproductive health carefrom people by making it
impossible to access.
And the Republican budget billin particular ratcheted up this
strategy, and rural communitiesand other marginalized groups
are really bearing the brunt.
Jennie (26:00):
Yeah, and I also think it's important that people who
may not be familiar with likerural areas as much of like
hearing that their localhospital is closing or their
local Labor and Delivery unit isclosing, it may be a
significant distance to get tothe next available Labor and
Delivery unit.
So I think for people who livein more urban areas or like
(26:24):
where I grew up was rural, butit's not that rural.
So, like, our next closesthospital is further, but it's
not like super significantlyfurther.
But there are people who livein much further out rural areas
where the next availablehospital could be ours.
Sarah (26:40):
Yeah.
And when you think about whenwomen have to travel further for
care, uh, for women in ruralareas, this does often mean
traveling 30 to 60 miles or morein order to get to a hospital
once they go into labor.
And that, you know, when whereevery minute is critical, um,
particularly in emergencysituations.
(27:01):
And in some cases, it wouldmake it even more difficult to
access, you know, their routineprenatal appointments.
So a lot of people will justend up delaying or skipping
their prenatal care, which is socrucial to their maternal
health outcomes as well.
Yeah, and the farther thetravel, the greater the risk of
maternal morbidity and adverseinfant outcomes such as
(27:21):
stillbirth and NICU admission.
I mean, when you think aboutit, like imagine a mother having
to travel or birthing personhaving to travel an hour just to
deliver a birth.
You know, I'm a mom, you know,I live in DC.
And while I was in active laborwith my second child, I barely
made it in time under 20 minutesto of travel.
(27:44):
It's just unimaginable.
And we can have a separateconversation about DC as a
maternity care desert and theimpact on urban and safety net
hospitals that this that thisbill would have.
But I think it is reallyimportant to really put into
context what this means becauseI'm so glad that you asked this
question.
It's easy to forget when we'retalking about, like, numbers and
(28:05):
potential risk and statistics,that we really lose sight of
what this all means for peopleand who was disproportionately
impacted.
And I just we we wanted to, youknow, dive a little bit deeper
into that uh analysis of thehospitals that are at risk of
closing their Labor and Deliveryunits.
And we found that 10% ofIndigenous women in the US live
(28:26):
in those 126 counties that areat risk of losing their Labor
and Delivery units.
In fact, they are the mostdisproportionately impacted
group of women that may beimpacted by these potential
closures.
And while it's unsurprising, umit's still devastating, as this
would further compound thematernal mortality crisis as
(28:47):
American Indian and AlaskaNative women experience some of
the highest rates of maternalmortality and morbidity in the
U.S.
We also found that Latinos arealso disproportionately likely
to live in affected counties andthat women at risk of losing
their only hospital withbirthing services are more
likely to be poor and have lowereducational attainment.
(29:08):
And so we just had to rememberthat behind every data point is
a family whose lives could beupended in an instant when care
isn't available.
And when these Labor andDelivery units close, families
are really left without the carethat they need when they need
it most.
And so, I think it's just soimportant to put in into context
what this bill would will dofor families, particularly at a
(29:32):
time when our healthcaresystem's already broken.
Our healthcare system isalready struggling, we're in
crisis.
And then think about who willbe disproportionately impacted.
And then this will indeedexacerbate inequities, you know,
as higher income and moreeducated individuals are more
likely to be able to try totravel further, like Ashley
mentioned, to go across statestate lines to access better
(29:53):
maternally related care orabortion services for those who
live in abortion advanced stateswho need to go across state
lines to access abortion care.
That's going to furtherexacerbate and deepen
inequities.
Jennie (30:06):
So we spend a lot of time talking about the health
impacts and how people's accessto health care is going to be
impacted, but that's not theonly groups that are going to be
impacted.
So maybe we should take aminute and talk about workforce
and how this is going to impactpeople who work at the
hospitals.
Sarah (30:22):
Absolutely.
Yeah.
The Republican budget bill andthe Medicaid cuts will have
devastating consequences for notonly health outcomes, as you
mentioned, but also jobs and theeconomy of rural communities.
Labor and Delivery unitclosures and hospital closures
in general can like reallydestabilize entire communities.
A Labor and Delivery unitclosure can result in declining
(30:44):
patient volumes, which can thenput other critical health
services at risk of cutbacks orcuts to local healthcare jobs.
And then imagine when ahospital shuts down or a Labor
and Delivery unit shuts down,then the nearby hospital that is
able to continue to offer thoseservices can now become
potentially overburdened as theyabsorb those patients from
(31:07):
other areas.
That could lead tounderstaffing, burnout, strained
resources, and ultimatelyworkforce shortages.
So it's like a vicious cycle.
And then the entire communitycan just feel the ripple
effects, particularly women, asmore than 80% of people working
in hospitals in rural areas arewomen.
(31:27):
So these impacts are justcompounded.
You know, you lose your job andyou lose your access to
hospital-based birthingservices.
That's just devastating.
Jennie (31:40):
It's like you just keep pulling back the layers, and
there's just, like, moreterrible underneath all the
terrible.
