Rural Health News is a weekly segment of Rural Health Today, a podcast by Hillsdale Hospital.
Most Urgent
On Thursday, December 11, the Senate failed to pass legislation that would extend enhanced premium tax credits for ACA Marketplace health plans or reach any kind of compromise between parties. As anticipated, healthcare costs will skyrocket for the current 21.8 million enrollees, and we expect to see a record low in Marketplace enrollment this year. KFF estimates that the expired subsidies will cause annual premiums to more than double, making health plans completely unrealistic for many Americans who will now be paying out-of-pocket. By creating a payer population that lacks proper reimbursement for hospitals, we’re not putting money back in the hands of American people or healthcare providers, as the current administration claims. Hospitals will suffer under the effects of this decision, especially those with a historically high rate in Marketplace payers.
This month, Health and Human Services repealed a rule that required long-term care facilities participating in Medicare and Medicaid to provide residents with a minimum total of 3.48 hours of nursing care per day, with additional specific requirements. While nursing homes want to adequately care for their residents, this rule disproportionately burdened rural hospitals facing healthcare workforce shortages.
Damage Report
Healthcare systems and industry leaders have been eyeing the new $100,000 fee attached to each H-1B visa as a potential recruiting challenge and now, rural health is feeling the impact in real time. Some hospitals in remote areas rely on international programs that bring foreign-born healthcare professionals to the US. H-1B visa recipients fill open positions for doctors, nurses, technicians and other roles that are essential patient care. Now, rural hospitals are the most vulnerable in the face of visa fees because recruiting inside the US has proven impossible on many fronts. Most big urban health systems offer sign-on bonuses and other perks that rural hospitals can’t afford. Working in rural health provides an unmatched opportunity to be a part of a family, care for a community you love, and grow in unique ways across your field that aren’t possible in larger system silos. Yet, rural hospitals struggle most to find talent locally and have to look outside the US to support their team and patients.
With resources spread thinner than ever across rural hospitals, many will sustain long-term damage from having to choose between a staggering fee and remaining short-staffed, which impacts patient care in addition to the strain on hospital employees.
According to a report from the Health Resources and Services Administration, rural areas will experience the greatest staffing shortages as overall rates of shortages increase. By 2037, HRSA predicts a shortage of more than 187,000 full-time physicians alone. A 2023 government survey revealed that 16% of registered nurses, 14% of physician assistants and 14% of nurse practitioners and midwives working in US hospitals are immigrants. As of last year, around 25% of physicians went to medical school outside the US or Canada, according to the Federation of State Medical Boards.
We’re following the lead of the American Hospital Association and other industry leaders urging the Trump Administration to exempt the healthcare workforce from the $100,000 H-1B visa fee.
Success Story
Rural communities are considerably under-resourced compared to their urban counterparts, and one of the most significant needs is childcare. Data shows that more than half of Americans live in communities that are classified as childcare deserts. When parents can’t find affordable and accessible childcare for their kids, they can’t consistently work, support their families or contribute to the economic development of their community. This also effects the population of rural areas as families with young children can be prevented from moving to a rural area because of the lack of resources. Many experts predict a declining rate of longevity for rural communities as long as childcare access remains inadequate.
In rural Jasper County, Indiana, a critical access hospital turned their former administrative office building into a childcare center. In the midst of the COVID-19 pandemic, most administrative staff were working remotely and the building was empty for several years before this Franciscan Health hospital partnered with a nonprofit childcare center called Appletree to lease the space and provide childcare for the hospital’s staff.
This is a growing trend for rural hospitals as staff express the need for childcare services and struggle to make a hospital work schedule fit with inflexible school or day care calendars. Understanding how needs like this fit into the rest of the community is vital for a hospital that wants to support its teams and provide the best possible care for its neighborhood. As other rural resources disappear due to funding cuts across the US, we know hospitals will continue stepping up as long as they can to support their communities with needs like childcare, food security, crisis readiness and more.
News sources for this episode:
American Hospital Association, “Dueling Senate bills to address health care affordability fail to pass,” December 11, 2025, https://www.aha.org/news/headline/2025-12-11-dueling-senate-bills-address-health-care-affordability-fail-pass.
Chris Stein, “Senate rejects dual healthcare bills as Obamacare tax credits expiration nears,” December 11, 2025, https://www.theguardian.com/us-news/2025/dec/11/senate-vote-obamacare-tax-credit-bills, The Guardian.
U.S. Department of Health and Human Services, “HHS’ Cleanup of Federal Nursing Home Minimum Staffing Standards Rule Expands Access to Rural and Tribal Health Care,” December 2, 2025, https://www.hhs.gov/press-room/hhs-cleanup-federal-nursing-home-minimum-staffing-standards-rule-expands-access-rural-tribal-health-care.html.
Arielle Zionts and Phillip Reese, “Rural Health Providers Could be Collateral Damage from $100k Trump Visa Fee,” December 9, 2025, https://kffhealthnews.org/news/article/h1b-visa-fee-rural-hospitals-foreign-worker-shortages-north-dakota/, KFF Health News.
Rick Pollack, “Exempting Health Care Personnel from H-1B Visa Fees Is Good for Patients and Providers,” October 17, 2025, https://www.aha.org/news/perspective/2025-10-17-exempting-health-care-personnel-h-1b-visa-fees-good-patients-and-providers, American Hospital Association.
Federation of State Medical Boards, “Physician Licensure in 2024,” 2025, https://www.fsmb.org/u.s.-medical-regulatory-trends-and-actions/u.s.-medical-licensing-and-disciplinary-data/physician-licensure/.
Scott Hulver et al., “What Role Do Immigrants Play in the Hospital Workforce?,” June 17, 2025, https://www.kff.org/racial-equity-and-health-policy/what-role-do-immigrants-play-in-the-hospital-workforce/, KFF Health News.
Visas & Immigration Team, ”$100,000 H-1B Sponsorship Fee Hits Rural U.S. Hospitals Hard,” December 9, 2025, https://www.visahq.com/news/2025-12-08/us/100000-h-1b-sponsorship-fee-hits-rural-us-hospitals-hard/, Visa HQ.
Rural Health Information Hub, “In Rural Communities, Where Child Care Is Often Scarce, Healthcare Organizations Are Finding Creative Ways to Help,” December 10, 2025, https://www.ruralhealthinfo.org/rural-monitor/child-care?utm_source=racupdate&utm_medium=email&utm_campaign=update121025.
Rasheed Malik et al., “America’s Child Care Deserts in 2018,” December 6, 2018, https://www.americanprogress.org/article/americas-child-care-deserts-2018/, The Center for American Progress.
Jazmin Orozco Rodriguez and KFF Health News, “Child Care Gaps in Rural America Threaten to Undercut Small Communities,” December 27, 2023, https://dailyyonder.com/child-care-gaps-in-rural-america-threaten-to-undercut-small-communities/2023/12/27/, The Daily Yonder.
Rural Health Today is a production of Hillsdale Hospital in Hillsdale, Michigan and a member of the Health Podcast Network. Our host is JJ Hodshire, our producer is Kyrsten Newlon, and our audio engineer is Kenji Ulmer. Special thanks to our special guests for sharing their expertise on the show, and also to the Hillsdale Hospital marketing team. If you want to submit a question for us to answer on the podcast or learn more about Rural Health Today, visit ruralhealthtoday.com.
