Amid wide healthcare cuts, a bright spot for rural hospitals

Summary

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Marketplace Morning Report Summary

Episode: Amid wide healthcare cuts, a bright spot for rural hospitals
Date: January 2, 2026
Host: David Brancaccio

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Episode Overview

This episode explores the shifting landscape of American healthcare at the start of 2026, highlighting the financial pressures rural hospitals face following the rollback of enhanced premium tax credits and Medicaid cuts. It then pivots to the travel and tourism sector—especially the impact on U.S. museums after a pandemic-era recovery stalls—and finally updates listeners on gender representation in film direction and import tariffs. The overall tone is informative and pragmatic, mixing economic insight with voices from affected communities.

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Key Discussions & Insights

1. Rural Healthcare: Cuts and Opportunities

Timestamps: 00:31 – 02:31

• Expiration of Tax Credits & Challenges:

  • The pandemic-era, enhanced premium tax credits for Affordable Care Act plans have expired, disproportionately affecting rural residents who already face poorer health outcomes and struggling hospitals.
  • Alison Davis (Center for Economic Analysis of Rural Health) notes:

    "It helped rural residents because it made their access to care more affordable. It helped rural communities because the hospitals within those communities were now being compensated for the care they were providing." (01:22)

  • The average person enrolled was saving $900 annually, money that also circulated in local economies.

• Difficult Choices Ahead:

  • Carrie Henning-Smith (University of Minnesota Rural Health Research Center) voices concern over increased financial strain:

    "Does that mean that you're making choices between paying for housing, paying for food on your table, or paying for health insurance? We shouldn't have to make these choices, but we do." (01:43)

  • Budgets are tightening across rural America, forcing households to prioritize essentials over health coverage.

• Federal Infusion – The Rural Health Transformation Project:

  • Despite cuts, $50 billion in federal funds are being injected into rural healthcare ecosystems for technological investment, partnership building, and training.
  • Henning-Smith is “excited about initiatives like technological investment, partnership building, [and] training opportunities.” (02:02)
  • Still, both Davis and Henning-Smith agree these investments, while positive, are insufficient to offset immediate losses:

    “It’s just too little too late.” (Allison Davis, 02:18)

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2. Cinema: Falling Number of Female Directors

Timestamps: 02:31 – 03:24

• The percentage of women directing the top 100 U.S. movies dropped by 8% in 2025, returning to half of 2020’s level, according to a University of Southern California study.

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3. Import Tariffs Update

Timestamps: 03:05 – 03:24

• Tariffs on kitchen cabinets and upholstered furniture had been increased by 25% in October, but further increases are paused as trade talks progress. Concerns about affordability are partly driving this.

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4. Museums: Setbacks and Silver Linings

Timestamps: 04:09 – 07:27

• Economic Headwinds for Museums:

  • Mitchell Hartman reports that after pandemic recovery, U.S. museums face falling attendance and waning federal grants:

    “Attendance and financial performance are both trending in the wrong direction and are both being compounded by a third of museums having lost federal grants or contracts this year.” (Netanya Kashan, American Alliance of Museums, 04:51)

  • Rising travel costs and economic uncertainty are causing fewer visitors, especially from abroad.

• Mixed Performance:

  • About half of museums are faring worse than in 2019; the rest are stable or improving.

• Portland Art Museum Success Story:

  • The Portland Art Museum just opened the renovated Rothko Pavilion after a $146 million campaign and met its 2025 fundraising goal.

