Rural hospital closures further strain cardiovascular care access in underserved areas. A new care model may close the gap.
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Rural healthcare is facing a crisis. As of 2026, there are an estimated 1,797 rural community hospitals operating in the U.S., according to the American Hospital Association. The USDA has estimated that 146 rural hospitals in the U.S. closed or stopped providing inpatient care between 2005 to 2023, with financial instability cited as the primary culprit. But the true cost of rural hospital closures is often most felt by the communities that they serve through missed diagnosis, longer drives to receive care, and outcomes that could have been avoided.
The rural healthcare landscape shows mixed signals of relief from financial distress, despite financial policies and programs to support rural hospitals administered by the federal government. Most recently, the Rural Health Transformation Program (RHTP), launched under the One Big Beautiful Bill Act (OBBB) in 2025, will distribute $50 billion in funds to states from 2026 to 2030. However, RHTP doesn't offset the approximately $1 trillion in cuts to Medicaid by the OBBB over ten years and its impacts to the 16.1 million Americans living in rural communities who rely on Medicaid.,
Rural hospitals are defined broadly by the U.S. Office of Management and Budget and the Census Bureau as hospitals in non-metropolitan areas. They are often short-term, general acute care hospitals. The Centers of Medicare & Medicaid provides special funding to eligible rural hospitals designated as Critical Access Hospitals (CAH) based on select criteria such as size and location. Rural Emergency Hospitals (REH) are similarly designated to sustain emergency care services in remote communities and avoid complete closures.
estimated rural community hospitals are operating in the U.S. as of 2026.
rural hospitals closed or stopped providing inpatient care between 2005 and 2023.
of the decline in U.S. community hospitals between 2017 and 2021 were rural hospitals.
Financial distress was the main driver behind rural hospital closures from 2005 to 2023. Rural residents might also choose to bypass the rural hospitals entirely for more distant care facilities. Lower bed occupancy in rural communities means that rural hospitals often aren't as profitable as their urban counterparts. Additionally, patients living in rural communities often depend on Medicare and Medicaid to pay for their inpatient hospital bills (which only cover 50 percent of hospital inpatient costs), meaning rural hospitals are generally more challenged by lower reimbursement from Medicare and Medicaid. As a result, rural hospitals often operate less profitably than urban areas, making them more vulnerable to financial challenges.
Rural hospitals are closing at a disproportionate rate, placing further strain on cardiovascular care in underserved areas. Between 2017 and 2021 (the most recent data period available), rural hospitals accounted for 71% of the decline in U.S. community hospitals.
The effect of hospital closures in rural areas is underscored by the fact that individuals living in underserved communities face a 20% higher prevalence of coronary heart disease than their urban counterparts, with mortality rates following a similar pattern. As rural hospitals face closures, patients at risk for cardiovascular disease must navigate even longer distances to primary care clinics, emergency and specialty cardiac care, widening an already serious gap in access.
Rural health clinics, Tribal and Urban Indian health centers, VHA medical centers, Medicaid Managed Care Organizations, and policymakers have a key role to play in closing this gap. A new model for cardiovascular care can help strengthen access and outcomes for the communities served by these groups.
higher prevalence of coronary heart disease in underserved communities than their urban counterparts.
Get access to our report and identify key insights to strengthen access and improve outcomes in rural communities. Our report discusses:
Common factors for why rural communities face higher rates of cardiovascular disease.
Challenges rural hospitals face in delivering cardiovascular care.
A new model for cardiovascular care to address rural health challenges.
The benefits of increased access to advanced cardiovascular care to rural communities and healthcare organizations.
