Rural Hospitals—and their Labor and Delivery Units—Face Rising Threat

Impending Medicaid cuts, the One Big Beautiful Bill Act’s defunding of Planned Parenthood, and the freezing of Title X funding have fueled clinic closures across rural areas. Ashley Kurzweil, Senior Policy Analyst for Reproductive Health and Rights at the National Partnership for Women and Families and Sarah Coombs, Director for Health System Transformation at the National Partnership for Women and Families sit down to talk with us about the future of rural hospitals and clinics and the patients they care for.  

Many Medicaid cuts will take effect in January of 2027. One of the most immediate impacts of the law is the failure to extend premium tax credits-- which helps those who do not have access to Medicaid or employer-sponsored health coverage-- afford marketplace coverage.  Rural residents, who have higher rates of Medicaid coverage and benefits from enhanced ACA premium tax credits, will be disproportionately affected. Increased financial strain will be placed on these rural hospitals, and maternal health programs, labor and delivery units, and reproductive health care clinics will be dire in rural areas. This will disproportionality impact Black communities, indigenous communities, and Latina communities, as well as rural health workers.

LINKS FROM THIS EPISODE

National Partnership for Women and Families on X
National Partnership for Women and Families on Instagram
Republican’s New Health Care Law Will Impact Over 130 Rural Labor And Delivery Units
National Partnership for Women and Families Hospital Hitlist
At-Risk Labor and Delivery Units List
Three Years Post-Dobbs, Abortion Bans & Criminalization Threaten More Than 15 Million Women of Color
Repeal, Defund, and Deauthorize: The 15-Year War Against the ACA
At Risk: Critical Medicaid Benefits for Moms
DEI Is Not a Political Trend: Why Inclusion Must Survive Every Presidency

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Transcript

Jennie: Welcome to rePROs Fight Back, a podcast on all things related to sexual and reproductive health, rights, and justice. [music intro]

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Hey rePROs, how's everybody doing? I'm your host, Jennie Wetter, and my pronouns are she/her. So, I have been trying to be really good this year and not buy a bunch of books and read the ones I already have on my e-reader. It has gone okay. I know. I saw this great sticker that I feel like fits me perfectly. It says, "I'm not a bookworm, I'm a book dragon." I mean, yes, I hoard books. It happens. There, I feel like there are worse addictions I could have and worse things I could do than buy all the books I want to read. But I've been really trying to put effort in into not buying, but I feel like what has that has turned into then is I have like a wish list of books, and then I'll get a Barnes and Noble “we're having a triple sticker or 25% off all pre-orders” or whatever. And then I will go on like a spree and make up for all of the books that I read off of my TBR and generally more. So, it's not going great. But I'm still putting the effort in and trying and trying to not be a book hoarder. But I think that's just my thing, y'all. I think I'm just a book hoarder. It's not like I never read them, it just takes me a while, but my list on my little iPad mini of books that are on it right now is kind of long and I really need to read it down a little bit. So, I'm still gonna work on it. But that all being said, it's holiday season and I love nothing more around the holidays than to read cheesy Christmas romances. So, if y'all have any suggestions for ones you like or have found fun, send them my way, please. I'm gonna get a couple to read over the holidays. So, if you have some you love, let me know. You can email me at jennie@reprosfightback.org. Or feel free to reach out to me on social media at @JennieInDC on Bluesky. I still have an account on Twitter, I'm just not there as much. But feel free to reach out to me at either place and let me know of any fun, cheesy holiday romances that you feel like I should read. Yeah. And maybe next year will be better about book hoarding. I doubt it. But maybe. I did just buy some again, and I know, I know. But like I said, there are worse problems to have, and I will read them all eventually, most likely. It is my one one really bad thing if I do book hoard. But I love it. Okay, let's see. What else is exciting and new? I don't know. I am getting ready to head up to New York for a quick visit, see an old roommate and go out for dinner, and have a couple things that I need to do. I'm hoping to maybe hit up the holiday market at some point in Bryan Park. So, we'll hopefully hit that up at some point while I'm up there. But yeah, I am so looking forward to that. Other than that, I just feel like work has been a little wild. I've had a lot of things and deadlines and things to get out. Ooh, I should also mention our Senior Fellow Preston Mitchum released a brand-new brief that you all should check out. We'll make sure to include it in the show notes. It is a great brief. Preston is such a great writer, so make sure to check it out. It's up on our socials, but I'll make sure that we have the link in the show notes as well. With that, let's go to this week's episode. This is one that is near and dear to my heart. I mean, honestly, so many of them are, because I'm the host and I pick our topics. So, we get to talk about things I care about. But this one hits very close to home, literally. We're gonna be talking about the cuts to Medicaid and what this is gonna mean to rural hospitals. As many of you know, I am from rural Wisconsin. The hospital that I grew up going to is considered a rural hospital. So, hearing about how all these Medicaid cuts are gonna impact rural hospitals really does hit very near and dear. So, with that, let's turn to this week's interview. I have two wonderful guests from the National Partnership for Women and Families, Ashley Kurzweil and Sarah Coombs. And with that, let's go to my interview with Ashley and Sarah. Hi, Ashley and Sarah. Thank you so much for being here today. Thanks so much for having us, Jennie. Thank you so much for having us. Before we get started, would you like to take a minute and introduce yourselves? Let's go alphabetical. Ashley, go first.

