Rural Issues


Texas has 148 rural hospitals with unique needs and challenges. About 15% of Texas’ population is rural, including 586,000 rural Texans without health insurance. Compared with their urban counterparts, rural hospitals serve a larger proportion of older, uninsured, and publicly insured patients.

Hospitals in remote parts of the state need help from lawmakers on several fronts.

Twenty-one rural hospitals in Texas have closed in the last decade – more than any other state – and other rural hospitals have eliminated key service lines, like labor and delivery. In 2022, a report from Kaufman Hall found 26% of Texas rural hospitals were found to be at risk of closure, compared to 16% in 2020 . Today, only about 40% of Texas rural hospitals provide labor and delivery services according to the Texas Organization of Rural and Community Hospitals.

Preventing additional rural hospital closures and protecting rural hospitals’ ability to deliver high-quality care is critical now more than ever.

Protecting high-quality health care in rural communities means:

  1. Maintaining adequate Medicare and Medicaid reimbursement (including Medicare reimbursement for critical access hospitals at 101% of costs) and preserving Medicaid hospital supplemental payments.
  2. Reducing the number of uninsured Texans.
  3. Protecting special financing arrangements that address some of rural hospitals’ unique circumstances and challenges.
  4. Increasing access to telehealth and boosting broadband for remote hospital services.
  5. Encouraging education and workforce training incentives and funding for rural hospital staffing.