Rural Health Transformation Initiative-Statewide Analysis

 Rural Health Transformation Program

As promised, this is the follow-up to this month’s article on the vulnerability of hospitals across the United States because of the federal Medicaid cutbacks. (Winter, 2026)This article reviews all fifty abstracts submitted to the Centers for Medicare and Medicaid for the Rural Health Transformation grants. (Centers for Medicare and Medicaid, 2026) Rural healthcare does impact about half of the U.S. population, and it is difficult to resource because of population and geographical limitations.

As a plaster to the hemorrhaging from the trillion-dollar Medicaid reduction at the federal level, the Trump Administration is offering a one-time 50-billion-dollar five-year federal grant administered by the Centers for Medicare and Medicaid. All state submissions for the RHI grants were reviewed. Many states did not provide any specific details on how they intend to use the funds, measurable targets, or other details. Further, states which are not rural, such as Delaware, applied for the grant, it would be more prudent to allocate funds based on the proportion of state population that is actually rural. States which did not provide detailed proposals for use of the RHI Grants such as measurable targets and budgets for programs included: Connecticut, Georgia, Idaho, Illinois, Maryland, New York, Oklahoma, South Carolina South Dakota, Texas, and Utah.

After reading the proposals for each state, the most interesting proposals include:

1.       Maine tied its grant request to achievement of specific patient health outcomes

2.       Proposals to build more patient care capacity by loosening licensure for pharmacists, physician assistants, and community health workers.

3.       Investment in school-based health centers, yes to school nurses and counselors

4.       Establishing regional rural care collaborations, for data sharing and resourcing

5.       Creative proposals on non-urgent medical transport and mobile clinics

Best In Class-States which submitted concrete proposals and budgets for ways to improve rural health care include; Hawaii, Iowa, Nevada, New Mexico, Pennsylvania, Rhode Island, Vermont, Virginia, and Wyoming. The table below highlights each state’s summary response to the request for a proposal for the RHT grant funding.