Okay, so I don't want to focusanymore on the like, this is all
terrible, because that is sofrustrating and just makes me
angry.
So let's like redirect myanger.
What can we do?
What can the audience do topush back in this moment?
Sarah (32:02):
So, one, I think it's so crucial, especially now in this
moment where we couldpotentially face yet another
shutdown, unfortunately, inJanuary, that people share their
stories.
Uh, right now, the the focalpoint in Congress is whether and
how to extend those ACA premiumtax credits.
(32:25):
And so if folks can share howhaving affordable health
insurance with premium taxcredits have helped them and
their communities, that could goa long way.
Sharing stories is the best wayto help make this issue a
priority for the public, themedia, and policymakers.
I also, you know, would urgefolks to contact their
(32:50):
representatives to advocate forextending the enhanced tax
credits because again, they willexpire at the end of this year,
at the end of this month, ifCongress does nothing.
Members of Congress um made apromise when they reopened the
government last month that uhthey would address the issue by
(33:13):
mid-December, by mid this month.
We're already, it's December4th today, and we had yet to see
real movement on a solution toextend those tax credits.
So encourage folks to contacttheir representatives.
I also think that it'simportant to just raise
awareness of what is happeningin their local communities,
(33:37):
raise awareness of why this isso important to everyone.
As Ashley mentioned, one of ourcolleagues, Mackenzie, our
amazing communications intern,has put together a hospital hit
list that she has shared on ourTikTok.
And that has really beenhelpful to raise awareness and
(33:58):
spread information, greaterreach to folks that may not be
following us, following ourwebsite, but could be following
us on other platforms tounderstand where these closures
are occurring and how often.
And so, just raising awarenessis also a really important tool.
Ashley (34:16):
Have you hop in here and I really appreciate you
carrying the conversation in apositive direction, Jennie,
because it's so important tohelp people feel empowered to
take action amid suchdevastation.
And this budget bill is part ofthe Project 2025 playbook to
(34:39):
ban abortion nationwide anddismantle public health programs
and roll back civil rights.
So I can share more about whatlisteners can do to address
issues around reproductivehealth care access, especially
for folks in rural areas, uh,because of immense federal
(35:00):
gridlock, and that's putting itlightly around abortion rights.
On issues for access and ruralaccess in particular, I'd say
that it's super important forfolks to advocate for policies
to protect and expandreproductive health care access
(35:22):
to their state representatives.
In particular, I think thatfolks should be advocating for
telehealth medication abortionaccess so that folks in rural
areas that don't have accessiblein-person care can still get
abortion pills mailed to them.
(35:42):
There's a lot to say about howtelehealth can really be a
lifeline for rural communitiesnow, especially telehealth for
reproductive health care, tofill in gaps in access to
contraceptive care, for example,as well, and to counter
provider shortages in rural andunderserved areas.
My other recommendation is abig one.
(36:05):
And it is essential thatlisteners call on their
state-elected officials to passor to strengthen state shield
laws, which help preserve somemeasure of abortion access, even
in states with bans, even forfolks in rural areas.
(36:26):
So, with shield laws, providersof protection from out-of-state
legal action if they mailabortion pills to patients in
states with bans, which is veryindicative of what a lot of
rural folks are facing.
And we know that uh theseshield laws are essential.
(36:46):
And the anti-abortionextremists are targeting them
because they are one of thestrongest tools that we have to
protect abortion access in apost-roe dystopia and
post-Medicaid cuts reality.
So, really important thateveryone uh use their voices to
(37:07):
get behind uh strengthening uhshield laws at the state level.
But if you can't get medicationabortion via telehealth and you
have to cross state lines forabortion care, the costs are
super high, as we talked aboutearlier.
So, as people need to travelmore frequently and longer
(37:30):
distances for care, it isessential that listeners do what
they can to step up and supportabortion funds, including
donating to abortion funds.
As we're thinking about thespecifics on the challenges that
rural people face in accessingreproductive health care and how
(37:52):
to address those hurdles, theneed to travel hundreds of miles
for care and to shoulder thosecosts really stands out to me.
And abortion funds helpfinancially support folks with
all the costs that areassociated with seeking care.
(38:12):
So, community support networks,grassroots organizations, and
abortion funds are movingmountains, literally, to help
make reproductive healthservices more affordable.
And we all need to help themout.
Sarah (38:27):
I'd also like to add thinking about what folks can do
to support or mitigate harms tomaternal health, particularly
in rural areas.
I think folks can urge theirstates to maintain postpartum
coverage for burden people up to12 months.
That is unfortunately anoptional benefit that many
(38:50):
states have opted to take up,but it's an optional benefit.
And with looming Medicaid cuts,states may be in a predicament
where they may need to eliminateoptional benefits like
postpartum coverage, up to 12months.
So, I think we need to urgestates to maintain that
essential coverage as we knowthat a significant percentage of
(39:12):
maternal deaths occur up to oneyear post-birth.
I would also add that just toremind folks that maternity
care, particularly in inlow-risk situations, don't need
to occur in a hospital-basedsetting.
That women should have theautonomy to choose where they
give birth and of course whenand and how.
(39:35):
And so, I think the option forcommunity-based models of care
is so important.
