Kentucky's campaign to improve rural cancer care is a national model. Federal cuts threaten its progress

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"Kentucky is a hotbed for cancer, with the highest incidence and among the highest mortality of any state, and the people here in Estill County, in the foothills of the Appalachians, are at greater risk of dying of cancer than urban residents. This is emblematic of a staggering nationwide disparity: In recent years, cancer care has been transformed by new technologies and treatments, radically altering prognoses for patients who can access them. But those advances have not reached rural areas to the same degree. Across the U.S., people in rural areas are 20% more likely to die of cancer than people in urban areas, and that gulf is widening.

Kentucky has been trying to close this divide, with a years-long, multilayered effort that has few parallels elsewhere. Health care providers have found novel ways to engage rural residents in preventive services, vaulting the state’s overall rates of colorectal and lung cancer screening from below average to among the highest in the country. More foundationally, they’ve upped the game of rural hospitals located closest to patients, so treatments guided by the best evidence and technology are no longer out of reach. The state’s efforts have become a national model, with imitators in Iowa, Nevada, and Mississippi.

But that progress could be imperiled by the tax and domestic policy bill signed into law by President Trump earlier this month, which analyses show will reduce rural health care spending more deeply in Kentucky than in any other state. Kentucky’s expansion of Medicaid coverage in 2014, along with subsidies for the Affordable Care Act’s marketplace, helped 189,000 rural adults get health insurance. Medicaid expansion was also a boon for economically depressed areas, according to Dustin Pugel, policy director of the Kentucky Center for Economic Policy, who called it “the largest ongoing federal investment in Appalachia since the Great Society” programs enacted in the 1960s. Today in some rural hospitals, a third of services are covered by Medicaid.

Now, over the next decade, the 2025 legislation is expected to reduce Medicaid spending by $12.3 billion in Kentucky’s rural areas alone, and risks putting dozens of hospitals out of business. "


https://www.statnews.com/2025/07/23/cancer-care-kentucky-national-model-threatened-medicaid-cuts/