Ashley: Thanks so much, Jennie. Hi, everyone. Ashley Kurzweil, I use she/her pronouns, and I'm the Senior Policy Analyst for Reproductive Health and Rights at the National Partnership for Women and Families.

Sarah: Hey, y'all. I'm Sarah Coombs. I use she/her pronouns. I'm the Director for Health System Transformation also at the National Partnership.

Jennie: I am so excited to talk to y'all, particularly about rural hospitals. I think that's something that a lot of people don't necessarily think about a lot, but the hospital where I'm from would be considered a rural hospital. So, it is something that is definitely near and dear to my heart. I still have a family that goes to that hospital. So, it is something that I always kind of keep a close eye on. So, let's talk about it. Tell us a little bit about rural hospitals and why this is such an important issue right now.

Sarah: Yeah, first, I think we should step back and talk about the big looming Medicaid cuts that we are expecting to see. I think we all know by now that in July, President Trump signed into law over one trillion cuts in Medicaid, also known as or HR one, also known as the "One Big Beautiful Bill Act." And this is considered one of the most harmful pieces of health legislation in US history. It's the largest roll bag of federal support for health care. Many of the Medicaid provisions don't take effect until January 2027, which of course was intentional. And those include, you know, things that we all know about, you know, Medicaid work reporting requirements, freezes and provider taxes, you know, which most states use to help finance their Medicaid costs. But I would say the most immediate impact of the law is that President Trump and Congressional Republicans failed to extend what are called the Affordable Care Act's enhanced premium tax credits that are set to expire at the end of this year. And these premium tax credits are so essential in helping people who don't qualify for Medicaid or have access to employer-sponsored coverage, whether because they work part-time or they are a small business owner, it helps them afford individual marketplace coverage. And in 2025, nine in 10 ACA marketplace enrollees had or received premium tax credits. That's about 22 million people. So, taking, you know, the Medicaid cuts, the ACA provisions in the law, CBO estimates, as the Congressional Budget Office, estimates that this law will result in 10 million more people becoming uninsured by 2034. And this will disproportionately affect rural residents who have higher rates of Medicaid coverage and who disproportionately benefit from the enhanced ACA previous tax credits. The estimated loss of coverage will lead to increased compensated care for rural hospitals and will also place increased financial strain on those hospitals. And as you probably know, Jennie, I know that you said you're from Wisconsin, the rural hospitals are already struggling with over 100 that have closed already in the last decade. So faced with additional financial loss, many rural hospitals may be forced to stop providing certain services or close altogether, leaving a devastating impact on access to essential health services in rural communities. So, I think that really gets us thinking about how this bill will really impact rural health in ways that I don't think a lot of people really understand.

Jennie: And I also think the other thing I've been thinking about too is people may not know that their hospital is considered a rural hospital, right? So, I live outside of town, but the city where the hospital is located, Beloit, Wisconsin, is like, I don't know, it's been a while since I've seen the population number. It was like 35,000, 40,000 people. So, they may not think that that hospital is considered a rural hospital. So, I think there's a lot of people across the country who may not know that this is going to impact their hospital.

Sarah: Absolutely. And I think a lot of people don't realize that, you know, whether you have Medicaid insurance, private coverage, employer-sponsored coverage, it does not matter what type of insurance coverage you have, everyone will be impacted by these cuts. Everyone who can access or has access to those hospitals that are at risk of closing, they are also at risk of losing their hospital access. And I think this also what is most striking to us is the impact on what this means for access to maternal health. And so, of course, the National Partnership for Women and Families, one of our biggest issue areas is maternal health. And we know that Medicaid is a lifeline for maternity care in rural communities. And so, we're really taking a close look at how this bill will impact maternal health as Medicaid pays for nearly half of all births in rural areas.

