In this episode, "Ready. Set. No. The State of Medicaid Work Reporting Requirements Readiness," Michelle welcomes Research Professors Tricia Brooks and Leonardo Cuello, as well as State Health Policy Analyst Hannah Green, all joining us from Georgetown University McCourt School of Public Policy Center for Children and Families, to discuss their report published on September 4, 2025 titled "Are States Ready to Implement HR 1 and Medicaid Work Reporting Requirements?" In this conversation, Michelle, Hannah, Tricia, and Leo discuss the implications of the HR1 Medicaid work reporting requirements, focusing on state readiness, the impact on coverage for lawfully present immigrants, including the dispelling of misinformation on the matter, and the challenges that counties and rural communities, households, and economies can expect to face and manage in the months and years to come. The discussion highlights the importance of states meeting quality performance indicators, how funding and staffing cuts can further undermine the achievement of even minimum standards, and explores strategies for community engagement with multiple parties, as well as the urgency of advocacy around the rising uninsured rate among children and the financial strain on rural hospitals. The conversation closes with a discussion about data collection and transparency, noting that researchers rely on timely and accurate CMS data to inform and educate policy decisions. This episode was made possible by our partner, the National Association of Rural Health Clinics, and they invite you to rendezvous with them in Reno. Starting October 20, the two-and-a-half-day NARHC Fall Institute offers a unique in-person agenda, along with three pre-conference webinars the week before. It's a rare opportunity to deeply engage with the pressing issues facing Rural Health Clinics today. Plus, with unmatched networking and a throwback 90s Bash, you'll leave energized and reconnected. Registration closes on the evening of October 19, so don't wait! Visit narhc.org to register.
In this episode, "A Conversation About What Undermines Local Government and Public Service," Michelle welcomes Brooks Williams to discuss how anger and rage are impacting local governments. Brooks is a city manager whose two decades span public and private leadership. He is known for turning strategy into results, such as stronger finances, healthier cultures, and clear metrics that track real performance. He serves the QTF Regional Program, a performance-excellence initiative that helps organizations apply the Baldrige Excellence Framework, continuous improvement, and disciplined measurement to achieve lasting outcomes. A doctoral candidate in Public Administration, with an MPA from Liberty University, Brooks also writes to move leaders from noise to substance. His books, Performative Outrage: How Manufactured Fury Undermines Local Government and Public Service and Rising to Serve: Reimagining Public Administration for a New Era, challenge institutions to prove value through measurable excellence, accountability, and public trust. Michelle invited Brooks to this episode to explore how anger and rage is impacting small governments. Together, they discuss the challenges and opportunities in public service, particularly in the context of performance outrage and the erosion of public trust. Brooks emphasizes the importance of transparency, civic engagement, and the role of social media in shaping public discourse. He advocates for a shift towards more constructive dialogue and the need for public servants to act as culture shapers within their communities. Brooks also highlights the necessity of civic literacy and education to empower citizens and improve local governance. This episode was made possible by our partner, The National Association of Rural Health Clinics, and they invite you to rendezvous with them in Reno!!! Starting October 20th, the two-and-a-half-day NARHC Fall Institute offers a unique in-person agenda, along with three pre-conference webinars the week before. It's a rare opportunity to deeply engage with the pressing issues facing Rural Health Clinics today. Plus, with unmatched networking and a throwback 90s Bash, you'll leave energized and reconnected. Registration closes the evening of October 19th, so don't wait! Head to narhc.org to register.
In this episode, "HRSA's Dwindling Rural Health Commitments," we kick off with a conversation between Michelle and Alexa McKinley Abel, Director of Government Affairs at the National Rural Health Association. They delve into recent developments from the House Appropriations Committee related to the FY2026 Labor-HHS appropriations bill, which proposes significant investments and increases in rural health funding. The two also dissect a new provision in the Rural Hospital Provider Assistance Program, which, if passed, offers financial support to at-risk hospitals. They wrap up with a discussion that underscores the need for increased funding and the impact of community stories in underlining the importance of these programs. Next, Michelle welcomes Carole Johnson, former Administrator of the Health Resources and Services Administration, and current Senior Fellow at the Century Foundation. Michelle speaks with Carole about the current state of rural health, focusing on the challenges posed by workforce reductions, funding cuts, and the need for community engagement. They discuss the impact of these issues on healthcare services in rural areas and the importance of advocacy in securing the necessary resources in the long term. Carole emphasizes the need for immediate action to address funding gaps and significant cuts to HRSA's workforce, responsible for administering rural health programs, some of which have been eliminated or paused. In the second half of this in-depth episode, Michelle speaks with Toniann Richard, CEO of HCC Network, about the critical issues facing rural health organizations, particularly in relation to Medicaid and the Rural Health Transformation Fund. They discuss the challenges of navigating policy changes, the importance of grassroots advocacy at the state level, and the need for community engagement in health initiatives. The conversation also addresses vaccine hesitancy in rural Missouri and the role of public health in these areas in building confidence and capacity, highlighting the importance of providing reliable information and support to communities. This episode was made possible by our partner, The National Association of Rural Health Clinics and they invite you to rendezvous with them in Reno!!! Starting October 20th, the two-and-a-half-day NARHC Fall Institute offers a unique in-person agenda, along with three pre-conference webinars the week before. It's a rare opportunity to deeply engage with the pressing issues facing Rural Health Clinics today. Plus, with unmatched networking and a throwback 90s Bash, you'll leave energized and reconnected. Registration closes the evening of October 19th, so don't wait! Head to narhc.org to register.