State	Grant Proposal
Alabama	Focused on maternal & fetal health, digital obstetric aids, telerobotic ultrasounds, increase rural training pipelines through simulation programs, mobile cancer screening
Alaska	Pay for value-promoting fiscally sustainable programs, payment innovation, Healthy Beginnings- to support maternal and child health
Arizona	Subsidizing EMR licensing, leveraging shared networks, reducing back office overhead(staff)
Arkansas	Improved coordination of care access through PACT
California	Create regional hub and spoke networks, OB Nest for prenatal & remote patient monitoring
Colorado	Pledged to run the RHI program and keep administrative costs below 3%, light on details
Connecticut	Generic proposal, no specific targets or budgets
Delaware	Create a state-run medical school with a primary rural healthcare track, train here-stay here, expand medical students, PA’s, NPs, and community health workers
Florida	Improve access for urban-led rural health centers, paramedicine using tele-health for remote monitoring, lifestyle focused initiatives
Georgia	Generic proposal, no specific targets or budgets
Hawaii	Create-statewide digital connection, expand EMS services, community paramedics, expand medical model for post-acute care, allocation of a fund for innovative value-based care models
Idaho	Generic proposal, no specific targets or budgets
Illinois	Generic proposal, no specific targets or budgets
Indiana	60% of funding to be allocated to regional grants
Kansas	Accountable food partnership, remote patient monitoring services, new transportation models, cost effective reforms
Kentucky	41.6% of population is rural-Expand the number of clinical and nonclinical rural healthcare workers, telehealth, community-based teams, strengthen EMS
Louisianna	Strengthen collaboration among rural hospitals, clinics, EMS, behavioral health, and allied professional networks
Maine	Set performance target for 75% of rural hospitals to achieve operating margins for solvency, reduce hospital re-admission rate by 10%, increase population with controlled-blood-pressure by 10%, reduce the population of adults delaying medical care by 10%
Maryland	Generic proposal, no specific targets or budgets
Massachusetts	7 initiatives including; expand payment methodologies to incorporate value of care and lower cost, support community informed prevention, address gaps in healthcare system
Michigan	Reduce gaps I care through care models that help keep residents close to home
Minnesota	Strengthen & stabilize rural providers through earn-while-you-learn programs-capital investments, sustained access to services
Mississippi	Close the gap between EMS, care management, and value of care
Missouri	Create regional hubs to enhance care coordination, alternative payment methods, modernize operations infrastructure
Montana	Sustainability through partnerships and restructuring, innovative care delivery models to improve access and outcomes
Nebraska	Regionalized rural access hubs, workforce acceleration partnerships, with NE Hospital Assoc, universities, community colleges
Nevada	Leverage physician extenders, 47% of the grant to create a flex fund to bolster modernization of rural systems; 44% to address gaps in workforce funding-education, certification
New Hampshire	Enhance care coordination, reducing use of acute care (ED) setting for care delivery
New Jersey	NJ has a million rural residents-Investing in mobile health care
New Mexico	Established budget for the grant for all criteria including; 31% awarded for community-led efforts, 20% for creation of a rural health sustainability center including technical assistance, operational support, creation of a rural data hub
New York	Only 10% of the population is rural, nothing specific in budgeting RHI initiatives
North Carolina	Catalyze innovative care models, improve patient screening tools, expand behavioral health and substance abuse treatment, create a value-based payment system, deployment of A/I to support real-time clinical decisions, documentation
North Dakota	Established budgets for all components-58% of RHI grant is geared toward transforming care models through mobile clinics, telehealth hubs, enhanced remote patient monitoring
Ohio	Rural health hub, school-based health centers, mobile clinics for vision, hearing, dental care, transformation of emergency care, funding to train rural healthcare workers with 5-year commitments of service, targeted outcome-20% increase in rural healthcare workers by 2031
Oklahoma	No specific budgets for value-based care, regional collaboration, data driven healthcare delivery
Oregon	33% of population is rural-Oregon Healthcare Authority will lead the program; Phase I grant awards will go to community projects that can be completed in two years, Phase II will address longer term collaborations to improve rural health
Pennsylvania	Creates 8 rural care collaboratives, provides upfront scholarships, housing assistance, investments in rural health pipeline, data analytic support for digital care models, dental care through a special care dental center at a state hospital, analysis of alternative payment models
Rhode Island	13 initiatives including: clinical care hubs, expand rural EMS service, community paramedicine, 24X& crisis stabilization center, state sponsored electronic medical record system, triage for tele-dentistry
South Carolina	Generic proposal, no specific targets or budgets, establishing mobile crisis units, rural health system facility upgrades
South Dakota	Implementation of statewide community behavioral health clinics, exploration of new Medicaid payment models
Tennessee	Up to 500 million offered in competitive awards to strengthen rural healthcare-championed by the governor, another 125 million will go to investments in rural hospitals
Texas	No specific budgets outlined, initiatives include; Lonestar advanced A/I telehealth, unified care infrastructure investment
Utah	77% of the state is rural-Program to be run by Department of Health & Human Services for state-no specific budget targets, focused on workforce development and technology innovation
Vermont	Grants will be distributed based on regionalization and care innovation strategies; increasing scope of practice for licensure of physician extenders, pricing transparency and insurance competition (this one has me stumped, insurance companies are not fighting over rural health care)
Virginia	Allocates 28% of total RHI grant to early-stage health technology startups for remote patient monitoring, 13% to fund rural health residencies, 41% to fund hub and spoke models for community health, improved maternal health, mobile health clinics, paramedicine
Washington	Grants to be awarded to public and nonprofit entities; including The Rural Health Redesign Center, The Rural Collaborative, Dept of Health, DSDS, state hospital association, and the University of Washington-no specific budgets listed
West Virginia	Integrating digital and in-person care, connecting community transportation with healthcare, updating payment & data tools, improved care management-no specific budgets listed
Wisconsin	Grant awards-33% to fund and finance health workers, 32% for telehealth innovation, 27% to partnerships transforming care
Wyoming	The least populated state had a very robust response in these priorities:  1) 48% of grant used for critical access hospitals/emergency care 2) Incentivizing small ambulance companies for regional consolidation  3) Create an affordable medical plan for people priced out of insurance  4) 25% of the grant to increase healthcare workforce by loosening scope of practice limitations for PA’s, dental hygienists, pharmacists 5) With 16% of grant allocated between creation of statewide telepsychiatry and crisis intervention program 6) Care management and coordination of nonemergency transportation for patients with chronic diseases

 Wyoming deserves a gold star, not only for their methodology, but their community assessment, and the responsiveness of their RHT grant proposal. The least populated state had one of the most impressive abstracts. My only concern is the target to limit administrative costs for the grant awards to under 1% when 3% is more standard.