Jennie: Perfect transition. Let's turn to: what is the impact going to be around maternal health?

Sarah: Yeah, sure. So, typically, maternity care services are the first to be sacrificed when a health system is struggling financially because, well, one, Medicaid reimbursement rates are subpar for maternity care. And there are also serious workforce shortages and high operational costs as well. So, we looked at data that was released from the University of North Carolina SHEP Center over the summer that identified 338 rural hospitals that were at risk or are at risk of closing due to the potential Medicaid cuts. So, we wanted to take a deeper look into how these potential cuts, for closures rather, would impact maternal health in rural communities. Because after all, we are living in a maternal health crisis where the US is the most dangerous place to give birth, especially for Black, Indigenous, and rural women. So based on UNC's foundational research, we found that there are 131 rural hospitals with Labor and Delivery units that are at risk of closing due to anticipated cuts under HR 1. And this is actually a pretty conservative number given the narrow financial criteria that the researchers used. But the number of potential closures represents a total of 126 counties across 39 states that may be impacted. And what's striking is that 96 of these counties are at risk of losing their only source of hospital-based obstetric care or birthing services in hospitals. So, we found that the states with the highest number of at-risk Labor and Delivery units were Kentucky, California, New Mexico, Louisiana, Indiana, and Washington State. And that's not so surprising because those states have the highest percentage of Medicaid enrollees in their states. But again, our analysis does not really paint the complete picture. States that we identified with few or no at-risk hospitals, like states like Georgia or Wisconsin, for example, could reflect that these states already have limited access to maternal health care. So, I think, you know, I think it's also just to take into account when you see these numbers, is to contextualize it that some of these states are already, you know, facing or undergoing a maternity care crisis. And it's also really critical to discuss how these attacks on healthcare access also intact protective health care.

Jennie: Yeah, I was definitely when I was looking through the report y'all put out, was shocked at some of the states that weren't at risk. And you explained it perfectly because I was like, oh, that's surprising that some of these aren't at risk. But when you're like, no, because they've probably already closed a lot of those Labor and Delivery units, then it was like, oh, that would be why. Okay, so let's turn to reproductive health care because this is also gonna impact that.

Ashley: Yeah, thanks so much, Jennie. So, for many, the link between Medicaid cuts, hospital closures, and abortion access isn't obvious. But it's so important that we elevate how these attacks that Sarah described on our healthcare systems also harm reproductive healthcare because the impacts on access are already immense. And the situation is likely to only grow more dire, especially for people in rural areas. The bottom line here when it comes to repro is that health care cuts and the dismantling of health systems impact all pregnancy care, including abortion care. So when hospitals are forced to reduce the maternity care services that they offer, or cut staff, or shut down operations entirely, that affects the availability of a range of obstetric and gynecological services. And in addition to the potential lever and delivery unit closures that Sarah mentioned, we're seeing dozens of hospitals close all together since the passage of these Medicaid cuts a few months ago. The national partnership actually put together a hospital hit list to really track this devastation. And all these closures erode access to full spectrum reproductive and pregnancy care from emergency abortion care that patients get in hospitals to services for a high-risk pregnancy that they get in Labor and Delivery units to family planning services that they get from their OBGYN. So, you have to consider the full picture. And if OBGYNs are forced to shift the services that they provide or relocate because their unit or their hospital closes, patients can't access a range of reproductive health services that OBGYNs offer, from abortion care to childbirth services to cancer screenings. And rural areas already face steep shortages of OBGYNs who are essential in providing preventive services that rural folks depend on, like contraceptive counseling and STI screening and testing. Especially in the wake of the Dobbs decision, many OBGYNs have been forced not to practice or train in states with abortion bans, which has really worsened provider shortages in many rural areas. And I have to go here next because it's so crucial to put the shuttering of hospitals and Labor and Delivery units in full context. The Medicaid cuts that Sarah talked about not only led to the closure of these facilities, but also to reproductive health clinic closures, as you know all too well, Jennie. Anti-abortion extremist politicians used the budget bill to not only attack marginalized people's access to health care, but also to ram through a backdoor ban on abortion care by defunding Planned Parenthood. So the budget bill prohibits Medicaid reimbursements to Planned Parenthood health centers. And the majority of clinics that have been at risk of closure because of this financial loss are in rural areas, medically underserved areas and areas with provider shortages. And it's really outrageous that these closures are taking away health care for patients that are most in need, like folks in rural and low-income communities and people of color who already face the most barriers to access. So now patients are in a situation where they are having to go without reproductive health care or they're having to contend with long wait times or delays or travel super far to find any affordable services. So, the logistical and financial obstacles that then come with the need to travel greater distances for care can be prohibitive for patients that want abortion care or need abortion care. And having to take often unpaid time off work to travel far to go to a provider and incur expenses for lodging and transportation and child care and the cost of the procedure itself really add up. So, when you look at everything all together, the Republican budget bill is waging war against women and birthing people on multiple fronts. It's closing reproductive health care clinics and making family planning and abortion care completely unattainable while at the same time cruelly shuttering hospitals and Labor and Delivery units that make it harder for people to get the maternal health care that they need.