In this episode, Education, Workforce & Tariffs: Rough Roads for Rural Ahead, the episode begins with Alexa McKinley Abel, Director of Government Affairs at the National Rural Health Association, who provides a rundown of the Senate Appropriations Committee's markup of the 2026 Labor Health and Human Services, Education, and Related Agencies Bill. Alexa detailed what the markup means for rural health; many of the programs that were initially proposed for elimination in the President's budget are actually funded and funded at higher levels than in past years. She continued the conversation by providing some key highlights of the bill and concluded by noting that the House and Senate must agree on numbers and pass the same budget. It remains to be seen where the house will stand in the FY26 funding bill. Next, Michelle welcomes Dr. Jeff Strohl, Research Professor and Director of the Georgetown University Center on Education and Workforce (CEW). They discuss the challenges facing rural education and workforce development, particularly in light of recent policy changes and economic shifts. They examine the impact of AI on job markets, the significance of community colleges, and the challenges that rural students face in accessing education and training. The discussion highlights the importance of aligning educational programs with labor market demands, as well as the need for increased investment in career navigation and employer engagement to support rural communities. In the second half of this in-depth episode, Gbenga Ajilore, Chief Economist at the Center on Budget and Policy Priorities, joins us to explore the significant impacts of recent policy changes on rural households and communities, focusing on education funding, Medicaid and SNAP cuts, tariffs, and tax cuts. Gbenga shares how these factors contribute to economic challenges in rural areas, emphasizing the need for advocacy and storytelling to highlight the real-life effects of these policies. SHOW RESOURCES https://cew.georgetown.edu/cew-reports/bridging-middle-skills-gap/ https://www.cbpp.org/research/economy/the-republican-agendas-triple-threat-to-black-households-economic-well-being This episode was made possible by our partner The National Association of Rural Health Clinics. The National Association of Rural Health Clinic invites you to rendezvous in Reno!!! Beginning October 20th, the two and a half day NARHC Fall Institute features a powerful in-person agenda plus three pre-conference webinars the week before, it’s your chance to engage deeply with the pressing issues facing Rural Health Clinics today. With unmatched networking, and a throwback 90s Bash, you’ll leave energized and reconnected. Registration closes the evening of October 19th, so don't wait! Head to narhc.org to register.
In this Rural Impact Extra Episode: A Conversation about Rural Prosperity and its Connection to Policies, Past, Present & Future, Michelle leads the episode with a discussion with two esteemed experts in the field. Tony Pipa, a Senior Fellow in the Center for Sustainable Development at the Brookings Institution, and Brent Orrell, a Senior Fellow at the American Enterprise Institute(AEI), bring their wealth of knowledge and experience to the conversation. Tony, Brent, and Michelle discuss the Brookings-AEI Commission on US Rural Prosperity, a significant bipartisan endeavor. This commission has a shared mission to enable rural prosperity in the 21st century by strengthening economic opportunity, resilience, and quality of life across rural America. Drawing on rigorous analysis and informed by a series of research symposia led by Brent and Tony, America’s Rural Future will share regular insights through policy briefs, public events, and narrative storytelling, informed by site visits and conversations with rural leaders across the country. The discussion explores the challenges and opportunities facing rural America, including economic transformation, workforce development in the age of AI, the importance of infrastructure, climate change resilience, health outcomes, and the need for effective governance and policy coordination. Together, they emphasize the crucial role of civic engagement and community involvement. This is not just a conversation, but a call to action for all those who care about the future of rural policy. In part two of this episode, Michelle is joined by Matt Hildreth, who serves as the Executive Director of RuralOrganizing and RuralProgress, a nationwide network of nearly one million advocates and civic leaders in small towns and rural communities that have successfully pushed for over $1 billion in new economic prosperity programs for economically disadvantaged communities. Matt and Michelle delve into the importance of empowering rural leaders, the impact of Medicaid on small communities, and the innovative 2050 Festival. This festival, aimed at engaging the next generation of civic leaders, is a beacon of hope for the future of rural America, inspiring optimism and confidence in the potential of our rural communities. This episode is brought to you by The National Association of Rural Health Clinics. NARHC invites you to rendezvous in Reno!!! Beginning October 20th, the two and a half day NARHC Fall Institute features a powerful in-person agenda plus three pre-conference webinars the week before. It’s your chance to engage deeply with the pressing issues facing Rural Health Clinics today. With unmatched networking and a throwback 90s Bash, you’ll leave energized and reconnected. Registration closes the evening of October 19th, so don't wait! Head to narhc.org to register.