We know that freestandingbirthing centers are so
essential to fill in the gaps.
Should birthing people choosethat setting, if they are
eligible, if they are low riskto be able to choose that
(39:58):
setting.
And there are other maternalhealth perinatal workforce
professionals that really cansupport and fill in the gaps
where they're needed, especiallyin rural areas, um, that
provide prioritized,personalized, accessible,
equitable care to communities.
Jennie (40:16):
And I will be the person to call out.
Almost all states have at thispoint opted for that one-year
expansion on maternal healthcare.
Wisconsin and Arkansas are theonly two who have not, at least
last time I've checked.
So um just putting that outthere, y'all.
Make some noise about that inyour state if you're in one of
(40:39):
those two states in particular.
Okay.
Sarah Ashley, thank you so muchfor being here today.
I had such a wonderful timetalking to you about uh rural
healthcare.
It's great chatting with you aswell.
Sarah (40:52):
Really appreciate the conversation.
Thanks, Jennie.
Jennie (40:56):
Okay, y'all.
I hope you enjoyed myconversation with Sarah and
Ashley.
It was really wonderful to getto talk to them all about rural
hospitals and all of the impactsthat they are going to be
seeing.
So with that, I will seeeverybody next week.
Welcome to rePROs Fight Back, a podcast on all things
related to sexual andreproductive health, rights, and
justice.
Hey rePROs, how's everybodydoing?
I'm your host, Jennie Wetter,and my pronouns are she/her.
So, I have been trying to bereally good this year and not
(01:40):
buy a bunch of books and readthe ones I already have on my
e-reader.
It has gone okay.
I know.
I saw this great sticker that Ifeel like fits me perfectly.
It says, "I'm not a bookworm,I'm a book dragon." I mean, yes,
I hoard books.
(02:01):
It happens.
There, I feel like there areworse addictions I could have
and worse things I could do thanbuy all the books I want to
read.
But I've been really trying toput effort in into not buying,
but I feel like what has thathas turned into then is I have
like a wish list of books, andthen I'll get a like Barnes and
(02:24):
Noble.
We're having triple sticker or25% off all pre-orders or
whatever.
And then I will go on like aspree and make up for all of the
books that I read off of my TBRand generally more.
So, it's not going great.
But I'm I'm still putting theeffort in and trying and trying
(02:48):
to not uh be a book hoarder.
But I think that's just mything, y'all.
I think I'm just a bookhoarder.
It's not like I never readthem, it just takes me a while,
but my but my list on uh on mylittle iPad mini of books that
are on it right now is kind oflong and I really need to read
it down a little bit.
(03:09):
So, I'm still gonna work on it.
But that all being said, it'sholiday season and I love
nothing more around the holidaysthan to read cheesy Christmas
romances.
So, if y'all have anysuggestions for ones you like or
have found fun, send them myway, please.
(03:30):
I'm gonna get a couple to readover the holidays.
So if you have some you love,let me know.
You can email me atjennie@reprosfightback.org.
Or feel free to reach out to meon social media at @JennieInDC
on Bluesky.
I still have an account onTwitter, I'm just not there as
(03:53):
much.
But feel free to reach out tome at either place and let me
know of any fun, cheesy holidayromances that you uh feel like I
should read.
Yeah.
And maybe next year will bebetter about the book hoarding.
I doubt it.
But maybe.
I did just buy some again, andI know, I know.
(04:15):
But like I said, there areworse problems to have, and I
will read them all eventually,most likely.
It is my one one really badthing if I do book hoard.
But I love it.
Okay, let's see.
What else is exciting and new?
I don't know.
I am getting ready to head upto New York for a quick visit,
(04:39):
see an old roommate and go outfor dinner, have a couple things
that I need to do.
I'm hoping to maybe hit up uhthe holiday market at some point
in Bryan Park.
So, we'll hopefully hit that upat some point while I'm up
there.
But yeah, I so looking forwardto that.
(04:59):
Uh other than that, I just feellike work has been a little
wild.
I've had a lot of things anddeadlines and uh things to get
out.
Ooh, uh I should also messmention our Senior Fellow
Preston Mitchum released a brandnew brief that you all should
check out.
We'll make sure to include itin the show notes.
It is a great brief. Preston issuch a great writer, so make
(05:22):
sure to check it out.
It's up on our socials, butI'll make sure that we have the
link in the show notes as well.
With that, let's go to thisweek's episode.
This is one that is near anddear to my heart.
I mean, honestly, so many ofthem are, because I'm the host
and I pick our topics.
So, we get to talk about thingsI care about.
But this one hits very close tohome, literally.
(05:45):
We're gonna be talking aboutthe cuts to Medicaid and what
this is gonna mean to ruralhospitals.
As many of you know, I am fromrural Wisconsin.
The hospital that I grew upgoing to is considered a rural
hospital.
So, hearing about how all ofthese Medicaid cuts are gonna
impact rural hospitals reallydoes hit very near and dear.
So with that, let's turn tothis week's interview.
(06:09):
I have two wonderful guestsfrom the National Partnership
for Women and Families,Ashley Kurzweil and Sarah
Coombs.