Jennie: That is just, like, so much all in like one terrible, terrible bill attacking access to prevent pregnancy, access for maternal health care. This is so much. And I think there are some distinct challenges that are faced by people in rural areas. So, what are some of the distinct challenges that we are going to see people in rural areas encountering?

Ashley: It's such a good question to really highlight these unique struggles because rural women's access to reproductive care has already been fraught for a Long time with legal barriers, logistical obstacles, financial challenges, but it's only gotten worse under Trump in particular, especially taken together Medicaid cuts, Planned Parenthood defund[ing], and the freezing of Title X family planning program funding that, you know, that fuels more clinic closures, add-on abortion bans, and add on so many other restrictive anti-abortion policies, and you have a mess. It essentially delivers a death by a thousand cuts to rural reproductive health care access. And the national partnership back in June released research on the impacts of abortion bans and criminalization three years post-Dobbs. And we focused on a variety of marginalized communities and how they are really impacted by those restrictive policies. So, we found that women who live in rural areas are especially likely to live in the 22 states where abortion is banned or under threat. Specifically, we found that 2.6 million women of reproductive age, or 50% of all rural women of reproductive age, live in these states without abortion access. And systemic underinvestment in rural areas and structural inequities and health care make reproductive care even less accessible for many Black, Indigenous, and Latina people in rural communities. Plus, research shows that rural workers have less access to paid sick days and paid leave that are really essential when you have to travel what could be hundreds of miles or across state lines to get abortion care. And nobody should ever have to risk losing their job or their paycheck because they have to take this time off to travel for essential health care. But a lot of pregnant people are being put in this impossible bind when navigating the ever-mounting barriers to reproductive health care. What this means in practice is horrifying. People living in states and rural areas with limited access to abortion because of bans and provider shortages and hospital closures face health risks and even forced pregnancy. We've seen countless stories of just harrowing delays in emergency abortion provision and fatal denials of care, in particular since the Dobbs decision. Many people have been forced to continue pregnancies that are nonviable or that put their own lives in jeopardy. And the irony is also not lost on me that the same extremists who pushed Medicaid and Title X cuts that are forcing all these reproductive health clinics to close across the country are bankrolling crisis pregnancy centers. And for folks that really aren't aware of what these anti-abortion fake clinics are up to and where they're located, I want to just provide a little bit more information because anti-abortion "crisis pregnancy centers" are super prevalent in rural communities by design. It's all on purpose. They exploit gaps in access to care to target rural women with misleading and coercive anti-abortion propaganda. They try to pass themselves off as you know viable alternatives to reproductive care, but they're typically run by individuals with little to no medical experience and they misinform people about their reproductive health options and try to dissuade them from seeking reproductive care and abortion care. So ultimately, this is how anti-abortion extremists take away reproductive health care from people by making it impossible to access. And the Republican budget bill ratcheted up this strategy, and rural communities and other marginalized groups are really bearing the brunt.

Jennie: Yeah, and I also think it's important that people who may not be familiar with rural areas as much— hearing that their local hospital is closing or their local Labor and Delivery unit is closing, it may be a significant distance to get to the next available Labor and Delivery unit. So, I think for people who live in more urban areas or, like, where I grew up was rural, but it's not that rural. So, our next closest hospital is further, but it's not, like, super significantly further. But there are people who live in much further out rural areas where the next available hospital could be hours.