It is important to note these are the abstract submissions, which simply means the state is interested in receiving the Rural Health Transformation funding. Full blown proposals and reporting requirements will be made public at some point.

And this is the healthpolicymaven signing off, encouraging you not to sign blanket releases when you agree to an inpatient procedure, do stipulate that for which you agree and decline, based on your medical directive. This article was written by Roberta Winter who received no compensation from any sector for the post.

References

Centers for Medicare and Medicaid. (2026, September 17). RHT Program State Project Abstracts. Retrieved from Centers for Medicare and Medicaid.gov: https://www.cms.gov/files/document/rht-program-state-provided-abstracts.pdf

Winter, R. E. (2026, September 2). Trump Administration Healthcare Cuts-State By State Analysis of Hospital Viability. Retrieved from healthpolicymaven.blogspot.com: https://healthpolicymaven.blogspot.com/2026/09/trump-administration-healthcare-cuts.html

 

The Problem With U.S. Healthcare Is It Is Designed To Deliver Reimburseable Interventions-Not Health

Healthcare in the United States is largely designed for reimbursement based on medical interventions that are not necessarily linked to creating health. Though the nation has excellent critical and specialty care facilities, the system fails to adequately account for critical factors impacting health including environmental, socio-economic, and access to care. These are fundamental contributors for health, but the hectic and excessively expensive health system of the U.S. doesn’t include them in most metrics of performance. The message is that the nation has chosen to treat late-stage chronic disease, provide for critical care, and accept mortality rates that are some of the worst in the industrialized world for suicide, gun deaths, and maternal deaths.

For example, the maternal mortality rate in the United States is four times as high compared to European nations. And this metric has not improved in over a decade. Women die because of complications from childbirth, which is largely preventable, and most of these deaths occur after discharge from the birthing facility. The Commonwealth Fund, a Massachusetts nonprofit health systems research group published a maternal mortality report in 2024 confirming the areas where the US is an outlier in maternal health. (Munira Z. Gunja, 2024) The article reviewed metrics which contribute to maternal health and mortality for nations with high income and national health programs, including Europe as well as Chile, Korea, and Japan. The rate of c-section births is much higher in the U.S. compared to most of these countries as well. (Joan Stephenson, 2022) Two thirds of the deaths in the United States occurred in the first forty-two days following childbirth and reflect a gross inadequacy of post-natal care. And most appalling, the maternal mortality rate for black women in the U.S. is 49.5 deaths per 100,000 births. That ranks with developing countries with poor access to health care. Clearly there is a lack of patient follow-up care for mothers in the United States.

Maternal Mortality Metrics	Best Nation	USA Rank
Maternal Deaths per 100,000 live births	Norway-less than 1 death per 100,000 live births	22 per 100,000 live births
Number of C-sections	Norway-160 per 1,000 live births	320 per 1,000 live births
Access to pre- and post-natal care	Korea provides home post-natal visits for up to 2 years for vulnerable families	Healthcare system does not guarantee maternity coverage, based on the state Medicaid plans and private insurance standards
Number of OB Gyns	Germany-27 per 1,000 mothers	12 per 1,000 mothers
Number of Midwives	Chile-80 per 1,000 mothers	4 per 1,000 mothers
Federally Mandated Paid Maternal Leave	Norway-86 days paid leave	None, 25% of women have private employer paid leave

 Tulane University ran a study that reviewed maternal mortality and restrictive abortion laws for 38 states and the District of Columbia and found the deaths of mothers increased by 7%. (Winter, Pregnancy in the US Just Got More Dangerous-Post Dobbs v Jackson Decision, 2022) Where is the outcry for this  travesty of preventable deaths?

How the Health System Does Not Align with Creating Health

Financialization of Healthcare Without Requirements to Generate Health

The financialization of healthcare by hedge funds to maximize profits without actually delivering care. This is the opposite of what public goods should do. Health should be a goal for our nation’s people and the most efficacious way to identify methods to improve health should be a mandate, not merely an option for investors. The hedge funds purchasing include; behavioral health facilities, medical devices, biotechnology, and physician practices. Hedge funds are buying healthcare-delivery assets, to make profits, not to generate health. In fact, if more people are chronically overweight, depressed, addicted, there will be more customers to buy their weight loss medicine, take the wonder drugs, enroll in specious behavior modification programs, and require medical interventions, which will add revenues to their medical device companies and specialty practices which generate lots of profits in targeted surgeries. Never mind that these procedures may be costly for patients and the health system and the health results short lived.