And with that, let's go to myinterview with Ashley and Sarah.
Hi, Ashley and Sarah.
Thank you so much for beinghere today.
Thanks so much for having us,Jennie.
Thank you so much for havingus.
(06:30):
Before we get started, wouldyou like to take a minute and
introduce yourselves?
Um, let's go alphabetical.
Ashley, go first.
Ashley (06:38):
Thanks so much, Jennie.
Hi, everyone.
Ashley Kurzweil, I use she/herpronouns, and I'm the Senior
Policy Analyst for ReproductiveHealth and Rights at the
National Partnership for Womenand Families.
Sarah (06:50):
Hey, y'all.
I'm Sarah Coombs.
I use she/her pronouns.
I'm the Director for HealthSystem Transformation also at
the National Partnership.
Jennie (06:58):
I am so excited to talk to y'all, particularly about
rural hospitals.
I think that's something that alot of people don't necessarily
think about a lot, but um thehospital where I'm from would be
considered a is considered arural hospital.
So it is something that isdefinitely near and dear to my
heart.
I still have family that goesto that hospital.
(07:19):
So, it is something that Ialways kind of keep a close eye
on.
So, let's talk about it.
Tell us a little bit aboutrural hospitals and why this is
such an important issue rightnow.
Sarah (07:31):
Yeah, first, I think we should step back and talk about
the big looming Medicaid cutsthat we are expecting to see.
I think we all know by now thatin July, President Trump um
signed into law over onetrillion cuts in Medicaid, also
known as or HR one, also knownas the "One Big Beautiful Bill
(07:54):
Act." And this is considered oneof the most harmful uh pieces
of health legislation in UShistory.
It's the largest rollbag offederal support for health care.
Many of the Medicaid provisionsdon't take effect until January
2027, which of course wasintentional.
And those include, you know,things that we all know about,
you know, Medicaid workreporting requirements, freezes
(08:16):
and provider taxes, you know,which most states use to help
finance their Medicaid costs.
But I would say the mostimmediate impact of the law is
that President Trump andcongressional Republicans failed
to extend what are called theAffordable Care Acts enhanced
premium tax credits that are setto expire at the end of this
(08:37):
year.
Um and these premium taxcredits are so essential uh in
helping people who don't qualifyfor Medicaid or have access to
employer-sponsor coverage,whether because they work
part-time or they are a smallbusiness owner, it helps them
afford individual marketplacecoverage.
And in 2025, nine in 10 ACAmarketplace enrollees had or
(09:02):
received premium tax credits.
That's about 22 million people.
So taking, you know, theMedicaid cuts, the ACA
provisions in the law, CBOestimates, as the Congressional
Budget Office, estimates thatthis law will result in 10
million more people becominguninsured by 2034.
And this willdisproportionately affect rural
(09:25):
residents who have higher ratesof Medicaid coverage and who
disproportionately benefit fromthe enhanced ACA previous tax
credits.
The estimated loss of coveragewill lead to increased
compensated care for ruralhospitals and will also place
increased financial strain onthose hospitals.
And as you probably know,Jennie, I know that you said
you're from Wisconsin, the ruralhospitals are already
(09:48):
struggling with over 100 thathave closed already in the last
decade.
So faced with additionalfinancial loss, many rural
hospitals may be forced to stopproviding certain services or
close altogether, leaving adevastating impact on access to
essential health services inrural communities.
So, I think that really gets usthinking about how this bill
(10:11):
will really impact rural healthin ways that I don't think a lot
of people really understand.
Jennie (10:17):
And I also think the other thing I've been thinking
about too is people may not knowthat their hospital is a
considered a rural hospital,right?
So uh the I live uh outside oftown, but the the city where the
hospital is located, Beloit,Wisconsin, is like, I don't
know, it's been a while sinceI've seen the population number.
It was like 35,000, 40,000people.
(10:38):
So like they may not think thatthat hospital is considered a
rural hospital.
So I think there's a lot ofpeople across the country who
may not know that this is goingto impact their hospital.
Sarah (10:49):
Absolutely.
And I think a lot of peopledon't realize that, you know,
whether you have Medicaidinsurance, private coverage,
employer-sponsored coverage, itdoes not matter what type of
insurance coverage you have,everyone will be impacted by
these cuts.
Everyone who can access or hasaccess to those hospitals that
(11:10):
are at risk of closing, they arealso at risk of losing their
hospital access.
And I think this also what ismost striking to us is the
impact on what this means foraccess to maternal health.
And so, of course, the NationalPartnership for Women and
Families, one of our biggestissue areas is maternal health.
(11:30):
And we know that Medicaid is alifeline for maternity care in
rural communities.
And so we're really taking aclose look at how this bill will
impact maternal health asMedicaid pays for nearly nearly
half of all births in ruralareas.
Jennie (11:44):
Perfect transition.
Let's turn to (11:46):
what is the impact going to be around
maternal health?
Sarah (11:50):
Yeah, sure.
I, so, typically, you know,maternity care services are the
first to be sacrificed when ahealth system is struggling
financially because, well, one,Medicaid reimbursement rates are
subpar for maternity care.
And there are also seriousworkforce shortages and high
operational costs as well.
