Insurers are choking rural hospitals and undermining healthcare access

In many parts of the country, especially rural America, a hospital is not simply a healthcare facility. It is critical infrastructure. It is where trauma care begins, where babies are delivered, and where chronic conditions are managed. When a community hospital becomes financially unstable, the consequences extend far beyond its walls. Local economies suffer. Emergency response systems weaken. Patients lose access to timely care.

I saw this firsthand while serving as a state Secretary of Health and Human Services and as a Medicaid Director. In those roles, the public sector’s payments were often blamed for instability. But what I repeatedly saw on the ground was something different: even when reimbursement rates were adequate, administrative delay could still choke a provider. The problem was not only “how much.” It was “how long,” “how often,” and “how hard it was to get paid for care that was already delivered.”

Rural hospitals today face sustained