Purchasing healthcare assets may cause disruption in services, for example, treating the delivery of health care as a commodity, rather than a public health property can reduce the availability of care when physician practices are consolidated. This is rarely to the advantage of patient care but is marketed as an improvement to regulators. For example, when Harrison Hospital was purchased by a Catholic hospital group, the first thing it did was expand urgent care clinics and facilities in wealthier areas and ultimately close the hospital in Bremerton, Washington, which provided care for many veterans, low-income residents, and persons with mental health and addiction issues. (Winter, Hospital Closures and the Impact on Health Services, 2016)This too was billed as nondisruptive, but when a community of 39,000 people loses its hospital, this is disruptive. The message-a disruption in services to the less wealthy is not a significant concern to the healthcare group. Take-a-way-from the boardroom-why deliver services in a poorer area, when the company can make more money by serving the wealthier, bonuses all around.

Nonprofit Hospitals Which Have Converted to For-profit Megaliths

First, why is shaving money off the top for shareholders a good technique for improving health care, and how will this contribute to affordability? The most affordable health care program in the U.S. is Medicare, a government run program for seniors and disabled persons, which has the lowest administrative cost (6%) of any program public or private. Steward Hospitals is an example of a private equity deal from the purchase of the nonprofit hospital Caritas Christi in Massachusetts. The hedge fund then sold off the assets of the hospitals (land) and created a second company for lease revenues from the hospitals which now paid rent to the hedge fund owners. True to form, those investors made all of their money in the first three years and spun off Steward to a physician group and walked away with leaseholds. The physician group, made up of some of the original members of the hospitals, started to lose money and within a decade the hospitals were auctioned off to other entities, but two failed to survive, Carney Hospital and Nashoba Valley Medical Center. The patients in rural Massachusetts and inner-city Boston have had to scramble to find care. (Brownstein, 2024) This seems more like the casualties of war, people treated as detritus in the machinery of for-profit healthcare-health entities operated without concern for the people they are supposed to serve. I wonder how many people died who couldn’t get to a hospital in their area?

Ninety percent of private equity deals in the health care sector are never reviewed for public interest or unintended consequences. Private equity funds are short-term profit driven and not geared to long-term investments in healthcare infrastructure. In 2022, according to DealBook, there were 863 healthcare deals in private equity. Only Oregon and Massachusetts have state laws which monitor private equity healthcare transactions. (The Growth of Private Equity in US Health Care: Impact and Outlook, 2025)

Reimbursement Policies Mostly Geared Toward Volume and Not Quality of Health Produced

Medicare Demonstration Projects have attempted to include quality metrics and reimbursement incentives linked to procedures for health measures, especially in the realm of cardiac care, stroke treatment, and reduction in hospitalizations from improved patient care for infection control. The Patient Protection and Affordable Care Act attempted to invigorate preventive care and wellness through mandated annual physical and well-child-care. However, the ability of middle-class people to afford medical insurance is tenuous, the reimbursement policies vary by state and insurance plan, and immigrants without permanent residency status are denied access to the federally subsidized health insurance programs. Several states have elected to change their Medicaid plans under 1115 waivers, which affords greater flexibility in benefit design and program allocation. Washington State is designing a Medicaid program that provides additional nutritional food support, housing assistance coordination, and medical transportation services. (Washington State Healthcare Authority, 2025)This is a good example of how the metrics are being modified to look at the larger picture of health creation. Afterall, it is hard to stay healthy if you are homeless, lack adequate food, and transportation to medical services.

U.S. Does Not Coordinate or Require National Investments in Creating Population Health

Because the U.S. healthcare system is geared to insurance reimbursement, many of the other factors that contribute to health are often not included in performance metrics. For example, adequate nutrition for children is a fundamental necessity in their physiological development, yet the Trump Administration has chosen to minimize funding for a Supplemental Food Program for families, at the same time, making tax cuts for billionaires permanent. This makes no sense at all for a nation which has an embarrassment of food stocks, where farmers are paid not to grow certain crops, and agribusiness receives all kinds of subsidies. Further, this cruel decision is exacerbated by the administration’s decision to limit funding for school lunches. There are literally silos of unused food in the country going to waste.