So, we looked at data that wasreleased from the University of
(12:14):
North Carolina SHEP Center overthe summer that identified 338
rural hospitals that were atrisk or are at risk of closing
due to the potential Medicaidcuts.
So we wanted to take a deeperlook into how these potential
cuts, for closures rather, wouldimpact maternal health in rural
(12:35):
communities.
Because after all, we areliving um in a maternal health
crisis where the US is the mostdangerous place to give birth,
especially for Black,Indigenous, and rural women.
So based off of UNC'sfoundational research, we found
that there are 131 ruralhospitals with Labor and
Delivery units that are at riskof closing due to anticipated
(12:57):
cuts under HR 1.
And this is actually a prettyconservative number given the
narrow financial criteria thatthe researchers used.
But the number of potentialclosures represents a total of
126 counties across 39 statesthat may be impacted.
And what's striking is that 96of these counties are at risk of
(13:19):
losing their only source ofhospital-based obstetric care or
birthing services in hospitals.
So, we found that the stateswith the highest number of
at-risk Labor and Delivery unitswere Kentucky, California, New
Mexico, Louisiana, Indiana, andWashington State.
And that's not so surprisingbecause those states have the
(13:42):
highest percentage of Medicaidenrollees in their states.
But again, our analysis doesnot really paint the complete
picture.
States that we identified withfew or no at-risk hospitals,
like states like Georgia orWisconsin, for example, could
reflect that these states arealready have limited access to
(14:03):
maternal health care.
So I think, you know, I thinkit's also just to take into
account when you see thesenumbers, is to contextualize it
that some of these states arealready, you know, facing or
undergoing um maternity carecrisis.
And it's also really criticalto discuss how these attacks on
healthcare access also intactprotective health care.
Jennie (14:25):
Yeah, I was definitely when I was looking through the
report y'all put out, uh wasshocked at some of the states
that uh that weren't at risk.
And you explained it perfectlybecause I was like, oh, that's
surprising that some of thesearen't at risk.
But when you're like, no,because they've probably already
closed a lot of those Labor andDelivery units, then it was
(14:47):
like, oh, that would be why.
Okay, so let's turn toreproductive health care because
this is also gonna impact that.
Ashley (14:55):
Yeah, thanks so much, Jennie.
So for many, the link betweenMedicaid cuts, hospital
closures, and abortion accessisn't obvious.
But it's so important that weelevate how these attacks that
Sarah described on ourhealthcare systems also harm
(15:16):
reproductive healthcare becausethe impacts on access are
already immense.
And the situation is likely toonly grow more dire, especially
for people in rural areas.
The bottom line here when itcomes to repro is that health
care cuts and the dismantling ofhealth systems impact all
(15:39):
pregnancy care, includingabortion care.
So when hospitals are forced toreduce the maternity care
services that they offer, or cutstaff, or shut down operations
entirely, that affects theavailability of a range of
obstetric and gynecologicalservices.
(16:00):
And in addition to thepotential lever and delivery
unit closures that Sarahmentioned, we're seeing dozens
of hospitals close all togethersince the passage of these
Medicaid cuts a few months ago.
The national partnershipactually put together a hospital
hit list to really track thisdevastation.
(16:20):
And all these closures erodeaccess to full spectrum
reproductive and pregnancy carefrom emergency abortion care
that patients get in hospitalsto services for a high-risk
pregnancy that they get in Laborand Delivery units to family
(16:41):
planning services that they getfrom their OBGYN.
So you have to consider thefull picture.
And if OBGYNs are forced toshift the services that they
(17:03):
provide or relocate becausetheir unit or their hospital
closes, patients can't access arange of reproductive health
services that OBGYNs offer, fromabortion care to childbirth
services to cancer screenings.
And rural areas already facesteep shortages of OBGYNs who
(17:27):
are essential in providingpreventive services that rural
folks depend on, likecontraceptive counseling and STI
screening and testing.
Especially in the wake of theDobbs decision, many OBGYNs have
been forced not to practice ortrain in states with abortion
(17:48):
bans, which has really worsenedprovider shortages in many rural
areas.
And I have to go here nextbecause it's so crucial to put
the shuttering of hospitals andLabor and Delivery units in full
context.
The Medicaid cuts that Sarahtalked about not only led to the
(18:10):
closure of these facilities,but also to reproductive health
clinic closures, as you know alltoo well, Jennie.
Anti-abortion extremistpoliticians used the budget bill
to not only attack marginalizedpeople's access to health care,
but also to ram through abackdoor ban on abortion care by
(18:35):
defunding Planned Parenthood.
So the budget bill prohibitsMedicaid reimbursements to
Planned Parenthood healthcenters.
And the majority of clinicsthat have been at risk of
closure because of thisfinancial loss are in rural
areas, medically underservedareas and areas with provider
(18:56):
shortages.
And it's really outrageous thatthese closures are taking away
health care for patients thatare most in need, like folks in
rural and low-income communitiesand people of color who already
face the most barriers toaccess.
So now patients are in asituation where they are having
(19:17):
to go without reproductivehealth care or they're having to
contend with long wait times ordelays or travel super far to
find any affordable services.
