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Trump bets on rural health as a winning midterm message

President Donald Trump wants Republicans to be known as the health care party heading into this year’s midterm elections, even as his administration has struggled to produce a comprehensive health care agenda. He tried to build the case again Friday by touting a $50 billion rural health program as evidence his administration can deliver results for voters facing rising costs and shrinking access to care.

Speaking at the White House, Trump and his deputies promoted the first $10 billion installment of rural health awards, distributed across all 50 states and designed to help communities where hospitals are struggling and residents say they face challenges obtaining care.

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“This is the big one,” Trump said, discussing his administration’s “unprecedented” investments in rural health. “For those that were trying to make a case that we weren’t taking care of the rural community - I’m all about the rural community.”

Policy experts say the rural health fund could help stabilize a system under strain. Rural hospitals and providers face staffing shortages, thin margins and declining patient volumes, pressures that experts say Republican-led Medicaid cuts and policy uncertainty have worsened, making it harder for providers to plan and invest.

The rural health fund is “helping even the playing field,” given long-standing gaps in funding for rural health care providers, said Carrie Cochran-McClain, chief policy officer of the National Rural Health Association. “Without this extra funding, many rural providers would not be able to pursue innovation [or] invest in new technologies.”

The initiative also has drawn more bipartisan interest and support than the administration’s other health care proposals, such as Trump’s “Great Healthcare Plan,” which was announced Thursday and immediately dismissed by experts and Democrats as vague and insufficient. Every Democratic governor applied for the rural health money, and some liberal lawmakers say it could be a useful down payment on boosting rural health care - although too limited to alter the longer-term outlook.

Republicans added the initiative to Trump’s signature legislative package, the One Big Beautiful Bill after some GOP lawmakers warned that Medicaid cuts intended to reduce the deficit would disproportionately harm rural hospitals. Those warnings also reflected concerns about how the cuts could hurt Republicans in rural-heavy districts.

Still, analysts note that the fund’s $50 billion is far smaller than the $911 billion in federal Medicaid spending that the nonpartisan Congressional Budget Office estimates the bill will cut over the next decade.

“Trump didn’t [tell voters] that there would be disproportionate cuts to rural America. And if you look at the Medicaid enrollment rates, they’re higher in rural America than they are in urban America,” said Timothy McBride, a health policy professor at Washington University in St. Louis.

McBride also called the distribution of the administration’s funding awards “bizarre,” citing the wide range in awards on a per capita basis, with California receiving about $100 per rural resident and Nevada receiving about $1,000. “In general the states with the largest rural population will receive the lowest allocation of funds,” he wrote.

According to the legislation, half of the rural health funding was intended to be distributed evenly among all states - regardless of the size of their population - with the other half allocated based on state-specific factors, such as the situation facing their hospitals. Federal health officials ultimately determine the awards and have said that they will reassess every year to reward promising ideas and take funding away from initiatives that are struggling to deliver.

Democrats have consistently criticized the Trump administration’s approach to rural health, pointing to a steady stream of rural hospital closures - such as MercyOne’s announcement this week that it will close a facility in rural Iowa - as evidence that the president’s policies are backfiring.

“Thanks to Trump’s $1 trillion cut to Medicaid in his Big Ugly Bill, rural hospitals across the state are struggling to stay afloat and are now closing, forcing Iowans to travel further to receive lifesaving health care when seconds and minutes matter,” Democratic National Committee spokesman Abhi Rahman said in a statement Thursday. Rep. Zach Nunn, who represents that Iowa district, is among the most vulnerable Republicans heading into the midterms - elections that will shape Trump’s agenda in his final two years.

The Trump administration and Republican allies have countered that rural hospitals’ funding woes are a decades-old problem that demand new thinking - and, potentially, new innovations funded by their initiative.

Centers for Medicare and Medicaid Services Administrator Mehmet Oz has touted proposals such as using drones to deliver medication in rural areas and advanced technology to help physicians practice remotely. Some of those ideas predate the Trump administration and have yet to transform care, but their proponents argue that they have faced challenges scaling without sustained funding.

“We’ll meet you where you are,” Oz said at the White House event. “If you’re a vet and depressed and you’re thinking of taking your life, we’ll be there. Just let us know you’re in trouble and we’ll help.”

Rural voters have been a cornerstone of Trump’s success, helping power his two successful presidential campaigns. Trump won rural voters in 2024 by 40 percentage points - 69 percent to 29 percent - over then-Vice President Kamala Harris, per a Pew analysis.

That affinity has shaped how Trump talks about rural health care, including on the 2024 campaign trail. At an Arizona rally, Trump was asked how he would help rural Americans access hospitals.

“We’re going to be helping rural America. Rural America votes for Trump. There’s nobody going to take that away,” Trump replied, pledging to resume his first-term efforts to invest in solutions.

Trump spent much of Friday’s event defending his new Great Healthcare Plan and its push for drug-price cuts, arguing it would address affordability across the country.

“I’m calling on Congress to pass this framework into law so that we can get immediate relief to the American people, including rural America,” the president said.

The White House has rallied behind Trump’s proposal, which outside analysts have called a grab bag of ideas with unclear impact.

“President Trump’s proposal includes reforms for every facet of our healthcare system: from codifying [Most Favored Nation] drug pricing to holding insurance companies accountable to making the ACA affordable by finally funding cost-sharing reductions,” spokesman Kush Desai wrote in an email.

Polls have shown that rural voters are more likely than other voters to trust Republicans on health care. A November 2025 poll by KFF, a nonpartisan health policy organization, found that 41 percent of rural adults trust Republicans to do a better job addressing the high cost of health care insurance, compared with 24 percent who trust Democrats more, bucking national trends.

“However, about three in ten [rural adults] say they trust neither party on these issues,” Liz Hamel, KFF’s director of public opinion and survey research, wrote in an email. “Similarly, most rural residents don’t think it’s likely that President Trump’s policies will lower prescription drug costs for people like them.”

Nearly 190 rural hospitals have stopped operating or ended their inpatient services since 2010, according to the National Rural Health Association. The organization also says that nearly half of rural hospitals are operating with negative margins, leaving them at high risk of shuttering.

The rural health fund also could be vulnerable to waste and fraud, Cochran-McClain and others said, with many organizations and vendors eager for a piece of the federal funding at a time when the Trump administration has cut other social services support.

CMS officials said in a statement that they would “closely monitor the program to ensure there is no misuse of funds or fraud,” through audits, reviews and ongoing oversight.

Paragon Health Institute, an influential conservative health policy organization that has advised the Trump administration and congressional Republicans, said last year that the fund was promising but also time-limited.

“If states use these resources wisely, they can create durable reforms that expand access, increase competition, and improve outcomes in rural communities,” Paragon wrote. “But if funds are poorly targeted or used to prop up inefficient institutions, rural providers will continue to struggle once federal dollars run out.”