OPINION:
Growing up in rural Texas, I have seen firsthand both the strengths and challenges of rural healthcare. Our state is proud to be home to millions of Texans, with a significant share residing in rural areas that are the backbone of our economy. Now, after years of widening gaps in rural healthcare, Washington is stepping up. The state of Texas is prepared to lead the way forward in closing these gaps.
On average, a Texan living in a rural area travels up to 59 miles to reach a referral center, and in my area, some patients even drive up to 109 miles. For new and expecting mothers, almost 100 rural hospitals are no longer delivering babies. Some women are driving up to 70 miles just to reach the nearest labor and delivery ward.
Texas has over 150 rural hospitals, more than any other state. Since 2010, a handful of rural hospitals in Texas have closed, with others continuing to struggle to keep their doors open due to new federal administrative burdens put on providers. And the most alarming statistic is that nearly 1 in 5 rural Texas counties had no licensed primary care physician as of 2024.
Some may ask how we got to this point where rural Texans are traveling miles on end to receive life-saving care or welcome their newborn child into this world. Three structural challenges have created this gap in rural care: a shortage of rural physicians, a financial structure that works against rural hospitals and regulations built for urban systems.
The rural physician workforce is aging, with retirements leaving entire communities without a doctor. Rural hospitals serve a higher share of Medicare and Medicaid patients, leaving them with less commercial revenue to offset low reimbursement rates. And regulations designed for high-volume urban systems simply don’t fit the realities of thin margins and long distances that define rural practices.
Rural Texans grow the food, produce the energy, and fill the ranks of America’s military; they deserve a healthcare system that reflects their contributions to this country. Much-needed federal investment is already flowing to rural healthcare across the country through the Rural Health Transformation Program, an historic $50 billion investment established under the Working Families Tax Cuts Act, to strengthen healthcare access and modernize health systems in rural communities.
For Texas, that investment means $1.4 billion over five years, the largest and most momentous investment in rural healthcare in a generation. Those dollars will go directly to work: recruiting and retaining healthcare workers in communities that have gone without; deploying telehealth and AI-assisted remote monitoring to bridge the distance gap; reducing chronic disease; upgrading equipment in hospitals that have been making do with outdated tools for years; and protecting patient data from the cyberattacks that have already hit too many rural Texas facilities.
In my own legislative work, I’ve focused on ending the behavioral health desert that cuts through every rural county in Texas. My EARLY Minds Act would expand community mental health block grant funding for prevention and early intervention, reaching rural youth before conditions become crises. I’ve also introduced the ANCHOR Act to create a Medicaid state plan amendment for states to adopt to give Medicaid options for individuals with serious mental illness and substance use disorder.
Soon, I will be introducing the RESCUE Act, which would require CMS to conduct annual rulemaking on the ambulance fee schedule and finally fix a 24-year-old payment structure that is pushing rural EMS services toward collapse. This is a huge step in ensuring rural communities do not lose access to emergency services.
I remain optimistic that we can further address the shortages and challenges facing rural healthcare. Congress stands at a generation-defining moment for rural healthcare, and Texas is more than ready to meet it. The funding is real, the plan is in place and the next fight is ensuring every rural community has sustainable access to high-quality, affordable care.
Rural Texans have always taken care of their neighbors; they deserve a healthcare system and a Congress that does the same. I am committed to making sure that happens.
• Rep. August Pfluger proudly represents Texas’ 11th Congressional District. He currently serves as Chairman of the Republican Study Committee (RSC), after being elected by his colleagues to lead the largest committee of conservatives on Capitol Hill with a record 190 members. He also serves on the influential House Energy and Commerce Committee and as Chairman of the House Committee on Homeland Security’s Subcommittee on Counterterrorism and Intelligence. In these leadership roles, Rep. Pfluger is a proven champion for American energy, agriculture, and national security. He is one of the most prolific lawmakers on Capitol Hill, with a record number of bills passing the House this Congress.
Please read our comment policy before commenting.