So the logistical and financialobstacles that then come with
the need to travel greaterdistances for care can be
(19:39):
prohibitive for patients thatwant abortion care or need
abortion care.
And having to take often unpaidtime off of work to travel far
to go to a provider and incurexpenses for lodging and
transportation and child careand the cost of the procedural
(20:02):
itself really add up.
So when you look at everythingall together, the Republican
budget bill is waging waragainst women and birthing
people on multiple fronts.
It's closing reproductivehealth care clinics and making
family planning and abortioncare completely unattainable
(20:23):
while at the same time cruellyshuttering hospitals and Labor
and Delivery units that make itharder for people to get the
maternal health care that theyneed.
That is just, like, so much allin like one terrible, terrible
bill attacking access to preventpregnancy, access for maternal
(20:46):
health care.
This is so much.
And I think there are somedistinct challenges that are
faced by people in rural areas.
So, what are some of thedistinct challenges that we are
going to see people in ruralareas encountering?
It's such a good question to really highlight
these uh unique strugglesbecause rural women's access to
(21:10):
reproductive care has alreadybeen fraught for a Long time
with legal barriers, logisticalobstacles, financial challenges,
but it's only gotten worseunder Trump in particular,
especially taken togetherMedicaid cuts, Planned
(21:31):
Parenthood defund[ing], and thefreezing of Title X family
planning program funding that,you know, that fuels more clinic
closures, add-on abortion bans,and add on so many other
restrictive anti-abortionpolicies, and you have a mess.
It essentially delivers a deathby a thousand cuts to rural
(21:55):
reproductive health care access.
And the national partnershipback in June released research
on the impacts of abortion bansand criminalization three years
post-Dobbs.
And we focused in on a varietyof marginalized communities and
how they are really impacted bythose restrictive policies.
(22:17):
So we found that women who livein rural areas are especially
likely to live in the 22 stateswhere abortion is banned or
under threat.
Specifically, we found that 2.6million women of reproductive
age, or 50% of all rural womenof reproductive age, live in
(22:41):
these states without abortionaccess.
And systemic underinvestment inrural areas and structural
inequities and health care makereproductive care even less
accessible for many Black,Indigenous and people in rural
(23:02):
communities.
Plus, research shows that ruralworkers have less access to
paid sick days and paid leavethat are really essential when
you have to travel what could behundreds of miles or across
state lines to get abortioncare.
And nobody should ever have torisk losing their job or their
(23:26):
paycheck because they have totake this time off to travel for
essential health care.
But a lot of pregnant peopleare being put in this impossible
bind when navigating theever-mounting barriers to
reproductive health care.
What this means in practice ishorrifying.
People living in states andrural areas with limited access
(23:50):
to abortion because of bans andprovider shortages and hospital
closures face health risks andeven forced pregnancy.
We've seen countless stories ofjust harrowing delays in
emergency abortion provision andfatal denials of care, in
(24:12):
particular since the Dobbsdecision.
Many people have been forced tocontinue pregnancies that are
nonviable or that put their ownlives in jeopardy.
And the irony is also not loston me that the same extremists
who pushed Medicaid and Title Xcuts that are forcing all these
(24:36):
reproductive health clinics toclose across the country are
bankrolling crisis pregnancycenters.
And for folks that reallyaren't aware of what these
anti-abortion fake clinics areup to and where they're located,
I want to just provide a littlebit more information because
(24:56):
anti-abortion "crisis pregnancycenters" are super prevalent in
rural communities by design.
It's all on purpose.
They exploit gaps in access tocare to target rural women with
misleading and coerciveanti-abortion propaganda.
(25:17):
They try to pass themselves offas you know viable alternatives
to reproductive care, butthey're typically run by
individuals with little to nomedical experience and they
misinform people about theirreproductive health options and
try to dissuade them fromseeking reproductive care and
abortion care.
So ultimately, this is howanti-abortion extremists take
(25:43):
away reproductive health carefrom people by making it
impossible to access.
And the Republican budget billin particular ratcheted up this
strategy, and rural communitiesand other marginalized groups
are really bearing the brunt.
Jennie (26:00):
Yeah, and I also think it's important that people who
may not be familiar with likerural areas as much of like
hearing that their localhospital is closing or their
local Labor and Delivery unit isclosing, it may be a
significant distance to get tothe next available Labor and
Delivery unit.
So I think for people who livein more urban areas or like
(26:24):
where I grew up was rural, butit's not that rural.
So, like, our next closesthospital is further, but it's
not like super significantlyfurther.
But there are people who livein much further out rural areas
where the next availablehospital could be ours.
Sarah (26:40):
Yeah.
And when you think about whenwomen have to travel further for
care, uh, for women in ruralareas, this does often mean
traveling 30 to 60 miles or morein order to get to a hospital
once they go into labor.
And that, you know, when whereevery minute is critical, um,
particularly in emergencysituations.
(27:01):
And in some cases, it wouldmake it even more difficult to
access, you know, their routineprenatal appointments.
So a lot of people will justend up delaying or skipping
their prenatal care, which is socrucial to their maternal
health outcomes as well.