Removal of Scientific Data from Public Resources About Environmental Problems

Another important aspect of health is an environment which is safe and free from poisons, yet the Trump Administration has defunded the Environmental Protection Agency and ceased to report on environmental hazards which impact public health, like forever chemicals[RW1] . The TrumAdministration is being sued by multiple groups for loosening the reporting and safety requirements for chemical manufactures which produce the following:  ethylene oxide, chloroprene, benzene, 1,3-butadiene, ethylene dichloride, and vinyl chloride, all known carcinogens. Why is it even a political decision to reduce harmful substances that endanger our health- there should be a national mandate for this. The first rule of a nation is to do no harm to its people, especially to the vulnerable.

Health and Welfare of Our Children is Being Ignored by Short-term Public Policy Decisions

An aspect of health is safety is the provision of reliable affordable childcare, without this people choose not to have children, and the country will not be able to support its aging population. For many families, children are unsupervised for long periods of time. This problem was recognized in the eighties while I served as the finance chair for a Campfire group, where we made the decision to sell the camp property and set up a fund to support the Latchkey Program, which was a recognition of the dearth in childcare in the country. This was a resource targeted for school-age children who were home after-school for extended periods before their moms returned home from work. I remember finding my son, a second grader, shivering on the steps of our home because he had forgotten his coat, while I trudged up the hill from the bus stop. After that, we came up with a plan where he would push the garbage can against the back gate, climb up, open the gate latch, go to the back door, and access the key under the mat. By the time he was in third grade he wore a lanier with the house key around his neck. I raised him to survive in a world where we were on our own. The travesty is this was our best recourse in a wealthy city in America.

Discriminatory Policy Decisions Which Harm Families and Contribute to The Unaffordability of Health Care

Further, those of us who have medical insurance, are still stuck with co-insurance liabilities that are completely unaffordable, $13,000 for co-insurance after deductibles per year? The annual burden for medical insurance for a family in the U.S. is $27,000 according to the nonprofit Kaiser Family Foundation. (Kaiser Family Foundation, 2024) The Patient Protection And Affordable Care Act(ACA) created a government cost neutral method for low-income and middle class people to obtain federally subsidized medical insurance by advancing tax credits. This provided medical insurance and access to treatment for thirty million people, including me. Further, the standardization of preventive care benefits, elimination of the pre-existing condition exclusion clause, and the requirement that insurance companies use at least 85% of insurance premiums to pay for medical services, has resulted in less costly care for the participants. Now, the Trump Administration wants to nullify the ingenious tax credit funding of the ACA.

Lack of Regard for the Mental and Emotional Health of the Nation’s People

The U.S. has one of the highest suicide rates in the industrialized world, especially for children and youth. Suicides outnumber homicides 2 to 1. A Harvard study found that states with fewer gun restrictions have higher suicide rates and Wyoming has the nation’s highest rate at 28 people per 100,000 lives. The global suicide rate is 8.9 deaths per 100,000 people and the U.S. has the highest rate of all industrialized countries, 14.2 suicides per 100,000 people. (The Commonwealth Fund) This metric is a glaring condemnation  of the nation malaise and insufficient support for its people.

For every dollar invested in wellness, through nutrition, maternal and child health services, and environmental cleanup, we save over $5 per person. In 2008, The Trust for America’s Health found an investment of $10 per person in community-based health programs would save $5.60 in medical expenses per head. (Trust for America's Health.org, 2008)  This table shows a statewide analysis of the return on investment of the community based health initiatives.

