Growing Texas’ rural health care sector

While Texas is home to some of the largest cities in the country, it is also home to a large rural population. Over 4.2 million Texans live in rural areas — more than live in many other states. For these Texas families, health care can look dramatically different than it does for their urban counterparts.

Rural Texans face challenges finding access to care due to a lack of nearby providers. Seventy-four of the state’s 254 counties — nearly one in three — have no hospital at all, meaning many Texans must travel long distances for emergencies or intensive inpatient care. In some parts of the state, residents live more than 75 miles from the nearest hospital, creating serious barriers to timely care for children, seniors and working parents alike.

These gaps are compounded by widespread provider shortages: the overwhelming majority of rural counties are designated Health Professional Shortage Areas, meaning that they have limited access to primary care, mental health services and specialists.

For young families, the challenges are especially acute. Nearly half of Texas counties (46.5%) are classified as maternity care deserts, with no hospital offering obstetric care and no practicing OB providers. That forces many rural mothers to drive long distances to deliver or receive prenatal care. Rural children face similar constraints with pediatric specialists often concentrated in metropolitan areas, leaving families with fewer options for timely, preventive and developmental care close to home.

Adding increased pressure are the high levels of uninsured Texans within rural communities. In our 2023 study, “Who Are the Uninsured?”, Texas 2036 found smaller and rural counties, particularly in the Texas Panhandle, West Texas and the Lower Rio Grande Valley, have higher percentages of uninsured residents even though they have far smaller populations relative to their urban counterparts.

Meeting the challenge on rural health care

Together, these challenges are straining already fragile rural health systems and putting essential services at risk. Limited provider availability, maternity and pediatric care gaps, and higher uninsurance rates make it harder for communities to deliver timely, preventive and specialty care, which often leaves rural Texans sicker and seeking care later when treatment is far more complex and costly.

Texas lawmakers and state agencies have taken steps to stabilize rural health systems and improve access. Recent efforts include targeted rural hospital grants, enhanced Medicaid reimbursement for rural providers and expanded support for telepsychiatry and virtual care services.

These investments build on past broadband and telemedicine expansion efforts, establishing the infrastructure needed for modern health care delivery while helping rural communities remain viable places to live and work.

As we look ahead to our bicentennial in 2036, it’s essential that we acknowledge the vital contributions of our rural communities and continue to work together to ensure that they have access to affordable, quality health care.