Yeah, and the farther thetravel, the greater the risk of
maternal morbidity and adverseinfant outcomes such as
(27:21):
stillbirth and NICU admission.
I mean, when you think aboutit, like imagine a mother having
to travel or birthing personhaving to travel an hour just to
deliver a birth.
You know, I'm a mom, you know,I live in DC.
And while I was in active laborwith my second child, I barely
made it in time under 20 minutesto of travel.
(27:44):
It's just unimaginable.
And we can have a separateconversation about DC as a
maternity care desert and theimpact on urban and safety net
hospitals that this that thisbill would have.
But I think it is reallyimportant to really put into
context what this means becauseI'm so glad that you asked this
question.
It's easy to forget when we'retalking about, like, numbers and
(28:05):
potential risk and statistics,that we really lose sight of
what this all means for peopleand who was disproportionately
impacted.
And I just we we wanted to, youknow, dive a little bit deeper
into that uh analysis of thehospitals that are at risk of
closing their Labor and Deliveryunits.
And we found that 10% ofIndigenous women in the US live
(28:26):
in those 126 counties that areat risk of losing their Labor
and Delivery units.
In fact, they are the mostdisproportionately impacted
group of women that may beimpacted by these potential
closures.
And while it's unsurprising, umit's still devastating, as this
would further compound thematernal mortality crisis as
(28:47):
American Indian and AlaskaNative women experience some of
the highest rates of maternalmortality and morbidity in the
U.S.
We also found that Latinos arealso disproportionately likely
to live in affected counties andthat women at risk of losing
their only hospital withbirthing services are more
likely to be poor and have lowereducational attainment.
(29:08):
And so we just had to rememberthat behind every data point is
a family whose lives could beupended in an instant when care
isn't available.
And when these Labor andDelivery units close, families
are really left without the carethat they need when they need
it most.
And so, I think it's just soimportant to put in into context
what this bill would will dofor families, particularly at a
(29:32):
time when our healthcaresystem's already broken.
Our healthcare system isalready struggling, we're in
crisis.
And then think about who willbe disproportionately impacted.
And then this will indeedexacerbate inequities, you know,
as higher income and moreeducated individuals are more
likely to be able to try totravel further, like Ashley
mentioned, to go across statestate lines to access better
(29:53):
maternally related care orabortion services for those who
live in abortion advanced stateswho need to go across state
lines to access abortion care.
That's going to furtherexacerbate and deepen
inequities.
Jennie (30:06):
So we spend a lot of time talking about the health
impacts and how people's accessto health care is going to be
impacted, but that's not theonly groups that are going to be
impacted.
So maybe we should take aminute and talk about workforce
and how this is going to impactpeople who work at the
hospitals.
Sarah (30:22):
Absolutely.
Yeah.
The Republican budget bill andthe Medicaid cuts will have
devastating consequences for notonly health outcomes, as you
mentioned, but also jobs and theeconomy of rural communities.
Labor and Delivery unitclosures and hospital closures
in general can like reallydestabilize entire communities.
A Labor and Delivery unitclosure can result in declining
(30:44):
patient volumes, which can thenput other critical health
services at risk of cutbacks orcuts to local healthcare jobs.
And then imagine when ahospital shuts down or a Labor
and Delivery unit shuts down,then the nearby hospital that is
able to continue to offer thoseservices can now become
potentially overburdened as theyabsorb those patients from
(31:07):
other areas.
That could lead tounderstaffing, burnout, strained
resources, and ultimatelyworkforce shortages.
So it's like a vicious cycle.
And then the entire communitycan just feel the ripple
effects, particularly women, asmore than 80% of people working
in hospitals in rural areas arewomen.
(31:27):
So these impacts are justcompounded.
You know, you lose your job andyou lose your access to
hospital-based birthingservices.
That's just devastating.
Jennie (31:40):
It's like you just keep pulling back the layers, and
there's just, like, moreterrible underneath all the
terrible.
Okay, so I don't want to focusanymore on the like, this is all
terrible, because that is sofrustrating and just makes me
angry.
So let's like redirect myanger.
What can we do?
What can the audience do topush back in this moment?
Sarah (32:02):
So, one, I think it's so crucial, especially now in this
moment where we couldpotentially face yet another
shutdown, unfortunately, inJanuary, that people share their
stories.
Uh, right now, the the focalpoint in Congress is whether and
how to extend those ACA premiumtax credits.
(32:25):
And so if folks can share howhaving affordable health
insurance with premium taxcredits have helped them and
their communities, that could goa long way.
Sharing stories is the best wayto help make this issue a
priority for the public, themedia, and policymakers.
I also, you know, would urgefolks to contact their
(32:50):
representatives to advocate forextending the enhanced tax
credits because again, they willexpire at the end of this year,
at the end of this month, ifCongress does nothing.
Members of Congress um made apromise when they reopened the
government last month that uhthey would address the issue by
(33:13):
mid-December, by mid this month.
We're already, it's December4th today, and we had yet to see
real movement on a solution toextend those tax credits.
So encourage folks to contacttheir representatives.
I also think that it'simportant to just raise
awareness of what is happeningin their local communities,
(33:37):
raise awareness of why this isso important to everyone.