In this extra episode of the Rural Impact Michelle welcomes Cynthia Wallace, Executive Director of the non-profit, New Rural Project, which she co-founded in April 2021 to discuss the impacts of H.R.1, as well as the how Cynthia and The New Rural Project are amplifying the voices of rural young people and marginalized residents in North Carolina so that they are heard and seen, and they get electorally and civically engaged. Before starting her non-profit, Cynthia spent over 25 years in financial services, retiring from Synchrony (formerly GE Capital) after 20 years spent there. She was the 2020 Democratic Nominee for North Carolina’s 9th Congressional District. Prior to running for public office, she was the Chair of the 9th Congressional District of the North Carolina Democratic Party. Cynthia was appointed in early 2021 to the NC State Banking Commission by Governor Cooper and serves on the boards of Democracy NC and the Levine Museum of the New South. Michelle and Cynthia discuss the challenges facing rural communities, particularly in light of recent legislative changes. She shares her background and the motivation behind founding New Rural Project, which aims to engage rural voters, especially those marginalized in the civic process. The discussion highlights innovative strategies for community engagement, including deep canvassing, barbershop conversations, and empowering young voices in politics. Cynthia emphasizes the importance of listening to community needs and the impact of grassroots activism on local policy. The conversation concludes with a call to action for listeners to support rural advocacy efforts, become and stay engaged in local politics, and a warning about a rapid increase in voter suppression laws enacted across the U.S. in 2025. Show Resources: https://www.newruralproject.org/ https://votingrightslab.org/report/2025-legislative-sessions-to-date-key-election-policy-trends/
Michelle kicks off this episode with Edwin Park, Research Professor at the Georgetown University Center for Children and Families, within the McCourt School of Public Policy. His work primarily focuses on Medicaid, the Children’s Health Insurance Program, and the Affordable Care Act. Previously, he worked for 17 years at the Center on Budget and Policy Priorities, most recently as Vice President for Health Policy. He was also a health policy advisor for the White House National Economic Council, a Medicaid professional staff member for the U.S. Senate Finance Committee, and a health law attorney in private practice. In addition, Edwin served on the Biden-Harris Presidential Transition team. He is also a member of the National Academy of Social Insurance. During this conversation, Michelle and Edwin discuss the implications of H.R.1, also known as the One Big Beautiful Bill Act, focusing on the significant cuts to Medicaid and their impact on rural health systems. They examine the financial strain on rural hospitals, the challenges faced by states implementing Medicaid expansion, and the broader implications for communities across the political spectrum. The discussion highlights the importance of advocacy and accountability in response to these changes. In part two of this episode, Michelle meets with Shawn Martin, Executive Vice President and Chief Executive Officer of the American Academy of Family Physicians (AAFP), and Nathan Baugh, Executive Director of the National Association of Rural Health Clinics (NARHC). Shawn provides strategic leadership to the AAFP and directs the mission-driven work of the nation’s largest primary care organization. A strategic leader with a proven track record of accomplishments, Shawn is nationally recognized for his thoughtful leadership on a range of health care policy and workforce issues. While his career portfolio includes focused work on numerous healthcare and public policy issues, he is best known for his extensive work and national leadership on the development and implementation of primary care delivery and payment models, as well as workforce issues. Before becoming the Executive Director of NARHC in July 2022, Nathan served as the Director of Government Affairs. In this role, he was instrumental in the passage of the Rural Health Clinic Medicare payment reforms, which were signed into law as part of the Consolidated Appropriations Act of 2021. This legislation was the most significant overhaul to the rural health clinic program in the last twenty-five years. As Executive Director, Nathan provides strategic direction for NARHC and remains involved in RHC advocacy priorities, including telehealth and Medicare Advantage. With all eyes focused on legislation that will have sweeping implications for rural health clinics and physicians, Shawn, Nathan, and Michelle discuss the impact of stagnant payment rates and administrative burdens, differences between rural health clinics and FQHCs, the effects of Medicaid cuts, barriers to healthcare, challenges in recruiting and retaining healthcare professionals in rural areas, the importance of advocacy at the state level to mitigate the negative impacts of recent legislation, and strategies for healthcare professionals to engage in policy discussions and advocate for change.