State	Potential Annual Savings	Return on Investment
Alabama	$250 million	5.6 to
Alaska	$47 million	7.2 to 1
Arizona	$242 million	4.2 to 1
Arkansas	$139	5 to 1
California	$1.7 billion	4.8 to 1
Colorado	$232 million	5 to 1
Connecticut	$231 million	6.6 to 1
Delaware	$57 million	7 to 1
Washington, D.C.	$57 million	9.9 to 1
Florida	$1 billion	6.2 to 1
Georgia	$426 million	4.8 to 1
Hawaii	$70 million	5.6 to 1
Idaho	$62 million	4.5 to 1
Illinois	$708 million	5.6 to 1
Indiana	$343 million	5.5 to 1
Iowa	$165 million	5.6 to 1
Kansas	$155 million	5.7 to 1
Kentucky	$248 million	6 to 1
Louisiana	$234 million	5.2 to 1
Maine	$98 million	7.5 to 1
Maryland	$332 million	6 to 1
Massachusetts	$476 million	7.4 to 1
Michigan	$545 million	5.4 to 1
Minnesota	$316 million	6.2 to 1
Mississippi	$150 million	5.2 to 1
Missouri	$334 million	5.8 to 1
Montana	$51 million	5.5 to 1
Nebraska	$102 million	5.8 to 1
Nevada	$115 million	5 to 1
New Hampshire	$76 million	5.9 to 1
New Jersey	$543 million	6.3 to 1
New Mexico	$88 million	4.7 to 1
New York	$1.3 billion	7 to 1
North Carolina	$473 million	5.6 to 1
North Dakota	$39 million	6.2 to 1
Ohio	$685 million	6 to 1
Oklahoma	$183 million	5.2 to 1
Oregon	$193 million	5.4 to 1
Pennsylvania	$791 million	6.4 to 1
Rhode Island	$73 million	6.8 to 1
South Carolina	$233 million	5.6 to 1
South Dakota	$42 million	5.5 to 1
Tennessee	$351 million	6 to 1
Texas	$1 billion	4.7 to 1
Utah	$89 million	3.7 to 1
Vermont	$43 million	7 to 1
Virginia	$385 million	5.2 to 1
Washington	$343 million	5.5 to 1
West Virginia	$124 million	6.9 to 1
Wisconsin	$337 million	6.2 to 1
Wyoming	$29 million	5.8 to 1

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These wellness programs included education and resources for improved nutrition, smoking cessation, and increased exercise. Not very sexy, but low-cost interventions that do provide long term benefits, including reductions in strokes, heart bypass surgeries, incidence of type II diabetes, and several typesof cancers. Not to mention a reduction in kidney failure, neuropathy, and other chronic disease comorbidities.  Another example of the positive impact of preventive healthcare is in Hawaii. The Hawaii State Medical Plan conducted an economic study of 166,000 members over a four-year-period which found it saved $350 in healthcare treatment for every investment of $10 in wellness programs. (Steven M. Schwartz, 2013)

US Spends More Money Than Any Other Nation-Where Does the Money Go

Using data for 2023 from the Centers for Medicare and Medicaid and other government agencies, these charts show where the healthcare dollars are spent by sector, who actually pays for the services, and how it looks on the consumer-end, for health services purchased. United States healthcare consumed 4.9 trillion dollars in 2023 and the breakdown of the cost of the programs was: Medicare and Medicaid consumed 2 billion, private insurance 1.5 billion, individual plans 490 billion, and third party entities the rest. The Who Pays pie chart shows which entities paid for the actual services and illustrates that private insurance plans only paid 18% of the total, despite the fact this is portrayed as the primary way residents of the U.S. obtain their medical insurance. The reality is the federal government pays 32% of all of the services, individuals pay 27%, state and local governments  pay 16%, and other private sources pay for 7% of the services.  The US Healthcare Expenses table shows how the services were split for hospital, clinical, prescription drugs, and other medical treatments. 

 

 

Source

Centers for Medicare & Medicaid

Notes

The RX or prescription drug budget is for retail scripts, not infusions or other applications

Other health care includes care through schools, residential treatment facilities for mental health, drug treatment, and community centers

Nondurable medical means-retail healthcare products, like surgical dressings, blood pressure cuffs, over the counter medicines

Durable Medical products means-contacts, eyeglasses, hearing aides

Other Professional Services means optometry, podiatry, chiropractic

Unspecified miscellaneous may include: weight loss counseling, ayruvedic health care, acupunture, massage, health retreats

Mental health care estimates includes; all behavioral health intervention according to the Substance Abuse and Mental Health Services Administration

 Analysis and Close

The United States spends more than any other nation on health care, but it doesn’t generate better health outcomes than nations which spend 40% less. In 2024, the average industrialized nation spent $7,371 and the United States spent $14,885 per person for health care. (Peter G. Peterson Foundation.org, 2025) Yet life expectancy is lower in the U.S. than in Japan and most European nations. Even more egregious is life expectancy for the working population is reducing. Our young people are dying at earlier ages than their parents.

