A new report from the Economic Research Service (ERS) at the U.S. Department of Agriculture found that most (87 percent) of the recent population growth in places with wildfire risk has been among persons age 60 and older. Already, the proportion of older people living in places with more wildfire risk is higher than in the population at large. In rural areas with the greatest wildfire risk, 35 percent of people living in those areas are age 60 and older.  The report examines population aging and wildfire risk for States, counties, and fire management areas.

A study recently published in the Journal of the American Medical Association (JAMA) explores health care spending and utilization in the United States from 2010-2019. The investigators founds that spending for oral disease was $93 million, which was higher than spending for heart disease.

Click here for the oral health summary of the article.
Click here to read the full article.

The Rural Health Value team is pleased to share a new resource, entitled  Introduction to Rural Clinically Integrated Networks (CINs). The purpose of this Rural Health Value topic brief is to define CINs, describe common CIN characteristics, and explore the unique value-based care advantages a rural CIN may bring to its members. The conclusion is that a collaboration of independent rural HCOs, incorporated as a CIN, can achieve the scale and develop the infrastructure necessary to successfully participate in value-based care and payment opportunities. Furthermore, CINs can be a powerful vehicle to deliver better rural health care, healthier rural people, and smarter spending.

Related resources on the Rural Health Value website:

• A Rural Accountable Care Organization’s Journey. For more than a decade, South East Rural Physicians Alliance Accountable Care Organization (SERPA-ACO) – a physician-led ACO that includes 16 physician-owned clinics in Nebraska – has been leveraging health care payment and delivery models to provide high quality, comprehensive, coordinated, and patient-centered care at a lower cost.
• Rural Value-Based Care – The Payer Perspective, Rural Health Value Summit Report. The Rural Health Value team convened professionals and executives from national and regional health care payer organizations to share and explore insights, innovations, successes, and challenges in rural health value-based care (VBC) contracting. This report summarizes challenges and solutions followed by suggestions for rural health care organization leaders from the Summit participants.

Rural Health Value facilitates the transition of rural healthcare organizations, payers, and communities from volume-based to value-based health care and payment models. Visit www.ruralhealthvalue.org

Contact information: Clint MacKinney, MD, MS, Co-Principal Investigator, clint-mackinney@uiowa.edu

From Becker’s Financial Management

Hospitals and health systems could face severe financial consequences if Congress moves forward with proposed Medicaid funding cuts, with new research projecting an $80 billion revenue loss for providers in 2026 and a sharp rise in uncompensated care costs.

This month, the Senate is expected to vote on a budget resolution passed by House Republicans on Feb. 25. The legislation directs the Energy and Commerce Committee, which oversees Medicare and Medicaid, to identify $880 billion in savings over the next 10 years.

The resolution does not specify how the committee must achieve these savings, but Medicare and Medicaid account for the largest share of its oversight. The Congressional Budget Office has said that reaching the $880 billion healthcare savings target over the next decade would likely require significant cuts to Medicaid or the Children’s Health Insurance Program.

A March 11 report from the Urban Institute and the Robert Wood Johnson Foundation analyzed the impact of potential federal funding reductions for Medicaid expansion programs. The findings suggest that if all 41 states that expanded Medicaid eligibility over the past decade were to drop the program in response to federal cuts, nearly 11 million people would lose coverage, leading to widespread financial strain on healthcare providers.

The analysis projects hospitals would bear the brunt of revenue cuts, facing a $31.9 billion decline in 2026 alone. At the same time, the cost of uncompensated care would rise by $6.3 billion. The study also forecasts:

• $20.9 billion less spent on prescription drugs
• $20.7 billion less on other healthcare services, including dental care, home healthcare and services from non-hospital providers
• $6.4 billion less on office-based physician services

The financial hit would not be evenly distributed, with some states — Arizona, Indiana, New Mexico, New York, North Carolina, North Dakota, Oklahoma and Oregon — facing healthcare spending cuts exceeding 6%. Researchers warn such reductions could be particularly devastating for rural hospitals, where Medicaid expansion has played a critical role in maintaining financial viability.

Medicaid expansion, introduced under the ACA, covers millions of working Americans who earn modest incomes but do not receive employer-sponsored insurance. The federal government currently funds 90% of the costs for states that opt into the expansion. If funding is cut, states may be forced to reconsider their participation, which could have far-reaching consequences beyond coverage loss, according to the report.

“As Republicans in Congress consider significant cuts to the Medicaid program, it is important that federal, state, and local policymakers and stakeholders consider potential adverse effects on healthcare coverage, access and affordability, and health providers,” Fredric Blavin, senior fellow at the Urban Institute, said in a news release.

Beyond the direct impact on hospitals and patients, the study underscores potential ripple effects across local economies. Katherine Hempstead, senior policy adviser at the Robert Wood Johnson Foundation, noted that hospitals are often the largest employers in their communities.

“A funding reduction of this magnitude would not only cause a massive coverage loss but would also be financially devastating for hospitals and other healthcare providers,” Hempstead said. “Hospitals are major employers and are often the economic bedrock of their communities. These cuts would have major ripple effects on local economies, especially in rural areas.”

Click here for more details on the report.

Every child deserves an equal opportunity for quality early care and education in their earliest years to ensure they are well prepared to learn, grow, and succeed. While the child care sector has been facing a workforce shortage impacting access to high-quality child care for families in recent years and particularly since the pandemic, we are hopeful the Governor’s proposed $55 million recruitment and retention effort will be included in final budget negotiations. Our 2025 interactive maps and corresponding fact sheets for the Start Strong PA campaign are now available and show data about the workforce, high-quality access, and quality. Fact sheets are available by county, school district, and legislative district.

Key data points include:

• The average annual salary of child care workers in 2023 was $29,480, which is over $39,000 less than the average annual salary of kindergarten teachers.
• Of the 177,710 eligible children under 5 years living in Pennsylvania, only 28% access the Child Care Works subsidized child care program. Of these 49,225 children, only 53% are enrolled in high-quality child care.
• Of Pennsylvania’s 104,470 eligible infants and toddlers, only 23% access the Child Care Works subsidized child care program. Of these 24,292 children, only 50% are enrolled in high-quality child care.
• Support the proposed investment of $55 million in a new and recurring Child Care Recruitment and Retention line item to grant licensed child care providers participating in the child care subsidy program an additional $1,000 per educator.
• To more fully address the child care staffing crisis and its impact on working families, businesses, and the economy, consider an investment above the proposed $55 million.

As part of the 2025-26 final state budget, Pennsylvania policymakers should:

• Support the proposed investment of $55 million in a new and recurring Child Care Recruitment and Retention line item to grant licensed child care providers participating in the child care subsidy program an additional $1,000 per educator.
• To more fully address the child care staffing crisis and its impact on working families, businesses, and the economy, consider an investment above the proposed $55 million.

Click here to access the fact sheets and online maps.