In this extra episode of Rural Impact, Michelle Rathman begins the episode with Anthony Flaccavento. Anthony is a farmer and rural development consultant from Abingdon, Virginia, in the heart of the Appalachian Coalfields. The Founder of Appalachian Sustainable Development, he has focused most of his work over the past four decades on building healthier food systems and more diverse, locally rooted economies in Appalachia and around the world. The Democratic Candidate for Congress in Virginia’s 9th District in 2018, Anthony, co-founded the Rural-Urban Bridge Initiative, or RUBI, in 2021. A national organization, RUBI works to help progressives, liberals, and Democrats understand the underlying causes of the rural-urban divide and take concrete steps to win back rural and working-class people through education, media work, policy change, and local community action. Michelle and Anthony discuss several pressing issues facing rural communities in America, including the importance of understanding the rural-urban divide, building trust, and developing effective communication strategies to engage rural voters. Anthony outlines seven key steps for the Democratic Party to reconnect with rural America, emphasizing the need for local investment and acknowledgment of past policy mistakes. The conversation highlights the significance of grassroots efforts and the Rural New Deal as a framework for revitalizing rural communities. Michelle closes out the episode by sharing with listeners some of the impacts of the One Big Beautiful Bill that passed the Senate on July 1, 2025, highlighting the critical effect of proposed Medicaid cuts on rural hospitals and communities. She cites alarming statistics regarding funding reductions, potential hospital closures, and the broader implications for healthcare, education, and economic stability in rural areas. Michelle emphasizes the urgent need for advocacy and awareness among policymakers to protect rural America from detrimental legislative changes.
Guests: President of the Association of State Democratic Committees Jane Kleeb DNC People's Cabinet Member and Co-chair of Dirt Road Dems Chris Jones DNC People's Cabinet Member and rural policy expert Will Westmoreland DNC Midwestern Regional Chair and Chair of the Missouri Democratic Party Russ Carnahan In this Rural Impact special, "Candid Conversations" episode, host Michelle Rathman delves into the real-world and real-time consequences of the Trump Administration's and the 119th Congress' policy decisions on rural America with a panel of guests from the Democratic National Committee (DNC). In this wide-ranging conversation, Michelle and guests explore how the Democratic Party is working to reengage and earn the trust of the over 60 million rural Americans whose voices are often overlooked and discuss plans for how Democrats are working to reach the estimated 63% of rural voters who cast their vote for a Trump second term. Panel guests include President of the Association of State Democratic Committees Jane Kleeb, DNC People's Cabinet Member and Co-chair of Dirt Road Dems Chris Jones, DNC People's Cabinet Member and rural policy expert Will Westmoreland, and DNC Midwestern Regional Chair and Chair of the Missouri Democratic Party Russ Carnahan. The conversation begins with Russ Carnahan exploring the challenges and opportunities in engaging rural voters with an emphasis on bridging the rural-urban divide. Next, Jane Kleeb addresses the adverse impacts of climate policies on rural communities. Following opening remarks by Jane, Chris Jones highlights the importance and relevance of diversity, equity, and inclusion, as well as the harms that eliminating such programs and funding would have. Closing out the first part of the conversation, Will Westmoreland shares the economic struggles faced by farmers and the implications of Medicaid cuts on rural health. Michelle then invites the entire panel to discuss several critical issues facing rural communities, including cuts to the Supplemental Nutrition Assistance Program budget and significant reductions to Medicaid; they also examine the impact of misinformation on rural voters, the erosion of public education, and the privatization of essential services such as the United States Postal Service. The episode concludes by emphasizing the importance of personal stories and building trust within communities to effectively advocate for policies that benefit rural families, as well as the importance of clear communication, building relationships, and the role of education in combating misinformation and promoting community engagement.
In this special “What’s Your Impact?” episode of Rural Impact, Michelle Rathman starts by speaking with Mindy Cook, National Senior Director for Rural Healthcare Quality Outcomes Research and Analytics at the American Heart Association National Center. The American Heart Association has been a partner of The Rural Impact, and this episode focuses on the impact of the American Heart Association’s Rural Health Care Outcomes Accelerator Program. Michelle and Mindy discuss the importance of improving cardiovascular care in rural hospitals, the challenges faced, and the initiatives in place to enhance quality and outcomes. Mindy shares success stories from participating hospitals and emphasizes the need for preventative health strategies to combat rising rates of heart disease. The conversation concludes with information on how rural hospitals can get involved in the program. In part two of this conversation, Michelle meets with Kallie Provost, Cox Monett Hospitals’ TCD Coordinator, to discuss the challenges and opportunities in rural healthcare, with a particular focus on cardiovascular care and stroke management. Kallie shares insights from her experience at Cox Monett Hospital, emphasizing the importance of evidence-based practices and community partnerships to improve patient outcomes. They explore the Get With The Guidelines Program and its impact on rural hospitals, highlighting the need for collaboration among healthcare providers and emergency medical services (EMS) to enhance care delivery. The Rural Impact thanks The American Heart Association for its 2025 sponsorship! The AHA believes that everyone, no matter where they live, deserves access to high-quality care. That's why they created the Rural Health Care Outcomes Accelerator, a program designed to help rural hospitals improve cardiovascular care and patient outcomes. The Rural Accelerator provides no-cost access to quality improvement programs, data-driven insights, learning collaboratives, recognition opportunities, and expert-guided education to support 1000 rural hospitals nationwide in delivering evidence-based care. Rural hospitals play a critical role in their communities. Enroll today and join the movement to improve rural heart health. Visit www.heart.org/ruralaccelerator to learn more.
