The One Big Beautiful Bill is expected to bring numerous changes to healthcare, including $1+ trillion in cuts to federal spending in the Affordable Care Act (ACA) marketplace and Medicaid over the next 10 years.

There’s one community that’s expected to see a particularly big impact from these changes: rural patients. Rural health already faces unique challenges, like staff shortages, lower salaries, and less specialty care. While the bill allocated $50 billion for a “rural health transformation program,” experts still fear the money will not be enough to keep these already struggling providers afloat and may even lead to facility closures.

“Something is going to collapse,” Lora Sparkman—a partner and VP of clinical solutions, patient safety, and quality for workforce management company Relias—told Healthcare Brew. “It’s going to be the already fragile and underserved, and that’s rural healthcare.”

Coverage cuts. Cuts to public insurance funding are a particularly big concern, as KFF reported almost 1 in 4 people in rural areas rely on Medicaid and 17 million people (on top of the 25.3 million uninsured US children and adults as of 2023) could lose insurance due to the changes.

Rural health is likely to see added challenges.—CM

There’s a multibillion-dollar game of tug-of-war happening between drugmakers, hospitals, and Medicaid over a popular drug discount program, and everyone says they’re fighting for the greater good.

According to a new report funded by trade group PhRMA (aka the pharmaceutical industry’s lobbyist squad), the 340B program reduced the amount rebated to managed care beneficiaries by $6.5 billion in 2024.

Wait, what’s 340B again? Glad you asked. Created in 1992, 340B requires drugmakers that participate in Medicaid to give drug discounts to hospitals and clinics; these “covered entities” treat a large proportion of low-income, uninsured patients.

The idea is for medical centers to use these discounts to help serve their communities and keep their doors open. But critics have accused some providers, especially large nonprofit health systems, of using program savings to bolster profits rather than reinvesting them into costly community care.

Here’s what the different sides are saying.—CC

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In 2017, Hurricane Maria devastated Puerto Rico.

The storm led to a collapse of the island’s healthcare system, a 2021 study reported, following power outages and a lack of disaster management plans that contributed to 3,000+ deaths. KFF reported in 2017 that Puerto Ricans living on the island already had low access to healthcare before the hurricane hit. Years after the storm, the region faced ongoing staffing shortages and issues with federal funding that restricted care, according to CBS News.

That’s why, in October 2017, Emmanuel Oquendo and Israel Figueroa founded BrainHi, a health tech company with an AI receptionist called Lara, which completes administrative tasks for providers. The tool can answer missed calls and schedule appointments, and is designed to reduce clinicians’ workloads. Some of the company’s clients include NeoMed Center, Ashford Hospital, Manatí Medical Center, and Mennonite Healthcare System, all based in Puerto Rico. 

Oquendo spoke with Healthcare Brew about his goals for the company going forward.

Learn more about the company here.—CM

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