Sarah: Yeah. And when you think about when women have to travel further for care, for women in rural areas, this does often mean traveling 30 to 60 miles or more in order to get to a hospital once they go into labor. And that, you know, when every minute is critical, um, particularly in emergency situations. And in some cases, it would make it even more difficult to access, you know, their routine prenatal appointments. So, a lot of people will just end up delaying or skipping their prenatal care, which is so crucial to their maternal health outcomes as well. Yeah, and the farther the travel, the greater the risk of maternal morbidity and adverse infant outcomes such as stillbirth and NICU admission. I mean, when you think about it, imagine a mother having to travel or birthing person having to travel an hour just to deliver a birth. You know, I'm a mom, you know, I live in DC. And while I was in active labor with my second child, I barely made it in time with under 20 minutes of travel. It's just unimaginable. And we can have a separate conversation about DC as a maternity care desert and the impact on urban and safety net hospitals that this bill would have. But I think it is really important to really put into context what this means because I'm so glad that you asked this question. It's easy to forget when we're talking about, like, numbers and potential risk and statistics, that we really lose sight of what this all means for people and who was disproportionately impacted. And I just wanted to, you know, dive a little bit deeper into that analysis of the hospitals that are at risk of closing their Labor and Delivery units. And we found that 10% of Indigenous women in the US live in those 126 counties that are at risk of losing their Labor and Delivery units. In fact, they are the most disproportionately impacted group of women that may be impacted by these potential closures. And while it's unsurprising, it's still devastating, as this would further compound the maternal mortality crisis as American Indian and Alaska Native women experience some of the highest rates of maternal mortality and morbidity in the U.S. We also found that Latinas are also disproportionately likely to live in affected counties and that women at risk of losing their only hospital with birthing services are more likely to be poor and have lower educational attainment. And so we just had to remember that behind every data point is a family whose lives could be upended in an instant when care isn't available. And when these Labor and Delivery units close, families are really left without the care that they need when they need it most. And so, I think it's just so important to put into context what this bill will do for families, particularly at a time when our healthcare system's already broken. Our healthcare system is already struggling, we're in crisis. And then think about who will be disproportionately impacted. And then this will indeed exacerbate inequities, you know, as higher income and more educated individuals are more likely to be able to try to travel further, like Ashley mentioned, to go across state lines to access better maternally related care or abortion services for those who live in abortion advanced states who need to go across state lines to access abortion care. That's going to further exacerbate and deepen inequities.

Jennie: So, we spend a lot of time talking about the health impacts and how people's access to health care is going to be impacted, but that's not the only groups that are going to be impacted. So maybe we should take a minute and talk about workforce and how this is going to impact people who work at the hospitals.

Sarah: Absolutely. Yeah. The Republican budget bill and the Medicaid cuts will have devastating consequences for not only health outcomes, as you mentioned, but also jobs and the economy of rural communities. Labor and Delivery unit closures and hospital closures in general can really destabilize entire communities. A Labor and Delivery unit closure can result in declining patient volumes, which can then put other critical health services at risk of cutbacks or cuts to local healthcare jobs. And then imagine when a hospital shuts down or a Labor and Delivery unit shuts down, then the nearby hospital that is able to continue to offer those services can now become potentially overburdened as they absorb those patients from other areas. That could lead to understaffing, burnout, strained resources, and ultimately workforce shortages. So, it's like a vicious cycle. And then the entire community can just feel the ripple effects, particularly women, as more than 80% of people working in hospitals in rural areas are women. So, these impacts are just compounded. You know, you lose your job and you lose your access to hospital-based birthing services. That's just devastating.

Jennie: It's like you just keep pulling back the layers, and there's just, like, more terrible underneath all the terrible. Okay, so I don't want to focus anymore on the like, this is all terrible, because that is so frustrating and just makes me angry. So, let's redirect my anger. What can we do? What can the audience do to push back in this moment?

Sarah: So, one, I think it's so crucial, especially now in this moment where we could potentially face yet another shutdown, unfortunately, in January, that people share their stories. Right now, the focal point in Congress is whether and how to extend those ACA premium tax credits. And so, if folks can share how having affordable health insurance with premium tax credits have helped them and their communities, that could go a long way. Sharing stories is the best way to help make this issue a priority for the public, the media, and policymakers. I also, you know, would urge folks to contact their representatives to advocate for extending the enhanced tax credits because again, they will expire at the end of this year, at the end of this month, if Congress does nothing. Members of Congress made a promise when they reopened the government last month that they would address the issue by mid-December, by mid this month. We're already, it's December 4th today, and we have yet to see real movement on a solution to extend those tax credits. So, encourage folks to contact their representatives. I also think that it's important to just raise awareness of what is happening in their local communities; raise awareness of why this is so important to everyone. As Ashley mentioned, one of our colleagues, Mackenzie, our amazing communications intern, has put together a hospital hit list that she has shared on our TikTok. And that has really been helpful to raise awareness and spread information, greater reach to folks that may not be following us, following our website, but could be following us on other platforms to understand where these closures are occurring and how often. And so, just raising awareness is also a really important tool.