In this extra episode, once again focusing on fast-moving developments related to health policy, Michelle welcomes back Joan Alker, Executive Director of the Center for Children and Families (CCF) and Research Professor at the Georgetown McCourt School of Public Policy, to discuss "Medicaid and Its Impact on Maternal and Infant Health." Joan is a nationally recognized expert on the Children's Health Insurance Program (CHIP) and Medicaid and the lead author of CCF's annual report on trends in children's healthcare coverage. She has been published in numerous journals, reports, and blogs, covering a wide range of issues, including Medicaid Section 1115 waivers, child and family health, and the role of Medicaid in Rural areas. During this conversation, Michelle and Joan Alker discuss the critical role of Medicaid in supporting maternal and infant health in rural communities. They explore key findings from a recent research paper, highlighting the importance of Medicaid coverage for women of childbearing age, the geographic disparities in coverage, and the potential impact of proposed Medicaid cuts on rural healthcare access. The discussion highlights the pressing need for community engagement and advocacy to safeguard vital healthcare services in rural areas. The Rural Impact is pleased to welcome The American Heart Association as a sponsor for this and future episodes! Here's why! The AHA believes that everyone, no matter where they live, deserves access to high-quality care. That's why they created the Rural Health Care Outcomes Accelerator, a program designed to help rural hospitals improve cardiovascular care and patient outcomes. The Rural Accelerator provides no-cost access to quality improvement programs, data-driven insights, learning collaboratives, recognition opportunities, and expert-guided education to support 1000 rural hospitals nationwide in delivering evidence-based care. Rural hospitals play a critical role in their communities. Enroll today and join the movement to improve rural heart health. Visit www.heart.org/ruralaccelerator to learn more. Show Resources: Digital Equity Funding: https://www.digitalinclusion.org/wp-content/uploads/2025/02/DEA-Funding-Per-State.pdf Medicaid Role in Maternal and Infant Health: https://ccf.georgetown.edu/2025/05/15/medicaid-plays-a-key-role-for-maternal-and-infant-health-in-rural-communities/
In part one of this extra episode, Disconnected: A Conversation about Health Care, Broadband, Access and Economics, Michelle is joined by award-winning journalists Caresse Jackman and Sarah Jane Tribble. Sarah Jane Tribble is the lead reporter on the rural health desk of KFF Health News. She created the organization’s first narrative podcast, “Where It Hurts,” about the closure of a rural Kansas hospital. An Emmy winner, she has received honors for her work from the National Press Club, the National Institute for Health Care Management, and the Association of Health Care Journalists. Caresse Jackman is an award-winning national consumer investigative reporter with InvestigateTV/Gray Media based in Washington DC. Prior to InvestigateTV, she was a Consumer Investigative Reporter at WSMV-TV in Nashville. Caresse is a member of the National Association of Black Journalists, Investigative Reporter and Editors, the Ida B. Wells Society for Investigative Reporting, and Alpha Kappa Alpha Sorority, Inc. Their conversation explores the critical issues surrounding rural health, particularly the impact of broadband access on telehealth services. Sarah Jane and Caresse discuss their investigative work highlighting the struggles faced by rural communities in accessing healthcare due to inadequate internet connectivity. They share personal stories from individuals affected by these challenges and emphasize the need for funding and infrastructure improvements to address these disparities. The discussion also touches on the intersection of health, food insecurity, and economic implications for rural areas. Part two of this episode features a conversation between Michelle, and Vice President of Policy and Industry Innovation at NTCA- The Rural Broadband Association, Joshua Seidemann. In his role, Joshua focuses on Federal regulatory issues as well as technology and market trends affecting the rural telecom industry. He leads research initiatives for Smart Rural CommunitySM, promoting inter-industry collaboration to deploy broadband-enabled applications to improve agriculture, education, health care and other sectors. Josh is the staff liaison for the NTCA Innovation and Business Opportunity Committee and has served on industry bodies administered by the FCC and National Institute of Standards and Technology. Michelle and Joshua discuss the ongoing challenges of rural broadband access in the United States, particularly in light of the digital divide and the impact on healthcare. They explore the economic factors contributing to dead zones, the importance of federal funding, and innovative programs aimed at improving connectivity for rural communities. The conversation emphasizes the need for advocacy and community engagement to ensure equitable access to broadband as a fundamental utility. The Rural Impact is pleased to welcome The American Heart Association as a sponsor for this and future episodes! Here's why! The AHA believes that everyone, no matter where they live, deserves access to high-quality care. That's why they created the Rural Health Care Outcomes Accelerator, a program designed to help rural hospitals improve cardiovascular care and patient outcomes. The Rural Accelerator provides no-cost access to quality improvement programs, data-driven insights, learning collaboratives, recognition opportunities, and expert-guided education to support 1000 rural hospitals nationwide in delivering evidence-based care. Rural hospitals play a critical role in their communities. Enroll today and join the movement to improve rural heart health. Visit www.heart.org/ruralaccelerator to learn more. To find the resources referenced in the show visit: > https://www.investigatetv.com/2025/04/09/dead-zone-rural-hospitals-patients-are-disconnected-modern-care/> https://www.investigatetv.com/2025/03/10/millions-us-live-places-where-doctors-dont-practice-telehealth-doesnt-reach/> https://www.smartruralcommunity.org/
