By Cindy Perryman
What would you do if you lost your freedom to choose rural life? What would you do if that choice was threatened — and you didn’t even realize it was happening?
I’m writing about a hidden, urgent, and bipartisan issue that affects all of us, the survival of our rural hospitals. As a licensed professional mental health therapist with 30 years of experience, a business owner, and a neighbor, I am committed to ensuring that our rural communities continue to thrive.
Unseen danger
Rural hospitals — also known as Critical Access Hospitals (CAHs) — are more than just health care facilities. They provide emergency care, maternity services and essential jobs. In rural America, access to medical care is the foundation of our economy and our way of life. When a local hospital closes, the entire community suffers.
We rely on six CAHs in our area, in Tonasket, Omak, Brewster, Republic, Colville and Chelan. The only hospital in our north-central region that is not a CAH is in Wenatchee. Imagine our entire region having to rely solely on Wenatchee for emergency care.
Due to the proposed dismantling of the funding that has kept CAHs open since 1997, these hospitals are at risk.
Historically, rural hospitals have struggled to survive. Small populations, high infrastructure costs, low insurance coverage, and poor reimbursement rates made it difficult for rural hospitals to stay open. By the 1990s, rural hospitals were closing at alarming rates.
In response, leaders from both parties worked together to protect health care access for rural Americans by passing the Balanced Budget Act of 1997. With a Republican-dominated Congress, this act passed with overwhelming bipartisan support: House of Representatives: 346–85, Senate: 85–15. Lawmakers prioritized fiscal responsibility and health equity which saved hospitals across rural America by creating CAHs.
However, rural hospitals remain financially fragile. To stay open, they rely on the multiple funding sources of government insurance programs, grants, and commercial insurance.
In Okanogan County, 27.9% of residents rely on Medicaid, 17.7% rely on Medicare and 9% depend on Department of Veterans Affairs health benefits.
The Affordable Care Act (ACA) also plays a critical role in rural health care. Expanded insurance coverage means fewer uninsured patients. Protections for pre-existing conditions ensure continued access to care. Coverage mandates for essential health benefits include mental health and preventative care. Large employers must provide health insurance for employees.
While the ACA brought challenges, like higher deductibles for some, it also stabilized rural health care systems by increasing insured populations.
The new threat: budget cuts
According to an April 16, 2025, Washington Post article “Internal budget document reveals extent of Trump’s proposed health cuts,” the Department of Health and Human Services (HHS) would face a $40 billion cut. Among the programs proposed for elimination: Rural Hospital Flexibility Grants, State Offices of Rural Health, Rural Residency Development Programs, and At-Risk Rural Hospital Program Grants.
These programs are the backbone of rural health care. They provide emergency preparedness, healthcare system development, workforce recruitment and retention, technical assistance, rural data management, and more.
Okanogan County currently relies on programs like the Rural Hospital Flexibility Grant and At-Risk Rural Hospital funding. Eliminating these programs would be devastating.
Alan Morgan, CEO of the National Rural Health Association, said: “Those are essential to ensuring access to care for rural Americans and critical to keeping rural hospitals open. If these cuts come to fruition, it would be shocking news, because these programs have had such bipartisan support.” (Washington Post, April 16, 2025.)
These cuts don’t just trim budgets, they eliminate programs. They cut lives short and weaken the core of rural America.
Critical Access Hospitals are not only about health care — they’re about economic survival. Studies show that rural hospital closures lead to a 14% reduction in health care-related jobs, 2.7% to 4% decline in local income, and a 1.6% rise in unemployment. Population loss occurs as people move away to access care. Declining property values and shrinking local tax bases further damage the economy.
Health care access is not optional for rural life — it’s essential. This is not about party politics — it’s about people.
Act now to protect your freedom to choose a rural life. Call your representatives and tell them to fund rural health care.
Cindy Perryman, who lives in Twisp, has an MA in psychology, and is a Licensed Marriage and Family Therapist with 30 years of experience. She currently owns a group psychotherapy practice with offices throughout Washington.
