High-level briefing: Rural healthcare downs & ups | Healthcare affordability in focus | Viruses to watch like a hawk in 2026 | more

Where have the missing rural American hospitals gone? And where is rural healthcare headed?

In the 21 years between January 2005 and the present, almost 200 rural hospitals have either closed or been converted into less comprehensive healthcare facilities with no inpatient services. 

The exact numbers as of Jan. 19, 2026, are 110 complete closures and 85 conversions. The update comes from the Cecil G. Sheps Center for Health Services Research at the University of North Carolina. Another 42 rural hospitals have stayed open but pared service lines to become rural emergency hospitals, or REHs, a new designation that went into effect in 2023. The Sheps Center tracks the status of rural care across the country by gathering information from numerous sources, including CMS data and the Federal Office of Rural Health Policy, the National Rural Health Association, the American Hospital Association and the public. In coverage of the latest Sheps update, Business Insider predicts the problem of dwindling care options for rural Americans is soon to get “much worse—and quickly.” 

• The dour outlook is based on a BI review of Medicaid changes in President Donald Trump’s One Big Beautiful Bill Act. These shifts will “limit key sources of federal funding to these hospitals, risking future closures,” the outlet reports. “And the administration’s $50 billion investment in rural health initiatives might not be enough to offset the harm.” 
   
  • Here’s more from the news analysis, filed Jan. 19 by BI economy reporter Allie Kelly:
     
• Two dozen of the 195 permanently closed rural hospitals shuttered in just the last five years. The UNC researchers found that the majority of these hospitals are in especially small and isolated locations, leaving residents with few options to see a doctor for preventive or urgent care, Business Insider reports. “[M]any of these closure locations are near one another, creating healthcare deserts,” reporter Kelly writes. “Nearly 800 more rural hospitals are currently at risk of closure due to financial distress, the Center for Healthcare Equity and Reform estimates.”
   
• In the years since 2005, some 85 rural hospitals have avoided complete closure by converting to care facilities without inpatient services. The results have included urgent care clinics, nursing homes, rehab centers and skilled nursing operations. “This strategy saves money but can come at the expense of patients,” BI points out. “More than 500 hospitals closed their labor and delivery departments in the last decade, more than half of which were in rural areas.”
   
• Rural emergency hospitals have no inpatient beds, but they sometimes have the only doctors for miles around. REHs are designed to handle immediate trauma cases, BI reporter Kelly underscores. “These hospitals are stand-alone ERs and don’t exceed an average patient stay of 24 hours,” she writes. 
   
• The phenomenon of rural hospital closings and conversions is leaving millions of people without access to medical services. “Some now have to travel long distances for their annual checkup, while others worry paramedics won’t arrive in time if they need help,” Kelly reports. Meanwhile rural hospitals have historically been “major employers, and closures can leave hundreds of people without a job.”
   
  • Hold on. Weighing in on the side of the Trump administration’s $50B injection into rural healthcare state by state is—who else?—the Trump administration. “Rural hospitals suffer from chronic challenges with extremely low patient volume—they have both smaller bed counts than urban hospitals and occupancy rates that are much lower (37%) than those of their urban counterparts (62%),” a White House fact sheet states. “Therefore, when legacy programs link funding to reimbursements for services provided, they do not promote long-term sustainability as the overall volume of services provided in these facilities remains low.”
     
    • In other words, these programs do not actually provide hospitals with investments that would help them sustain themselves. “Distinct from these [legacy] programs, the Rural Health Transformation Program is designed to promote innovation in payment and flexibility,” the fact sheet adds. “These funds can be used to help these facilities make investments necessary to better meet the needs of the communities they serve and become more sustainable over the long term.” 
       
      • Hear out the White House on this subject here and here.
         

There’s really only way to achieve greater healthcare affordability at the level of the U.S. population.  

That would be lowering underlying healthcare costs across the board. Larry Levitt, MPP, puts some meat onto the bone of that position in commentary published this month in JAMA Health Forum. 

• There will always be people who cannot afford healthcare on their own because of their low incomes or high healthcare needs, writes Levitt, executive VP at KFF (formerly Kaiser Family Foundation). The Affordable Care Act, aka Obamacare, “aimed to address this situation,” he reflects, “and it is what the debate over extending enhanced premium tax credits has centered on: How much can people afford to pay for health insurance?”
   
• Government subsidies or employer contributions to health benefits can reduce out-of-pocket premiums for individuals—but those costs must be borne by someone. “And as healthcare costs increase, there is pressure on the government to reduce spending on public health insurance programs and on employers to shift costs to workers,” Levitt notes. Working out a way to reduce those underlying healthcare costs, he believes, “may be the next big healthcare reform debate.”
   
  • That’s his conclusion. To see how he arrived at it, read the piece. 
     

Influenza A. Monkeypox. Oropouche fever.

These are the top three viral threats of 2026 in the estimation of one alert expert in infectious diseases. The expert is Patrick Jackson, MD, of the University of Virginia health system. He’s also concerned, albeit somewhat less so, about global outbreaks of chikungunya virus, measles cases in the U.S. and a resurgence of HIV. 

• There are more. “As-yet-undiscovered viruses can always emerge in the future as humans disrupt ecosystems and travel around the world,” Jackson points out in commentary posted in The Conversation. “Around the world, people, animals and the wider environment are dependent on each other. Vigilance for known and emerging viral threats and the development of new vaccines and treatments can help keep everyone safe.”
   
  • Get the rest, including helpful information on the unfamiliar viral threats named above—looking at you, Oropouche and chikungunya—here.

Also of interest:

• Trump’s ‘Great Healthcare Plan’ has promise but should add more freedom for Americans ... Empowering patients is good. Let’s give them a lot more choice and independence (Reason) 
   
• Trump’s ‘Great Healthcare Plan’ is not great. It’s not even a plan. ... And this is not what it looks like when you’re serious about lawmaking. (The Bulwark) 
   
• What the first medical evacuation from the International Space Station tells us about healthcare in space ... The evacuation raises a question worth exploring: how do astronauts stay healthy in space, and why is this early evacuation so unusual? (Space.com)

From HealthExec’s sibling news outlets:

• Radiologists say hospital physician-practice acquisitions driving up healthcare costs (Radiology Business)
   
• Vascular surgeon indicted for murder of ex-wife and her husband (Cardiovascular Business)