1. United States
2. Maine
3. Letter

I am contacting you to express my urgent concern regarding aspects of the leaked FY26 budget draft and to advocate strongly for continuing to fund crucial federal programs that support rural healthcare. These include, among others, the Flex Program, which is slated to be cut per the budget draft; the State Offices of Rural Health, which coordinate Flex and numerous programs for rural providers and communities, including the At-Risk Rural Hospitals Program; and the Rural Residency Planning and Development Program, which addresses workforce shortages in rural healthcare.   Since 2010, 193 rural hospitals have closed, including 36 that have converted to Rural Emergency Hospitals; many remaining hospitals have lost vital community services such as Labor and Delivery. Over the same period, rural adults have experienced higher rates of mortality from heart disease, cancer, unintentional injury, and stroke relative to urban adults (Chatterjee P. Causes and consequences of rural hospital closures. J Hosp Med. 2022 Nov;17(11):938-939. doi: 10.1002/jhm.12973. Epub 2022 Oct 3.PMID: 36190813; PMCID: PMC9633454.) Rural hospitals support many Medicare and Medicaid recipients; per the Kaiser Family Foundation, in 2023, Medicare accounted for 53% of hospital discharges in rural areas, while Medicaid covered 19%.   In 1997, the Flex Program was created by the Balanced Budget Act (BBA) to support access to primary and emergency healthcare services, improve the quality of rural health services, provide services that meet community needs, and foster a health delivery system that is both efficient and effective at Critical Access Hospitals. The loss of these essential federal programs would put providers, patients, and local economies at risk. A 2006 study of hospital closures from 1990-2000 showed that “the closure of the sole hospital in the community reduces per-capita income by $703 (p<0.05) or 4 percent (p<0.05) and increases the unemployment rate by 1.6 percentage points (p<0.01)” (Holmes GM, Slifkin RT, Randolph RK, Poley S. The effect of rural hospital closures on community economic health. Health Serv Res. 2006 Apr;41(2):467-85. doi: 10.1111/j.1475-6773.2005.00497.x. PMID: 16584460; PMCID: PMC1702512.)   All Americans deserve access to healthcare regardless of geographic location or socioeconomic status. 60.8 million Americans live in rural areas, and 86% of the nation’s land is considered rural. Without federal programs that support rural healthcare, more small rural hospitals will lose essential programs such as L&D or will be forced to close entirely. The communities that depend on these hospitals will struggle, and patients will suffer. I ask that you use your platform to fight for the Flex Program, State Offices of Rural Health, and rural healthcare nationwide.