Podcast Summary: "Rural Health Care is in Crisis"
Podcast: Uncared For
Host: SuChin Pak (Lemonada Media)
Original Air Date: August 20, 2025
Overview
This episode of Uncared For delves into the crisis of rural health care in the United States, focusing on Mississippi as a case study. Host SuChin Pak talks with Dr. Kimberly Sanford, an OB-GYN who has served rural Mississippi communities, and Dr. Daniel Edney, the state's health officer. The discussion highlights personal experiences, systemic challenges, financial strains, and the broad consequences of rural hospital closures, all amplified by insufficient Medicaid funding and the recent failure to expand Medicaid in Mississippi.
Key Discussion Points & Insights
1. The Stark Reality of Rural Healthcare in Mississippi
- Mississippi's health system ranks lowest in the nation, with high uninsured rates and gaping health care disparities, especially for people of color and poor communities.
- Over half the state's population is rural, making the threat to rural hospitals a statewide problem.
Dr. Edney: "When we talk about rural health care, we're really talking about statewide care. Even in our more urban areas, because we truly don't have an urban area." (05:58)
2. Personal Perspectives: The Human Impact
Dr. Kimberly Sanford’s Experience
- Moved from urban areas to rural Mississippi in 2016 as part of a loan forgiveness program; faced a cultural and professional “shock.”
- Witnessed first-hand the barriers to care, including long drives for emergencies, transportation challenges, and financial constraints.
Dr. Sanford: "Once you move here, you start to see the disparities of just being in a rural place and having access to healthcare. It's just what people are used to, right? We live an hour away from the hospital and we only go if we absolutely have to." (03:05)
Typical Patient Experiences
- Most are “the working poor”—cannot miss a paycheck or take time for regular preventive care.
- Many only make it to a handful of prenatal visits instead of the recommended 14 due to transportation and work limitations.
- Patients often depend on family or outdated information and resort to emergency rooms for basic care.
Dr. Sanford: "You're supposed to see a patient 14 times during the pregnancy, so you might only see them six times or seven times because that's the only number of times they can get in." (13:24)
3. Systemic Barriers and Hospital Closures
- Mississippi did not expand Medicaid under the ACA, worsening the uninsured rate.
- Nearly half of rural hospitals in Mississippi operate at a deficit. Nationwide, nearly 200 rural hospitals have closed in the last two decades.
Dr. Edney: "When I first took over in 2022, it was just one hospital after another, notifying us that they were shutting down services." (08:48)
The Domino Effect
- Closure of hospital departments impacts entire communities beyond health care—hospitals are often the biggest employers.
- Department closures (labor & delivery, ICU, neurosurgery, dialysis) mean patients must travel further for basic and emergency care.
Dr. Edney: "When you look at rural communities, usually the largest employer in all those communities is healthcare." (09:44)
4. Labor & Delivery Closures: A Case Study
Greenwood Leflore Hospital
- Dr. Sanford’s unit (labor and delivery) was abruptly closed in October 2022—a trend seen in more than 500 U.S. rural hospitals since 2010.
- Closure means high-risk pregnancies, emergencies, and even basic deliveries must be managed elsewhere, increasing risk and barriers to care.
Dr. Sanford: "Surely somebody's gonna step in and go, let's, you know, too big to fail. Right. No, that didn't happen. And what it did... was what you don't want to hear: that these people don't matter." (16:19)
- The nearest labor & delivery is now a 45-minute drive away, compounding risk for pregnancy complications.
Dr. Sanford: "It's 34 miles away, which, you know, in miles does seem [not] too bad. But what if you don't have a car?" (17:35)
5. The Importance of Preventive Care—And Its Absence
- Preventive measures (Pap smears, mammograms) become a luxury; lack of regular checkups results in advanced diseases that could have been caught earlier.
- Patients often do not realize the importance of preventive care, leading to serious health consequences.
Dr. Sanford: "Pre-cancerous cells unattended over six to ten years can become carcinoma or cancer. And so that's what you see." (26:31)
Memorable Story
- A 74-year-old with a 46-year-old IUD, not removed due to lack of care access, presented only after symptoms appeared. Found embedded in a cervical tumor, it illustrated the dangerous cost of skipping preventive care.
Dr. Sanford: "I had a 74 year old lady who came in... [the] IUD is embedded into a cervical tumor because she had not also gotten a Pap smear in 46 years." (27:54–29:15)
6. Financial Lifelines and Federal Policy
- Greenwood Leflore was narrowly saved from closure through a federal demonstration project allowing full reimbursement for care (rather than the underpaying set fee-for-service model).
