From the piece:

> Further, only 4 percent of the country’s ob-gyns practice in rural areas, which is where 10 percent of women ages 15 to 49 live. And that proportion is likely to fall even more because many new entrants to the field are not willing to do a residency or start a practice in states that restrict abortion, many of which are more rural.

> An even greater challenge will be the massive cuts to Medicaid within the One Big Beautiful Bill Act, many of which Congress set to go into effect after this fall’s elections. Medicaid covers more than 40 percent of American births overall and an even higher proportion in rural areas. More generally, the program is crucial to the financial viability of many rural hospitals, such that even if the cuts didn’t touch pregnant women at all, they could still deprive women of care by producing more rural-hospital closures. As an inducement to get votes from conservative rural congressional members, the OBBBA included a $50 billion Rural Health Transformation Fund, but this is substantially less money than the Medicaid cuts will total across rural America.

Rural America is too far into the gravity well to reach escape trajectory of a positive outcome. There is no will to spend today what it would cost to fix this (ie provide sufficient funding to maintain rural healthcare services and systems at a reasonable baseline for the local rural healthcare consumer base), and over time, the cost will only continue to rise.

(think in systems)