PolicyLab

Statement of Problem

Mothers and caregivers in rural areas are more likely to be uninsured or underinsured, rely on public insurance, or depend on public subsidies to afford health insurance through state exchanges. At the same time, Pennsylvania's rural health systems, especially maternity care, are strained and dependent on payments from state and federal programs. 

The 2025 passage of H.R. 1 cut Medicaid funding and ended enhanced premium tax cuts that helped people purchasing health insurance through state exchanges. Together, these changes are expected to pull roughly $58 billion in federal funding from rural communities over the next decade and could lead to  17 rural hospital closures in Pennsylvania. By February 2026, nearly 1 in 5 enrollees in Pennsylvania’s health marketplace, Pennie, had dropped their coverage, with the highest terminations among rural Pennsylvanians. Additional Medicaid changes are set to  take effect in 2027, creating even more uncertainty for rural communities and the health systems that serve them. These changes are projected to be particularly devastating for women’s health, and will deepen existing health disparities.

As H.R. 1’s effects reach rural Pennsylvania, they will do so at a time when local news coverage is already shrinking. The decline of rural newsrooms has left many communities with fewer sources of reliable local information and less explanation of how national policies affect their daily lives. It also means rural voices are heard less often beyond their own communities, allowing stereotypes and misinformation to go unchallenged. Nationwide, 80% of news deserts are rural, more than 130 newspapers closed in the past year, and newspaper employment continues to drop. As these media outlets close, rural Pennsylvanians lose an important source of local reporting, including the in-depth coverage needed to understand how these federal decisions matter for them.