- The sustainability of this model is uncertain, especially in the face of sweeping federal Medicaid cuts.
Dr. Edney: "They're not fully healthy yet, but they're getting healthier every day. And I do fully expect them to stabilize and get strong and thrive again, but only because of the demonstration opportunity." (24:00)
- Medicaid cuts, like the recent $1 trillion federal reduction, threaten all hospitals—even those not predominantly serving Medicaid patients—because Medicaid payments support community-wide infrastructure.
Dr. Edney: "Even though I have never been on Medicaid and never will be on Medicaid, when I go to the hospital, I have benefited from the Medicaid program because my hospital benefited from the Medicaid program." (24:51)
7. Urgent Message for Policymakers—And for the Nation
- Rural health is not a niche issue—most Americans live in rural or small-town communities, and their struggles preview greater national problems.
- Dr. Sanford urges policymakers to prioritize people over politics and properly fund rural care.
Dr. Sanford: "For once, don't take politics first. For once, actually put the people first, like you say you do in every campaign, in every speech." (31:23)
- Medicaid pays for nearly half of all rural births; cuts affect everyone, not just Medicaid recipients.
8. Why Providers Stay
- Despite the hardships, doctors like Sanford continue for the personal impact: "When you could change the way a lady or woman feels and she didn't even know she felt that, you know, man, that's rewarding." (32:27)
- Dr. Sanford reflects on the meaning of being “the first person to touch everybody’s baby” (32:44), a profound reminder of the stakes.
Notable Quotes & Memorable Moments
| Timestamp | Speaker | Quote/Content | |-----------|---------|---------------| | 03:05 | Dr. Sanford | “Once you move here, you start to see the disparities of just being in a rural place and having access to healthcare. It’s just what people are used to, right? We live an hour away from the hospital and we only go if we absolutely have to.” | | 05:58 | Dr. Edney | "When we talk about rural health care, we're really talking about statewide care... Jackson, Mississippi, is our largest city. It has a population of less than 150,000." | | 08:48 | Dr. Edney | “When I first took over in 2022, it was just one hospital after another, notifying us that they were shutting down services.” | | 13:24 | Dr. Sanford | "You're supposed to see a patient 14 times during the pregnancy, so you might only see them six times... because that's the only number of times they can get in." | | 16:19 | Dr. Sanford | "It was a huge element of disbelief... What it did, what it said was, what you don't want to hear is that these people don't matter." | | 24:51 | Dr. Edney | “...when I go to the hospital, I have benefited from the Medicaid program because my hospital benefited from the Medicaid program. And, you know, I need all Mississippians to understand that you cut Medicaid, you hurt everybody.” | | 26:31 | Dr. Sanford | “Pre-cancerous cells unattended over six to ten years can become carcinoma or cancer. And so that's what you see.” | | 27:54–29:15| Dr. Sanford | (On the 74-year-old with an IUD embedded in a cancer mass) “She had not also gotten a Pap smear in 46 years.” | | 31:23 | Dr. Sanford | “For once, don’t take politics first. For once, actually put the people first, like you say you do in every campaign, in every speech.” | | 32:44 | Dr. Sanford | (On being an OB-GYN) “And then I realized one day I’m the first person to touch everybody’s baby... That’s like, I touched you first. Put my mitts on you first.” |
Timestamps for Key Segments
- Mississippi’s Rural Health Crisis Introduced: 03:05–06:48
- Personal Stories From the Delta: 13:24–17:35
- Labor and Delivery Unit Shut Down: 15:29–19:04
- Aftermath and Long-Term Impacts: 19:38–24:00
- The Rural Community Hospital Demonstration Program: 23:29–24:00
- Preventive Care Gaps: 26:31–29:15
- Appeal to Policymakers: 31:05–32:10
- Personal Mission of Dr. Sanford: 32:27–33:01
Conclusion
This episode paints a vivid, urgent picture of the crisis facing rural healthcare—not only in Mississippi but across the U.S. Economic pressures, policy decisions, and deep-seated disparities all converge to threaten access for millions. The hosts and guests stress that what's happening in Greenwood Leflore is not isolated—it's a warning for the country. The episode closes with an appeal for civic engagement and policy change, and a reminder of what’s at stake if rural healthcare continues to erode.
For deeper engagement with the guests’ stories and continued coverage, listen to the full episode on Lemonada Media or subscribe for bonus content on Lemonada Premium.