In this extra episode of The Rural Impact, James M. Decker joins Michelle Rathman to discuss issues impacting rural areas, including revitalization, agriculture, community engagement, economy, and education. James is serving his fourth term as Mayor of his hometown of Stamford, Texas, where he also practices law in his office in the downtown square. In his Westof98 blog and podcast, which is found on substack.com, James writes about rural revitalization and community building. He is also the co-host of the Rural Church and State podcast. In this conversation, James shares his journey from a small-town lawyer to the Mayor of Stanford, Texas, emphasizing the importance of community involvement in finding solutions rather than problems. James also shares insights on why and where to start solving decades-long American agriculture challenges, failing local economies, and the necessity of policy changes to support farming and community pride. Decker advocates grassroots engagement and the need for individuals to take responsibility for their communities, emphasizing that community involvement is an obligation and responsibility. The Rural Impact is pleased to welcome The American Heart Association as a sponsor for this and future episodes! Here's why! The AHA believes that everyone, no matter where they live, deserves access to high-quality care. That's why they created the Rural Health Care Outcomes Accelerator, a program designed to help rural hospitals improve cardiovascular care and patient outcomes. The Rural Accelerator provides no-cost access to quality improvement programs, data-driven insights, learning collaboratives, recognition opportunities, and expert-guided education to support 1000 rural hospitals nationwide in delivering evidence-based care. Rural hospitals play a critical role in their communities. Enroll today and join the movement to improve rural heart health. Visit www.heart.org/ruralaccelerator to learn more. To find James M. Decker’s work visit: https://westof98.substack.com/
In this extra episode of The Rural Impact, Michelle Rathman is joined by Julie Rovner, KFF Health News Chief Washington Correspondent. Julie hosts the KFF Health News weekly health policy news podcast, "What the Health?" Previously, she spent 16 years as a health policy correspondent for NPR, where she helped lead the network's coverage of the passage and implementation of the Affordable Care Act. Julie is the author of the critically praised reference book "Health Care Politics and Policy A to Z," now in its third edition. In 2005, she received the National Press Foundation's Everett McKinley Dirksen Award for Distinguished Reporting of Congress. Michelle and Julie delve into the current state of health policy in the U.S., focusing on the implications of recent cuts to health programs, the strategies regarding Social Security and Medicare, and the impact of Medicaid work requirements. They discuss the challenges the Department of Health and Human Services (HHS) faces in the wake of massive layoffs and department consolidation, the potential consequences for public health at the state level, and how the confusion in health policy is impacting local health initiatives. The conversation highlights the urgency of these issues, the legality of the Trump Administration's withholding of Congressionally approved and allocated funding, and the staggering uncertainties for America's rural hospitals and health clinics to maintain essential health services. In addition to our featured conversation, The Rural Impact is pleased to welcome The American Heart Association as a sponsor for this and future episodes! Here's why! The AHA believes that everyone, no matter where they live, deserves access to high-quality care. That's why they created the Rural Health Care Outcomes Accelerator, a program designed to help rural hospitals improve cardiovascular care and patient outcomes. The Rural Accelerator provides no-cost access to quality improvement programs, data-driven insights, learning collaboratives, recognition opportunities, and expert-guided education to support 1000 rural hospitals nationwide in delivering evidence-based care. Rural hospitals play a critical role in their communities. Enroll today and join the movement to improve rural heart health. Visit www.heart.org/ruralaccelerator to learn more.
Just after returning to the studio after two back-to-back episodes where Michelle spent time at the National Rural Health Association (NRHA) Policy Institute and the National Association of Community Health Centers' Policy and Issues Conference in D.C., Michelle continues the conversation with NRHA's Government Affairs and Policy Director, Alexa McKinley Abel for an update about the impact of the Continuing Resolution on rural health organizations and what to watch for from Congress as the budget reconciliation process continues. In the second part of this episode, Michelle meets with the Executive Director for Blue Missouri, Jessica (Jess) Piper. Born and raised in rural America, Jess is a mother to five and grandmother to three, lives on a small farm on the Missouri/Iowa border and was an American Literature teacher for 16 years. After the 2016 election of Trump, Jess became politically active. Jess ran for office in 2022 as a State Representative in HD1 in Northwest Missouri. She was unsuccessful but used the experience to organize progressives in rural Missouri. Jess also hosts a weekly podcast called "Dirt Road Democrat." In this conversation, Jess Piper shares her journey from being a teacher to running for state office in Missouri, highlighting the challenges faced by rural communities, particularly in education and political representation. Michelle and Jess discuss the impact of information silos and news deserts, as well as the importance of grassroots organizations in engaging rural voters. Jess emphasizes the need for Democrats to reconnect with rural constituents and the long-term strategy required to effect change in these areas. The Rural Impact is pleased to welcome The American Heart Association as a sponsor for this and future episodes! Here's why! The AHA believes that everyone, no matter where they live, deserves access to high-quality care. That's why they created the Rural Health Care Outcomes Accelerator, a program designed to help rural hospitals improve cardiovascular care and patient outcomes. The Rural Accelerator provides no-cost access to quality improvement programs, data-driven insights, learning collaboratives, recognition opportunities, and expert-guided education to support 1000 rural hospitals across the country in delivering evidence-based care. Rural hospitals play a critical role in their communities. Enroll today and join the movement to improve rural heart health. Visit www.heart.org/ruralaccelerator to learn more.
