Gaps in Trump’s $50B Rural Health Fund Leave Rural Gaps
WILLIAMSTON, N.C. — Two years after her brother died of a heart attack, Debra Pierce still wonders whether the 50-year-old would have survived if Martin County’s only hospital had not closed. Emergency crews from a neighboring town worked on Stanley Sears for 30 minutes in 2024 but could not revive him for the long drive to the closest hospital. “The sad thing is we’ll never know if he could have been saved that night or not, because we don’t have a higher level of care in this county,” Pierce told NPR and KFF Health News.
Pierce’s story illustrates the human cost of a widening healthcare crisis in rural America — and the limits of a $50 billion federal fund that was supposed to help.
The $50 Billion Promise
The Rural Health Transformation Program (RHTP), created as part of President Trump’s One Big Beautiful Bill Act signed on July 4, 2025, provides $50 billion over five years to states with approved rural health transformation plans. The fund was added late in the legislative process to secure votes from lawmakers representing rural districts. President Trump has championed the fund, holding a rural health roundtable in January 2026 with HHS Secretary Robert F. Kennedy Jr. and CMS Administrator Dr. Mehmet Oz.
But a KFF analysis reveals that the $50 billion offsets only about 37% of the estimated $137 billion in Medicaid cuts affecting rural areas over ten years — cuts that are part of the same bill. The fund is temporary (five years), while the Medicaid cuts are permanent. Nearly two-thirds (64%) of the reductions occur after FY2030, meaning the fund will have expired before the deepest cuts take effect.
A Catch-22 for Closed Hospitals
Martin County, home to roughly 22,000 people in eastern North Carolina, lost its only hospital — Martin General — when it closed abruptly in August 2023 after 73 years of operation. The hospital was owned by Quorum Health, which filed for bankruptcy. County taxpayers have spent an estimated $2.9 million on maintenance and utilities to preserve the shuttered facility.
Despite the state’s $213 million first-year allocation from the rural fund, County Manager Drew Batts said the money will not help reopen Martin General. “The $50 billion is not something that is specifically going to help our situation,” Batts said. “It’s not going to help us get this place reopened.”
According to NC Health News, North Carolina is distributing its allocation through a hub-and-spoke model to existing health organizations. Federal CMS rules limit how much can be spent on construction and building renovations. Because Martin General is already closed, it cannot receive direct relief from the fund — a Catch-22 that excludes the communities arguably in greatest need.
A Healthcare Desert
The closure has placed enormous strain on the region’s healthcare system. ECU Health, the region’s largest health system, reported a 132% increase in daily ER visits since Martin General closed. Its Greenville hospital — the only Level 1 trauma center east of Raleigh — has median ER wait and treatment times of nearly 4.5 hours, longer than 96% of hospitals nationwide, according to federal data.
Brian Floyd, ECU Health’s chief operating officer, described the situation as “a real healthcare crisis that has already proven itself to have lost lives that perhaps didn’t have to be lost.” He added: “They just want to not die because there’s nowhere to go when you have an emergency.”
Residents describe harrowing experiences. Vannessa Little’s 6-year-old daughter suffered severe burns over 30% of her body in 2024; an ambulance had to come from a neighboring county for the 30-mile drive to the nearest ER. The girl was ultimately airlifted more than 100 miles to Chapel Hill. “The only changes that people are making is they’re taking away everything,” Little said.
A Political Flashpoint
The rural health fund has become a central issue in the closely watched U.S. House race between Rep. Don Davis (D-NC) and Republican challenger Laurie Buckhout in North Carolina’s redrawn 1st Congressional District, which encompasses Martin County. Buckhout is attacking Davis for voting against the One Big Beautiful Bill Act, even though the fund’s structure prevents it from helping the very community at the center of the debate.
Davis called the fund “essentially putting a band-aid on a much, much broader situation that needs dire help.” He has introduced legislation to increase Medicaid reimbursements for rural hospitals, though it has not advanced.
Matt Mercer, a spokesperson for the North Carolina Republican Party, called the rural fund a “once in-a-generation opportunity” for the state. But critics note that half of the fund ($25 billion) is distributed equally among all states with approved applications, meaning a state with 3 rural hospitals could receive the same amount as a state with 90.
The Rural Hospital Crisis
Martin County is not alone. According to the Cecil G. Sheps Center for Health Services Research at UNC, nearly 150 rural hospitals across the U.S. have closed or drastically scaled back services since 2010. Twelve of those facilities are in North Carolina.
Martin County is one of the poorest counties in the state, with a median household income of $44,799 — $21,387 less than the state average. Life expectancy is about 72 years, four years below the statewide average.
What’s Next
ECU Health signed a letter of intent in 2025 to reopen Martin General as a rural emergency hospital — a model that provides 24/7 emergency care and outpatient services but not inpatient care. The deal requires Martin County to pay for refurbishment and the North Carolina General Assembly to provide $210 million. No community has ever successfully reopened a closed hospital under this model.
Brock Slabach of the National Rural Health Association noted that the rural emergency program was “never designed to be an answer for all the problems of rural health.”
For residents like Debra Pierce, the wait continues. She said she is praying the county can reopen the hospital. “There’s some answered prayers happening every day,” she said. “So, we can only pray and hope, you know?”
As the $50 billion fund begins distributing money later this year, the question remains whether it will reach the communities that need it most — or whether structural gaps will leave them behind.