One of the reasons for the disparity is the U.S. spends far more on administration with terribly inefficient 50-state standards for private and government run health plans. Other nations use the money collected from taxes and private payers to actually pay for services. For example, long term care administration in the U.S. cost $1,079 versus $339 in France in 2023.

The United States of America, a nation for which my grandfather fought in the Revolutionary War to create, is failing to generate health for our children and those who work to pay for it. Yet, the Trump Administration is systematically gutting medical research, tax subsidies for the Affordable Care Act, government reporting on quality measures, and oversite for government and private sector agencies. A nation which starves its people is a nation in decline. If you aren’t familiar with the robber baron era, look it up, for the current administration wants to make us serfs in lifetime penury to the ultra rich.

And this is the healthpolicymaven signing off encouraging you not to sign blanket releases for inpatient procedures, do stipulate that for which you agree and decline. This article was written by independent journalist and healthcare analyst, Roberta Winter, who received no compensation from anyone in healthcare.

References

(n.d.). The Commonwealth Fund.

Brownstein, M. (2024, December 16). Private Equity's Appetite For Hospitals May Put Patients At Risk. Harvard, TH Chan School of Public Health. Retrieved November 3, 2025, from https://hsph.harvard.edu/news/private-equitys-appetite-for-hospitals-may-put-patients-at-risk/

Joan Stephenson, P. (2022, July 22). Rate of First Time Cesarean Deliveries On The Rise In The U.S. JAMA Health Forum, 2022;3;(7):e222824. doi:doi:10.1001/jamahealthforum.2022.2824

Kaiser Family Foundation. (2024, October 9). Annual Family Premiums for Employer Coverage Rise 7% to Average $25,572 in 2024, Benchmark Survey Finds, After Also Rising 7% Last Year. Retrieved November 5, 2025, from Kaiser Family Foundation-Health Affairs: https://www.kff.org/private-insurance/annual-family-premiums-for-employer-coverage-rise-7-to-average-25572-in-2024-benchmark-survey-finds-after-also-rising-7-last-year/

Munira Z. Gunja, E. D. (2024, June 4). Insights into the U.S. Maternal Mortality Crisis: An International Comparison. The Commonwealth Fund Issue Brief. Retrieved November 9, 2025, from https://www.commonwealthfund.org/publications/issue-briefs/2024/jun/insights-us-maternal-mortality-crisis-international-comparison

Peter G. Peterson Foundation.org. (2025, October 7). How Does the U.S. Healthcare System Compare to Other Countries? Peter G. Peterson Foundation Brief. Retrieved November 10, 2025, from https://www.pgpf.org/article/how-does-the-us-healthcare-system-compare-to-other-countries/

Steven M. Schwartz, C. I. (2013). The Economic Value of a Wellness and Disease Prevention Program. Population Health Management, 13, 309-3017. doi:1942-7891

The Growth of Private Equity in US Health Care: Impact and Outlook. (2025). Retrieved from NIHCM.org: https://nihcm.org/publications/the-growth-of-private-equity-in-us-health-care-impact-and-outlook

Trust for America's Health.org. (2008). Prevention for a Healthier America. Trust for America's Health. Retrieved November 8, 2025, from https://www.tfah.org/report-details/prevention-for-a-healthier-america/#:~:text=The%20report's%20conclusions%20include:%20*%20An%20investment,ways%20we%20could%20reduce%20health%20care%20costs

Washington State Healthcare Authority. (2025, November 9). Section 1115 Medicaid Waiver-Foundational Community Supports Program. Retrieved from Washington State Healthcare Authority: https://www.hca.wa.gov/about-hca/programs-and-initiatives/medicaid-transformation-project-mtp/foundational-community-supports

Winter, R. E. (2016, September 3). Hospital Closures and the Impact on Health Services. Straight Talk On Healthcare. Retrieved November 7, 2025, from https://healthpolicymaven.blogspot.com/2016/09/hospital-closures-in-united-states-and.html

Winter, R. E. (2022, August 26). Pregnancy in the US Just Got More Dangerous-Post Dobbs v Jackson Decision. Retrieved November 10, 2025, from healthpolicymaven.blogspot.com: https://healthpolicymaven.blogspot.com/2022/08/pregnancy-in-us-just-got-more-dangerous.html

 

 

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 [RW1] https://www.edf.org/media/community-health-and-environmental-groups-sue-stop-president-trumps-unlawful-toxic-air