    “It's chronological and it shows Mark Rothko's progression from figurative surrealist, and then he abandons all that for pure abstraction.” (Rima Reyes, 06:09)

  • The museum also set aside $30 million for its endowment:

    “More restrooms, more elevators, more seating. No one ever complains about those things and we really wanted to improve accessibility.” (Rima Reyes, 06:33)

• Long-term Viability:

  • Ray Madoff (Boston College Forum on Philanthropy and the Public Good) underscores the need for strong endowments:

    “So that they can manage the vicissitudes of annual giving and also just the regular problems... with their buildings.” (06:52)

• Adapting to New Realities:

  • Museums are seeking corporate sponsorships, brand partnerships, and expanded facility rentals, while cutting expensive traveling exhibits in favor of using their own collections:

    “They've also expanded facility rentals for private events and revamped membership programs while cutting back on traveling exhibitions in favor of exhibitions they can put on cheaper from their own collections.” (Mitchell Hartman, 07:14)

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Notable Quotes & Moments

• “We shouldn't have to make these choices, but we do.”
  Carrie Henning-Smith, 01:43

• “It's just too little too late.”
  Alison Davis, 02:18

• “Attendance and financial performance are both trending in the wrong direction...”
  Netanya Kashin, 04:51

• “No one ever complains about [more restrooms, elevators, and seating] and we really wanted to improve accessibility.”
  Rima Reyes, 06:33

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Timestamps for Key Segments

• 00:31 — Healthcare sector changes and rural hospital funding
• 01:05 — Impact of lapsed tax credits on rural families and economies
• 02:31 — Gender representation in film direction statistics
• 03:05 — Update on furniture and kitchen cabinet tariffs
• 04:09 — Travel/tourism impacts and museum finances
• 05:46 — Portland Art Museum’s Rothko Pavilion opening
• 06:41 — Museum financial strategy and sponsorships

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Tone

The episode is clear, factual, and solution-oriented, presenting both challenges faced by communities and examples of resiliency. Guest comments are direct—often somber regarding current difficulties, but hopeful about new investments and innovative responses to economic shifts.

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Transcript

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[Marketplace Host David Brancaccio]

Not the sort of exhibit museums embrace fewer visitors. I'm David Brancaccio in Los Angeles. First, we've been covering big jumps kicking in now to the cost of health care. With the rolling back of tax credits for Affordable Care act plans, many middle income people will feel this. Another of the many changes to health care in this new year expansion of the health care ecosystem outside cities and burbs. It's $50 billion in federal money for what's the Rural Health Transformation Project. Marketplace's Elizabeth Troval reports people in rural.

[Marketplace Host]

Areas have worse health outcomes and their hospitals are struggling to stay open. The now expired enhanced premium tax credits were helping on average $900 annually per person enrolled. Allison Davis is with the center for Economic Analysis of Rural Health.

[Marketplace Reporter]

It helped rural residents because it made their access to care more affordable. It helped rural communities because the hospitals within those communities were now being compens for the care they were providing.

[Marketplace Host]

It was money flowing through the local economy. Without it, budgets are going to have to adjust, says Carrie Henning Smith with the University of Minnesota Rural Health Research Center.

[Marketplace Reporter]

Does that mean that you're making choices between paying for housing, paying for food on your table or paying for health insurance? We shouldn't have to make these choices, but we do.

[Marketplace Host]

But billions of new dollars will be going towards boosting rural health care ecosystems. And Henning Smith says she's excited about.

[Marketplace Reporter]

Initiatives like technological investment, partnership building, training opportunities.

[Marketplace Host]

But she says they don't make up for the losses rural communities will feel from the expiration of tax credits and Medicaid cuts. Allison Davis agrees.

[Marketplace Reporter]

It's just too little too late.

[Marketplace Host]

Davis says it's good to invest in the future that rural hospitals and their patients are already struggling today. I'm Elizabeth Tropal for Marketplace.

[Marketplace Host David Brancaccio]

A new study finds 8% fewer women directed the top 100 movies in theaters in 2025. This from a University of California study. In fact, it's a University of Southern California study. Let's get that right last year's percentage was about half of 2020's levels, and among higher Trump administration import taxes are those on kitchen cabinets and upholstered furniture hiked 25% in October. But there's news this week that further increases in those tariffs will not happen as trade talks continue. Concern about affordability may also be a part of this.

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[Marketplace Host David Brancaccio]

Travel and tourism in the US is a mixed bag going into this new year. On one hand, the Automobile association calculates 2025 is now on track for a record year for people traveling around the holidays. Yet international travel to the U.S. is projected to be down more than 6%. That according to the U.S. travel association today. One effect America's museums here's Marketplace's Mitchell.

