Rural Health News is a weekly segment of Rural Health Today, a podcast by Hillsdale Hospital.
The ACA Marketplace remains a tumultuous field of discussion, and the fight isn’t over yet. Due to expiring enhanced premium tax credits, enrollments in Healthcare.gov and Marketplace plans are down from last year, and many enrollees who were automatically enrolled do not plan on paying for their coverage, resulting in “effectuated” enrollment.
More will be known about the damage the expired subsidies will have after the premium deadlines pass in the summer, but for now, hospitals are looking to their individual states to provide the support families will need to maintain coverage. However, for beneficiaries of Obama Care, premium subsidies may be extended another three years. The House voted to extend the subsidies last week, but it has yet to face the Senate. While the Senate has been failing to form a compromise that could bring the subsidies back so far, a bipartisan group of Senators is making headway in establishing a way forward that could restore coverage to many Americans.
Damage Report
A comparison of America’s overall health rankings from 2025 to previous years.
Mortality:
- Overall, drug deaths in the U.S. have been decreasing, but have increased for ages 65-74 and among Black populations.
- In 2024, 14.3 million adults contemplated suicide, 4.6 million made a plan and 2.2 million attempted. Recent rankings have not considerably varied from past years.
- The top five causes of premature death in the last report period were unintentional injuries, cancer, heart disease, suicide and homicide. COVID-19 was previously in the top five causes, but has not even ranked in the top 10 most recently.
Mental Health:
- Between 2024 and 2025, the number of mental health providers increased 5%.
- Mental health factors that haven’t changed include frequent mental distress and suicide.
- In 2024, 122 million Americans were living in areas with a mental healthcare professional shortage.
Rural Health Rankings:
- Although physical inactivity has been decreasing overall, it was 1.2 times higher among adults living in rural areas compared to urban areas.
- Cancer screening rates continue to rank lower in rural areas than urban areas, but the overall rankings are improving across both areas.
- Flu vaccinations have been decreasing each year, especially in rural areas. The most recent reports rank urban area vaccination rates as 1.2 times higher than rural areas.
- The prevalence of multiple chronic conditions was 1.5 times higher in rural areas.
- Smoking, which is the leading cause of preventable death in the U.S. is 1.5 times more common in rural areas than urban.
Success Story
The very first human lung transplant was performed 63 years ago, but it was another eight years before a recipient survived past the first month of receiving new lungs. Now, lung transplantation has become a treatment option for many patients facing lung disease, cystic fibrosis, pulmonary hypertension and more. One hospital in Chicago is paving the way for even more innovative transplantation options.
Northwestern Medicine’s transplant program is considered one of the greatest and most innovative in the country. In 2024, they completed the nation’s first successful double-lung and liver transplant. Since noticing how destructive COVID-19 was to patients’ lungs, they have been developing COVID-specific lung transplant procedures. Now, they are engaged in a race against time.
In transplantation, every second matters, from the moment an organ is procured to the time a recipient spends waiting for the transplant they need. Northwestern Medicine’s vision is to find new ways for organs to last longer than has been historically possible and achieve higher rates of transplant success by innovating the way procured organs are treated, as well as the care recipients receive post-operatively. With programs like this advancing the field of transplantation, it is exciting to consider how much more will be possible in the future.
Sources
Jared Ortaliza, “ACA Signups are Down, But Still an Incomplete Picture,” January 12, 2026, https://www.kff.org/quick-take/aca-signups-are-down-but-still-an-incomplete-picture/, KFF.
Sam Gringlas, “House votes to renew ACA subsidies, as Senate Republicans rebuke Trump on Venezuela,” January 8, 2026, https://www.npr.org/2026/01/08/nx-s1-5662625/house-vote-affordable-care-act-subsidies, National Public Radio.
America’s Health Rankings, “2025 Annual Report,” 2025, https://assets.americashealthrankings.org/ahr_2025annual_comprehensivereport_final-web.pdf.
Elizabeth Gregerson, “Northwestern takes on its biggest rival in transplants: Time,” January 9, 2026, https://www.beckershospitalreview.com/quality/patient-safety-outcomes/northwestern-takes-on-its-biggest-rival-in-transplants-time/, Becker’s Hospital Review.
Mackenzie Bean, “Nation’s 1st double lung-liver transplant performed at Northwestern,” March 28, 2024, https://www.beckershospitalreview.com/quality/patient-safety-outcomes/nations-1st-double-lung-liver-transplant-performed-at-northwestern/, Becker’s Hospital Review.
American Lunch Association, “Lung Transplant,” December 10, 2025, https://www.lung.org/lung-health-diseases/lung-procedures-and-tests/lung-transplant.
Tanmay S. Panchabhai et al., “Historical perspectives of lung transplantation: connecting the dots,” July 31, 2018, https://jtd.amegroups.org/article/view/22674/html, Journal of Thoracic Disease.
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.