Ashley: I will hop in here and I really appreciate you carrying the conversation in a positive direction, Jennie, because it's so important to help people feel empowered to take action amid such devastation. And this budget bill is part of the Project 2025 playbook to ban abortion nationwide and dismantle public health programs and roll back civil rights. So, I can share more about what listeners can do to address issues around reproductive health care access, especially for folks in rural areas, because of immense federal gridlock, and that's putting it lightly around abortion rights. On issues for access and rural access in particular, I'd say that it's super important for folks to advocate for policies to protect and expand reproductive health care access to their state representatives. In particular, I think that folks should be advocating for telehealth medication abortion access so that folks in rural areas that don't have accessible in-person care can still get abortion pills mailed to them. There's a lot to say about how telehealth can really be a lifeline for rural communities now, especially telehealth for reproductive health care, to fill in gaps in access to contraceptive care, for example, as well, and to counter provider shortages in rural and underserved areas. My other recommendation is a big one. And it is essential that listeners call on their state-elected officials to pass or to strengthen state shield laws, which help preserve some measure of abortion access, even in states with bans, even for folks in rural areas. So, with shield laws, providers of protection from out-of-state legal action if they mail abortion pills to patients in states with bans, which is very indicative of what a lot of rural folks are facing. And we know that these shield laws are essential. And the anti-abortion extremists are targeting them because they are one of the strongest tools that we have to protect abortion access in a post-Roe dystopia and post-Medicaid cuts reality. So, really important that everyone use their voices to get behind strengthening shield laws at the state level. But if you can't get medication abortion via telehealth and you have to cross state lines for abortion care, the costs are super high, as we talked about earlier. So, as people need to travel more frequently and longer distances for care, it is essential that listeners do what they can to step up and support abortion funds, including donating to abortion funds. As we're thinking about the specifics on the challenges that rural people face in accessing reproductive health care and how to address those hurdles, the need to travel hundreds of miles for care and to shoulder those costs really stands out to me. And abortion funds help financially support folks with all the costs that are associated with seeking care. So, community support networks, grassroots organizations, and abortion funds are moving mountains, literally, to help make reproductive health services more affordable. And we all need to help them out.

Sarah: I'd also like to add thinking about what folks can do to support or mitigate harms to maternal health, particularly in rural areas. I think folks can urge their states to maintain postpartum coverage for birthing people for up to 12 months. That is unfortunately an optional benefit that many states have opted to take up, but it's an optional benefit. And with looming Medicaid cuts, states may be in a predicament where they may need to eliminate optional benefits like postpartum coverage, up to 12 months. So, I think we need to urge states to maintain that essential coverage as we know that a significant percentage of maternal deaths occur up to one-year post-birth. I would also add that just to remind folks that maternity care, particularly in low-risk situations, don't need to occur in a hospital-based setting. That women should have the autonomy to choose where they give birth and of course when and how. And so, I think the option for community-based models of care is so important. We know that freestanding birthing centers are so essential to fill in the gaps. Should birthing people choose that setting, if they are eligible, if they are low risk to be able to choose that setting. And there are other maternal health perinatal workforce professionals that really can support and fill in the gaps where they're needed, especially in rural areas, that provide prioritized, personalized, accessible, equitable care to communities.

Jennie: And I will be the person to call out. Almost all states have at this point opted for that one-year expansion on maternal health care. Wisconsin and Arkansas are the only two who have not, at least last time I've checked. So, just putting that out there, y'all. Make some noise about that in your state if you're in one of those two states in particular. Okay. Sarah, Ashley, thank you so much for being here today. I had such a wonderful time talking to you about rural healthcare. It's great chatting with you as well.

Sarah: Really appreciate the conversation. Thanks, Jennie.

Jennie: Okay, y'all. I hope you enjoyed my conversation with Sarah and Ashley. It was really wonderful to get to talk to them all about rural hospitals and all of the impacts that they are going to be seeing. So with that, I will see everybody next week.