[Marketplace Reporter Mitchell Hartman]

Hartman five years ago, the COVID pandemic wreaked havoc on museums, visitor numbers and their finances. Every year since, the American alliance of Museums member survey has shown nationwide recovery until 2025, says spokesperson Netanya Kashan.

[Netanya Kashan]

Attendance and financial performance are both trending in the wrong direction and are both being compounded by a third of museums having lost federal grants or contracts this year.

[Marketplace Reporter Mitchell Hartman]

Economic troubles are manifesting in other ways, too.

[Netanya Kashan]

Rising costs are really forcing people to reconsider how they vacation. A significant proportion of museums reported decreases in attendance due to changes in travel and tourism as well as economic uncertainty. Plus, international tourism is significantly down this year. That impacts museums that are in major destination cities.

[Marketplace Reporter Mitchell Hartman]

In the survey, half of museums said they're doing worse now than in 2019. That leaves half that must be holding their own or doing a bit better. I found one of those right here in my hometown of Portland, Oregon. The local art museum facing a tree lined boulevard in the heart of downtown.

[Rima Reyes]

This is the fourth floor of the Rothko Pavilion.

[Marketplace Reporter Mitchell Hartman]

Portland Art Museum interim director Kerry Burch is showing me around the museum's brand new attraction, which just opened to big crowds after years of renovation and a major $146 million capital campaign. Mark Rothko grew up in Portland and his family is loaning the museum the pieces eight works.

[Rima Reyes]

It's chronological and it shows Mark Rothko's progression from figurative surrealist, and then he.

[Marketplace Reporter Mitchell Hartman]

Abandons all that for pure abstraction, burch says. Thanks to local giving, the museum met its fundraising goal for 2025. It even set aside $30 million to replenish its endowment, which will now help maintain the new facilities.

[Rima Reyes]

More restrooms, more elevators, more seating. No one ever complains about those things and we really wanted to improve accessibility.

[Marketplace Reporter Mitchell Hartman]

And maintaining a healthy endowment is key for museum's long term financial stability, says Ray Madoff at Boston College's Forum on Philanthropy and the Public Good, so that.

[Marketplace Reporter]

They can manage the vicissitudes of annual giving and also just the regular problems structural problems with their buildings.

[Marketplace Reporter Mitchell Hartman]

And museums are looking for ways to find new money, says Netanya Kashin at the American alliance of Museums, increasing their.

[Netanya Kashan]

Efforts to secure corporate sponsorships or brand partnerships. They've also expanded facility rentals for private.

[Marketplace Reporter Mitchell Hartman]

Events and revamped membership programs while cutting back on traveling exhibitions in favor of exhibitions they can put on cheaper from their own own collections. I'm Mitchell Hartman for Marketplace.

[Marketplace Host David Brancaccio]

Your Marketplace listening, I dare say, has turned you into the go to person at the table on matters economic. Feel the satisfaction of confirming your know how in this realm by taking our weekly Marketplace News quiz. It's online website like which famous investor is leaving who had a 5.5 million percent return over 60 years? Hint. Omaha, Nebraska our executive producer is Nancy Fargoli. Digital team includes Antoinette Brock, Emily McCune, and Dylan Miettinen. Marketplace Morning Report from APM American Public Media.

[Rima Reyes]

Hey everyone. You already listened to Marketplace podcasts, so you know that it's important to understand how economic forces shape our lives. And that feels especially important now as we're all trying to make sense of the latest headlines. I'm Rima Reyes, host of Marketplace's this is Uncomfortable, a show that explores how money bumps up against our relationships, our choices, and the parts of life we don't always say aloud. And starting January 15th, we are back every single week. New stories, new questions, and the kind of conversations that make you feel less alone in this quickly changing economy. We're tackling questions like Should I turn my hobby into a money making side hustle. How do I deal with layoff anxiety? Or what do we owe our parents financially? Don't miss an episode. Subscribe to this is Uncomfortable from Marketplace. Wherever you get your podcasts.