As Ashley mentioned, one of ourcolleagues, Mackenzie, our
amazing communications intern,has put together a hospital hit
list that she has shared on ourTikTok.
And that has really beenhelpful to raise awareness and
(33:58):
spread information, greaterreach to folks that may not be
following us, following ourwebsite, but could be following
us on other platforms tounderstand where these closures
are occurring and how often.
And so, just raising awarenessis also a really important tool.
Ashley (34:16):
Have you hop in here and I really appreciate you
carrying the conversation in apositive direction, Jennie,
because it's so important tohelp people feel empowered to
take action amid suchdevastation.
And this budget bill is part ofthe Project 2025 playbook to
(34:39):
ban abortion nationwide anddismantle public health programs
and roll back civil rights.
So I can share more about whatlisteners can do to address
issues around reproductivehealth care access, especially
for folks in rural areas, uh,because of immense federal
(35:00):
gridlock, and that's putting itlightly around abortion rights.
On issues for access and ruralaccess in particular, I'd say
that it's super important forfolks to advocate for policies
to protect and expandreproductive health care access
(35:22):
to their state representatives.
In particular, I think thatfolks should be advocating for
telehealth medication abortionaccess so that folks in rural
areas that don't have accessiblein-person care can still get
abortion pills mailed to them.
(35:42):
There's a lot to say about howtelehealth can really be a
lifeline for rural communitiesnow, especially telehealth for
reproductive health care, tofill in gaps in access to
contraceptive care, for example,as well, and to counter
provider shortages in rural andunderserved areas.
My other recommendation is abig one.
(36:05):
And it is essential thatlisteners call on their
state-elected officials to passor to strengthen state shield
laws, which help preserve somemeasure of abortion access, even
in states with bans, even forfolks in rural areas.
(36:26):
So, with shield laws, providersof protection from out-of-state
legal action if they mailabortion pills to patients in
states with bans, which is veryindicative of what a lot of
rural folks are facing.
And we know that uh theseshield laws are essential.
(36:46):
And the anti-abortionextremists are targeting them
because they are one of thestrongest tools that we have to
protect abortion access in apost-roe dystopia and
post-Medicaid cuts reality.
So, really important thateveryone uh use their voices to
(37:07):
get behind uh strengthening uhshield laws at the state level.
But if you can't get medicationabortion via telehealth and you
have to cross state lines forabortion care, the costs are
super high, as we talked aboutearlier.
So, as people need to travelmore frequently and longer
(37:30):
distances for care, it isessential that listeners do what
they can to step up and supportabortion funds, including
donating to abortion funds.
As we're thinking about thespecifics on the challenges that
rural people face in accessingreproductive health care and how
(37:52):
to address those hurdles, theneed to travel hundreds of miles
for care and to shoulder thosecosts really stands out to me.
And abortion funds helpfinancially support folks with
all the costs that areassociated with seeking care.
(38:12):
So, community support networks,grassroots organizations, and
abortion funds are movingmountains, literally, to help
make reproductive healthservices more affordable.
And we all need to help themout.
Sarah (38:27):
I'd also like to add thinking about what folks can do
to support or mitigate harms tomaternal health, particularly
in rural areas.
I think folks can urge theirstates to maintain postpartum
coverage for burden people up to12 months.
That is unfortunately anoptional benefit that many
(38:50):
states have opted to take up,but it's an optional benefit.
And with looming Medicaid cuts,states may be in a predicament
where they may need to eliminateoptional benefits like
postpartum coverage, up to 12months.
So, I think we need to urgestates to maintain that
essential coverage as we knowthat a significant percentage of
(39:12):
maternal deaths occur up to oneyear post-birth.
I would also add that just toremind folks that maternity
care, particularly in inlow-risk situations, don't need
to occur in a hospital-basedsetting.
That women should have theautonomy to choose where they
give birth and of course whenand and how.
(39:35):
And so, I think the option forcommunity-based models of care
is so important.
We know that freestandingbirthing centers are so
essential to fill in the gaps.
Should birthing people choosethat setting, if they are
eligible, if they are low riskto be able to choose that
(39:58):
setting.
And there are other maternalhealth perinatal workforce
professionals that really cansupport and fill in the gaps
where they're needed, especiallyin rural areas, um, that
provide prioritized,personalized, accessible,
equitable care to communities.
Jennie (40:16):
And I will be the person to call out.
Almost all states have at thispoint opted for that one-year
expansion on maternal healthcare.
Wisconsin and Arkansas are theonly two who have not, at least
last time I've checked.
So um just putting that outthere, y'all.
Make some noise about that inyour state if you're in one of
(40:39):
those two states in particular.
Okay.
Sarah Ashley, thank you so muchfor being here today.
I had such a wonderful timetalking to you about uh rural
healthcare.
It's great chatting with you aswell.
Sarah (40:52):
Really appreciate the conversation.
Thanks, Jennie.
Jennie (40:56):
Okay, y'all.
I hope you enjoyed myconversation with Sarah and
Ashley.
It was really wonderful to getto talk to them all about rural
hospitals and all of the impactsthat they are going to be
seeing.
So with that, I will seeeverybody next week.
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