Por Michael Chameides
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| Photo by John Warg |
When Dr. Ed Paul visits Nogales, Arizona, he sees well-trained, hardworking doctors and nurses. Yet as in many smaller towns and rural communities, its health care staffing, infrastructure, and funding doesn’t meet the needs of residents.
People who need health care have a tough time accessing it — and the people delivering it feel overburdened. With limited providers, Dr. Paul notes, it’s hard to get an appointment, so patients either wait, travel long distances, or simply go without.
As the Policy Director for the Rural Democracy Initiative, I support groups across the country who are working to ensure rural Americans have access to quality, affordable health care. But 80 percent of rural America is medically underserved — and Arizonans face particular barriers to care, ranking 42nd nationwide in the rate of providers to people.
Dr. Paul is trying to change that. He travels to rural and tribal communities across Arizona with colleagues in the Area Health Education Centers (AHEC) program to help create a workforce development pipeline for state medical school graduates.
AHEC is a federally funded program that helps provide medical staffing to underserved areas across the country. Dr. Paul’s work with AHEC keeps more graduates in Arizona and increases staffing in rural areas. Along with the University of Arizona, they’re creating new primary care training opportunities in rural areas so graduates don’t have to leave the state to find them.
“If we create more residency slots, we can keep more doctors in the state,” Dr. Paul said. “If we train more doctors in the state, more will stay in the state. Our focus is on developing more pipelines that lead to an increase in the primary care physician workforce.”
When doctors stay and practice in their own state’s rural communities, that makes more providers available to patients, improving the overall health care landscape.
The federal government should boost the efforts of Dr. Paul and those in other states who are driving solutions. But this decades-long work is being undermined by huge cuts to Medicaid as part of the GOP’s “Big Beautiful Bill” that Congress passed in 2025, which slashes programs like SNAP and Medicaid to fund tax cuts for the wealthy.
These Medicaid cuts, Dr. Paul fears, could cripple rural health care organizations, many with very tight operating margins. Fewer patients on Medicaid means fewer dollars flowing into Federally Qualified Health Centers (FQHCs), full-service health centers which are required to treat any patient, regardless of their ability to pay.
“We predict that enrollment in our state Medicaid program will drop significantly” once new eligibility requirements take effect in late 2026, Dr. Paul said. “It is a real conundrum. FQHCs funding is directly threatened because the cuts will result in lower reimbursement and increased numbers of uninsured. Hospitals and ERs will take the brunt of that.”
Rural hospitals need Medicaid revenue to cover the cost of services and pay for the doctors and nurses who deliver care. One quarter of rural Americans rely on Medicaid, and it covers nearly half of all rural births — plus 60 percent of individuals in rural nursing homes.
As funding erodes and revenue from insured patients evaporates, so does the availability of care. Rural hospitals, birthing centers, and clinics will face significant challenges to remain open as Medicaid cuts go into effect.
“The real bottom line is, based on the regulations that have been put forth, a lot of people will fall off the roster because of the requirements. More uninsured people is not good for the whole medical economy period,” Dr. Paul said. “We’re trying to fight back and make the point as to how this affects our most vulnerable citizens in our state, especially in rural communities.”
Michael Chameides is the Communications and Policy Director for the Rural Democracy Initiative.
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