AUSTIN, Texas – States that have expanded their Medicaid programs have seen a drop of more than three times in the number of uninsured rural residents, compared to states like Texas that opted not to expand coverage, according to a new report from the Georgetown University Center for Children and Families.

Patrick Bresette, executive director of the Children's Defense Fund in Texas, sees this report as a wake-up call.

He says his organization is able to sign up rural Texas children for health insurance through federal programs like the Children's Health Insurance Program, but not their parents.

"You're dealing with families who have very little in the way of an infrastructure around them to access care,” he points out. “In some urban areas, there may be more hospitals that they can access. There are free clinics, and we see people who have to drive miles and miles, just to get the kind of basic services that they need."

Prior to the Affordable Care Act in 2009, the uninsured rate for Texans in rural areas and small towns was 40 percent. In 2016, it was 36 percent – still among the highest in the nation, and lagging far behind metro areas of Texas, with a 29 percent rate.

In neighboring New Mexico, which expanded Medicaid in 2013, the uninsured rate has dropped from 46 percent to 21 percent.

Study co-author Joan Alker, executive director of Georgetown University Center for Children and Families, says expanding coverage to more residents of rural areas that already struggle with higher rates of unemployment and poverty makes economic sense.

"When there's a real option here on the table to take these Medicaid dollars, really, it's a wiser use of taxpayer dollars to provide them with the primary preventive care that comes with having health insurance up front, so they don't get sicker and wind up in the emergency room," Alker points out.

Bresette notes that rural hospitals are economic drivers and sometimes, the single largest employers in those communities. He adds that Texas leads the nation in the number of rural hospital closures.

"You do see the ripple effect, because then you don't have pharmacies nearby that are getting as much business. You don't have all the kind of ancillary health support systems that gather around a hospital when it's working,” he states. “So, it's definitely a multiplier and every time you lose one, you're hollowing out part of that rural community."

According to the report, 25 percent of those without coverage also are parents. Numerous studies have shown children's well-being improves when their parents have health insurance.


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Toughing it out during spring allergy season is not in your best interest if you want to avoid asthma later in life.

New Mexico has plenty of grass and weed pollens carried by the wind which contribute to itchy, watery eyes, a stuffy nose and sneezing fits this time of year.

Dr. Osman Dokmeci, associate professor of internal medicine at the University of New Mexico, suggested for those who suffer acutely, seek an allergy test and possibly medication to prevent asthma from taking hold.

"One out of 10 has asthma in America," Dokmeci pointed out. "Having seasonal allergies increases your chance of developing asthma at least fivefold."

He recommended treating allergies early and as aggressively as possible. May is "Asthma Awareness Month," which aims to bring attention to the health issue and highlight improvements in care and quality of life. Nationwide, asthma affects more than 25 million Americans, including 4 million children, and disproportionately affects certain racial and ethnic groups.

Allergies do not "cause" asthma but people who have allergies, or have family members who have allergies, are more likely to get asthma than those who do not. Research shows allergy season is starting earlier and lasting longer. A 2022 study from the University of Michigan found pollen count could increase by 200% by the end of the century due to climate change, which is why Dokmeci stressed it is important not to ignore the problem.

"There's no treatment that actually makes your asthma not happen," Dokmeci explained. "But once you develop asthma, there are good treatment options."

The estimated economic impact of asthma is more than $80 billion per year from direct and indirect costs, such as missed school and workdays.

Recent research shows approximately half of people who die by suicide had contact with a health care professional within the month prior to their death.

However, a recent study shows only 8% of hospitals are currently implementing all four recommended suicide prevention practices: safety planning, warm handoffs to outpatient care, patient follow-up and lethal means counseling.

Melissa Tolstyka, director of Behavioral Health Services for Trinity Health Ann Arbor, said a seamless transition from inpatient to outpatient care is critical. At Ann Arbor, she saw a 46% increase in compliance with comprehensive suicide risk assessments and patients discharged on the suicide care pathway now receive a safety plan, which she sees as progress.

"We continue to see a need for really robust programming," Tolstyka explained. "Not just within the behavioral health world, but in the medical world as well. Our organization really wanted to focus on bringing the behavioral health and the medical services together to enhance our safer suicide care practices for our patients."

The initiative is being piloted across various units at Trinity Hospitals in Ann Arbor and Grand Rapids including the emergency department, psychiatric medical and inpatient nursing units. If you or anyone you know is struggling or in crisis, help is available 24 hours a day, seven days a week, by calling or texting 988, the Suicide and Crisis Lifeline.

Casie Sultana, clinical nurse leader for Trinity Health Grand Rapids, prioritizes patient well-being, emphasizing support and improvement over solely managing risks within the facility.

"We want to be someplace that people feel welcome to come to who are dealing with suicide," Sultana emphasized. "You feel so alone. It's a very lonely journey and we want people to come seek help and feel welcomed when they do that."

Susan Burchardt, clinical services manager at Trinity Grand Rapids, advised other hospitals considering a similar program to learn from organizations already using it.

Support for this reporting was provided by The Pew Charitable Trusts.


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Access to reduced-price medication is a necessity for many rural Missourians with low income.

Rep. Cindy O'Laughlin, R-Shelbina, the Senate Floor Leader, said Big Pharma is trying to confuse legislators with unrelated hot-button topics such as abortion access and illegal immigration in a last-ditch effort to stop the state from joining a program to force drugmakers to sell medicines at a discount.

"Appealing to nuclear topics, which really do not apply in this situation, is a disingenuous way to try to defeat a bill that is actually good for Missouri," O'Laughlin asserted.

O'Laughlin pointed out the program is transparent, and uses the tax money saved to help low-income families deal with chronic conditions such as diabetes.

The drugmakers object to the government forcing them to give significant discounts, arguing hospitals' and for-profit pharmacies' bottom lines, particularly those owned by pharmacy benefits managers, are being exploited. Nationally, 46% of contract pharmacy agreements involve pharmacies linked to the three largest benefits managers.

Rep. Tara Peters, R-Rolla, introduced the 340B contract pharmacy access billand said the lobbying is absurd.

"Federally, 340B program does not allow for abortion drugs," Peters stressed. "Why would any legislation that we're trying to pass in the state allow for that? I mean, the thought of that even being in existence is absolutely ludicrous."

The Missouri Senate passed the bill 27-3 on Monday and it now goes to the House.


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