A Programming Note: This episode was recorded in February of 2025. As it drops on March 13, 2025, it's important to note that topics and issues raised about Medicaid funding, Congressional Appropriations, a potential Government shutdown, regulatory matters, and funding for key rural health programs have likely changed. In the second of our two-part health policy "Rural Impact on the Road" episode, we continue delving into urgent priorities and then expand the conversation to explore strategies for meaningful community-level engagement that focuses on building relationships and coalitions that help to build "civic muscle." Michelle's first conversation began at the National Rural Health Association (NRHA) Policy Institute in mid-February, where she sat down with Brock Slabach, Chief Operations Officer of the NRHA. The two discussed current challenges and priorities for rural healthcare, focusing on regulatory relief, securing key health programs, addressing the infrastructure needs of aging facilities, the importance of modernizing healthcare infrastructure, and the significant impact of cybersecurity threats on rural health facilities. Next, Michelle meets with Mark Holmes, PhD, Center Director of The Cecil G. Sheps Center for Health Services Research. The two discuss the importance of training healthcare providers in rural areas, the impact of research on policy, the need for advocacy to ensure continued funding for rural health research, and the necessity of informed policy-making to improve health outcomes in rural communities. From there, Michelle met with the Chief Revenue Officer of Mission Mobile Medical Group, Brad Watson. Brad met with Michelle at the NACHC P&I Forum and discussed the impact of public health outreach, particularly in underserved areas. The challenges community health centers face in accessing grant funding. They examine innovative financial models that can support mobile health initiatives without solely relying on grants, aiming to enhance healthcare access for vulnerable populations. We end this episode with a conversation between Michelle and Becky Payne, President & CEO of The Rippel Foundation, and discuss vital conditions for health and wellbeing, the importance of belonging and civic muscle as central elements of community health, the need for transformational change through shared stewardship, and the role of policy in enabling these conditions.
Guests: Joan Alker, Executive Director and Co-Founder of the Center for Children and Families, Georgetown University McCourt School of Public Policy Gina Capra, Chief Education Officer, National Association of Community Health Centers Wade Erickson, CEO, Horizon Health Julie K. Wood, MD, MPH, FAAFP, Senior Vice President, Science and Clinic Strategy, American Academy of Family Physicians Roger Wells, PA-C, Lexington Regional Health Center Sarah Hohman, MPH, CRHCP, Director of Government Affairs, National Association of Rural Health Clinics John Henderson, CEO, Texas Organization of Rural & Community Hospitals In the first of our two-part episode on the Road in D.C., we’re going deep into Health Policy Issues & Urgent Priorities right out of the gates in 2025. Michelle’s first conversation was recorded at the National Rural Health Association (NRHA) Policy Institute, where she sat down with Joan Alker, Executive Director and Co-Founder of the Center for Children and Families at Georgetown University McCourt School of Public Policy. The two discuss the critical role Medicaid plays in small towns and rural America, the potential impact of proposed cuts to Medicaid on children, families, and those who are disabled, and the importance of advocacy to protect Medicaid funding and ensure access to healthcare for vulnerable populations. Next, Michelle meets with Gina Capra, Chief Education Officer of the National Association of Community Health Centers (NACHC), from the NACHC Policy and Issues Forum, where they discuss pressing challenges faced by community health centers, including funding issues, workforce shortages, and the need for regulatory support. They discuss the importance of financial stability, the role of telehealth, and the critical nature of the 340B program in providing comprehensive care to underserved populations. From there, Michelle was joined by Wade Erickson, CEO of Horizon Health. He discussed the vital role of federally qualified health centers in rural and frontier South Dakota, acknowledging the need for balancing budgets and imploring policymakers to understand the unique challenges they face in recruiting and retaining healthcare professionals and the importance of policy support for sustainability. Next, Michelle sat down with Julie K. Wood, MD, MPH, FAAFP, Senior Vice President, Science and Clinic Strategy, American Academy of Family Physicians. They discussed the significant challenges physicians face, including prior authorization processes that hinder patient care and the importance of retaining enthusiasm among medical residents, especially in rural areas facing OB deserts. The discussion also highlights the need to build trust in primary care amidst political challenges and the importance of addressing social drivers of health through supportive policies. We end this segment with a conversation between Michelle and Roger Wells, PA-C, from Lexington Regional Health Center. Roger sounds the alarm on the critical state of provider health and well-being, mainly focusing on devastating rates of burnout among healthcare providers. They discuss the implications of this burnout on patient care and the healthcare system, emphasizing the need for policy changes to support providers and ensure sustainable healthcare practices. Lastly, Michelle concludes the episode with two conversations, both leaders working with hundreds of organizations that Medicaid cuts will dramatically impact. Sarah Hohman, MPH, CRHCP, Director of Government Affairs at the National Association of Rural Health Clinics, and John Henderson, CEO of Texas Organization of Rural & Community Hospitals, give a succinct and insightful overview of the consequences for rural health clinics and hospitals and discuss strategies for advocates to take to their members of Congress. Listen to the end of homework and the extra credit!
