Primary Care Collaborative
2025 evidence report
Rural health care in the U.S. is struggling with headwinds, including aging populations, a shrinking physician workforce and consolidation of health care services.
Some rural communities can access major health systems by interstate travel, while others are isolated by many miles, mountains and rough terrain, and lack adequate broadband and emergency services. When a rural hospital closes, it is an economic blow to a community as well as a blow to local health care access.
The 2025 passage of H.R. 1 — a large federal tax and reconciliation legislative package — creates more challenges for rural communities by reducing Medicaid coverage and spending. A KFF analysis suggests that federal Medicaid spending could fall by $137 billion in rural areas over the next decade.
Researchers and policymakers have generally not focused on factors that sustain rural primary care, with most attention focused on the availability of rural hospitals. Strengthening access to whole-person primary care — that supports chronic care, behavioral health, maternal and women’s health, and oral health, and connects residents to healthy food, self-care options and other resources — is a more attainable goal for many rural communities than sustaining a full-service hospital.
Access to whole person primary care, together with access to a pharmacy and integration with hospital care in larger rural communities, is likely to be the most cost-effective path to improving lagging rural health outcomes.
This report is a snapshot of the state of rural primary care in the U.S. It includes
A literature review
A description of federal legislative trends affecting rural primary care
A quantitative analysis of primary care trends
Five case studies that describe current rural practice models
The report concludes with policy recommendations to strengthen and sustain rural primary care so that all types of rural communities can thrive with better health.