In Illinois, more than one in five rural women of childbearing age rely on Medicaid for health coverage, according to the Georgetown University Center for Children and Families and coverage could be in jeopardy as the program faces massive budget cuts in Congress.

Medicaid pays for half of all births across the state.

Kathy Waligora, deputy director of external affairs for the advocacy group Everthrive Illinois, said rural communities already face health care challenges, including hospitals closing or no longer offering maternity care. She emphasized any threats to the program would leave millions without health insurance and affect health outcomes for women and babies across the state.

"We are currently in a fight, an existential fight, for the future of Medicaid," Waligora asserted. "The level of cuts that have been proposed by Republicans in Congress are so severe that every community that uses Medicaid will be threatened."

Waligora pointed out efforts such as the Medicaid expansion in Illinois have decreased maternal mortality by ensuring women are healthier prior to pregnancy.

The report showed severe cuts would result in declining Medicaid revenues and increase uncompensated care costs for rural hospitals. Waligora noted states such as Illinois have used Medicaid state-directed payments to increase reimbursement to rural health centers and hospitals to help them stay open. Currently, eight rural hospitals in Illinois are at risk of immediate closure.

"They are eliminating the ability for states to use those state-directed payments to support rural communities," Waligora underscored. "When we should be investing in a program that supports our communities, instead, we're cutting it to pay for tax cuts for the wealthy and corporations, which is just particularly reprehensible."

Joan Alker, executive director of the Georgetown University Center for Children and Families, said losing rural hospitals affects all women, not just those on Medicaid.

"It doesn't matter who their health insurer is. If they have private insurance, employer insurance, but there's no facility, then they can't safely give birth," Alker pointed out. "That's why these issues are so consequential."

Nationwide, nearly two-thirds of counties lacking a birthing facility or obstetrician are located in rural areas. More than 34% of counties in Illinois are defined as maternity care deserts.

Despite debate in Washington over ending incentives to help Alaska's smallest places move away from traditional oil and gas-based power generation in the most remote parts of Alaska, one village above the Arctic Circle has found success and plans to invest.

Kotlik, a Yupik native village nestled on the banks of the Yukon River is using alternative energy as an economic driver.

Richard Bender, president and CEO of Kotlik Village Corporation, said the village has developed a three-phase plan to move away from oil and gas-based power to generate electricity for its 600 residents.

"Phase 1 is to purchase a battery storage system and switch gear," Bender outlined. "Phase 2 of Kotlik's energy plan is to produce energy using solar panels. Phase 3 is production of electricity using wind turbines."

Despite the success of places like Kotlik, and its aggressive plans for future alternative energy development, Washington lawmakers are debating a budget bill which would eliminate tax incentives for investing in clean power in rural Alaska, which could reduce funding for the projects the village depends on.

Kotlik collaborated with the Alaska Public Interest Research Group to produce a video about the project, which Bender noted goes beyond providing sources of alternative energy to the village.

"In addition to energy sovereignty, and sustainability, this project will have a positive impacts on health education and workforce development," Bender explained.

Bender added creating stability in those areas will spill over into different parts of the community and help the village keep people working at home, rather than moving to other places.


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The mayor of a rural Utah town said the clean energy investments and tax credits created by the Inflation Reduction Act are helping drive economic growth and diversify her town's energy portfolio.

Lenise Peterman, mayor of Helper, stressed tax credits have been vital for communities like hers as they help modernize their systems. But the budget reconciliation package now in Congress would eliminate major parts of Inflation Reduction Act funding, including clean energy investments.

Peterman said it could be detrimental to local people who have been able to harness the power of tax credits to grow their businesses.

"The jobs are there," Peterman emphasized. "We just need to ensure that we have the educational resources available - especially to people who may be transitioning out of a traditional coal plant or coal mining, to be able to step into those roles. But the roles are there."

She added while federal dollars in rural communities affect fewer people, their effect is triple that of urban communities. Peterman said the Inflation Reduction Act incentives will foster energy independence as power use and costs are projected to increase. Sen. John Curtis, R-Utah, has been an outspoken critic of sunsetting the credits.

Peterman pointed out Helper is in a unique position, since the town of about 2,200 residents owns and operates its own electric grid. It purchases power from transmission stations but Peterman said they face challenges due to the town's aging and limited infrastructure. She sees the tax credits as part of the solution.

"For me, it's about hardening the grid so that we can then incorporate other energy types, which I hope will drive costs down for the consumers," Peterman underscored. "Because now we'll have options and not be beholden to a single energy source."

Republican leadership in Congress is hoping to pass the big budget bill and have it signed by President Donald Trump before July 4. Peterman hopes politicians are able to reach consensus and do what is best for all, rural and urban alike.

"I'm hopeful that we can move past the partisan positions that people seem to be stuck in and do what's best for all of the people," Peterman added. "I really hope that comes to fruition."


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It is not just the weather or commodity prices farmers have to worry about. Many rural communities struggle to keep their roads and bridges in good shape, making farming life even harder and now, North Dakota is trying to correct the issue.

This year, state lawmakers have expanded eligibility for agriculture infrastructure grants awarded to towns with populations under 1,500.

Rob Schmidt, chairman of the Olivier County Commission and a rancher in Hensler, said it is welcome news because some local roads have self-imposed speed limits of 25 miles an hour because of the shape they are in, citing the effects from heavy truck traffic linked to a nearby refinery and an ethanol plant.

"Basically, there's no local money to fix that wear," Schmidt explained. "Any money that would come from the state would certainly be appreciated to help remedy that."

Schmidt, also a member of the North Dakota Farmers Union, is hopeful some jurisdictions in his part of the state are able to take advantage of the changes. Oliver County's total population is around 2,000, with the biggest town home to 500 people. The grant program was established in 2023.

Schmidt noted rebuilding roads and bridges could join other quality-of-life benchmarks his county is trying to highlight in the long-standing push to attract residents.

"We've got a very nice school here and we've got all the infrastructure in place in town to be thriving a lot more than we are," Schmidt emphasized.

He acknowledged even when a smaller town makes infrastructure improvements and attracts more industry, it does not always result in bigger population numbers. He said they have had issues in the past where people might take a new job in the area but still commute from elsewhere.