In this extra episode, Michelle sat down with Dr. Seth D. Kaplan, a leading expert on fragile states, societies, and communities, and the author of Fragile Neighborhoods: Repairing American Society, One Zip Code at a Time. He is a Professorial Lecturer in the Paul H. Nitze School of Advanced International Studies (SAIS) at Johns Hopkins University, Senior Adviser for the Institute for Integrated Transitions (IFIT), and consultant to organizations such as the World Bank, U.S. State Department, U.S. Agency for International Development, United States Institute of Peace, and OECD. Michelle and Seth discuss the themes of fragility in American society, particularly in rural areas, as explored in his book 'Fragile Neighborhoods.' He emphasizes the importance of social relationships and local institutions in building resilient communities. The discussion covers the two faces of poverty, the impact of life expectancy and its connections to policy, the significance of community gathering spaces, and the challenges faced by both boys and girls in America’s education system. The conversation explores social fragility as a significant issue in America, how rural areas often experience higher levels of poverty, and targeting multiple drivers of health as well as the essential role rural schools play in their communities. They conclude the discussion with Seth sharing the importance of talent retention and attraction strategies, building trust and cohesion in rural communities, as well as creating more placemaking activities in rural communities. Resources: To learn more about Seth’s work visit: https://sethkaplan.org/author/
In the third episode of the new series, 2025 & The Impact of Policy Shifts, Michelle sat down with Dreama Gentry, President and CEO of Partners for Rural Impact, a national intermediary that mobilizes rural leaders, strengthens the capacity of rural organizations, and activates policymakers and philanthropic partners to ensure the 14 million children and youth living in rural America are on a path to upward mobility. Partners for Rural Impact has eight offices nationwide and 350+ employees with an annual budget of $60+ million. Michelle and Dreama discuss the challenges and opportunities in rural education, particularly focusing on the impact of federal funding and discretionary grants. They explore the importance of these funds in supporting educational programs, addressing persistent poverty, and ensuring equity in education. Dreama shares how Partners for Rural Impact is increasing access to high-quality programs and supports to improve outcomes for children in rural America, from kindergarten readiness to reading and math proficiency to college and career readiness. The discussion highlights the need for advocacy, storytelling, and collaboration among rural communities to sustain and improve educational outcomes for young people. Gentry emphasizes the critical role of local support and the economic implications of funding freezes, how collaboration among rural organizations strengthens advocacy efforts, and how every young person deserves unhindered pathways to upward mobility. Resources: To learn more about Partners for Rural Impact work visit: https://partnersrural.org/
In part one of the second episode of the new series, 2025 & The Impact of Policy Shifts, Michelle sat down with Mark Lieberman reporter for Education Week covering K-12 school finance nationwide. He previously covered technology for EdWeek, digital learning and online education in the postsecondary world for Inside Higher Ed, and local news and culture in the D.C. area for a variety of outlets. Michelle and Mark cover the financial struggles faced by rural schools due to funding cuts, particularly the implications of the Secure Rural Schools Act. They explore how these cuts can significantly impact school budgets, leading to potential layoffs and program reductions. The discussion shifts to the topic of private school choice, examining how it affects rural students and the challenges of limited private school options in these areas. The conversation highlights the complexities of education funding and the need for accountability in new educational policies. Continuing the conversation, Michelle was joined David Ardrey, interim Executive Director of the National Rural Education Association, and Executive Director of the Association of Illinois Rural and Small Schools (AIRSS). His decade-long service to the NREA includes his recent Presidency of the NREA in 2023; numerous board positions, committees, and legislative work; and serving on the NREA Foundation board. During their conversation, Michelle and David cover a wide range of critical rural education issues. They discuss the impact of potential cuts to the Department of Education, the challenges of funding disparities, the importance of research and policy in rural education, the interconnectedness of food security and education, and the urgent need for advocacy to support rural schools. David emphasizes the importance of prioritizing education to combat poverty and improve the quality of life in rural communities. Resources: https://www.edweek.org/policy-politics/rural-schools-are-set-to-lose-key-federal-funds-unless-congress-acts-fast/2025/01 https://www.edweek.org/policy-politics/video-whats-in-store-for-school-funding-in-the-new-trump-administration/2024/12