By Justin Leventhal, American Consumer Institute
One of the key reforms in the recently passed “One Big Beautiful Bill” was a change to Medicaid eligibility, projected to reduce rural healthcare spending by $155 billion over the next decade. Although a new $50 billion “Rural Health Transformation Program” partially offsets this, state governments and rural healthcare systems will still need to find ways to serve patients while remaining financially viable. Fortunately, several states have already set examples others can follow.
Telemedicine helps bridge the gap between where doctors live—urban areas—and where the communities most in need of them are—rural areas. While telemedicine can’t substitute for certain in person care, it enables access to specialists for chronic or non-urgent conditions. One way states have expanded telemedicine is through the Interstate Medical Licensure Compact (IMLC). Currently, 40 states and U.S. territories have joined, reducing the time required to get a license to practice in another state to seven to 10 days on average. Just over a third of new licenses go to physicians intending to serve rural areas, and states that join the IMLC typically see a 10 to 15 percent increase in the doctors licensed to practice in the state.
Washington D.C., Maryland, and Virginia’s created their own compact in the form of a reciprocity system that allows doctors licensed in one jurisdiction to offer services in all three. Other states, like Florida, offer separate telehealth licenses for out-of-state doctors. All of these efforts increase the supply of healthcare services, reduce wait times and lower patient costs.
To meet in person healthcare needs, states don’t just need to increase the supply of healthcare services in rural areas, they also need to make smart use of their workforce. Nurse practitioners (NPs) are fully capable of delivering primary care, though many states restrict them from doing so. In others, NPs are permitted only with a supervising physician. Pharmacists can also be capable of diagnosing, prescribing, and managing many conditions without a doctor. They are also the most accessible part of the healthcare system. Every routine illness treated at a pharmacy frees a hospital bed for more complex problems. Currently, 27 states and Washington D.C. grant NPs full practice authority. The rest should take note.
Non-physician healthcare providers are often more localized, making access easier. More communities have a pharmacy than a hospital. With capable non-physician staff handling routine care, reliance on primary care doctors diminishes—a welcome change given that fewer physicians are entering primary care as a specialty. Additionally, non-physician care often puts more emphasis on preventative care, easing pressure on rural hospitals.
By expanding the scope of practice for non-physician providers to include routine tasks like physicals, vaccines, and minor illnesses states effectively expand the healthcare supply without increasing personnel. In fact, empowering nurses and pharmacists may even help attract more workers, as demand for their services grows. Importantly, non-physician healthcare workers cost the healthcare system less than additional doctors.
The nationwide doctor shortage hit rural areas the hardest. While increasing the number of healthcare workers helps, improving their efficiency is just as important. Technological advances are critical to this. New AI tools for documentation, diagnostics, surgery, triage, and chronic care have the potential to boost provider capacity through significant efficiency gains.
AI is already helping doctors reduce the workload per patient, enabling them to treat more people without sacrificing quality. It can cut documentation time by 20 to 30 percent while improving the quality of the reports. AI can reduce x-ray time by 42 percent, detect cancers with greater accurately than doctors, and predict emergencies like sepsis in emergency rooms early.
As rural healthcare continues to struggle with limited funds, state legislatures should focus on two goals: giving patients access to the providers they need and giving those providers the tools to do their job as efficiently as possible. Expanding the pool of healthcare providers—while equipping them with the most efficient tools—will ease the burden on rural hospitals and expand access to quality care for rural Americans.
Justin Leventhal is a senior policy analyst for the American Consumer Institute, a nonprofit education and research organization. For more information about the Institute, visit www.TheAmericanConsumer.Org or follow on Twitter @ConsumerPal.