Rural Health Crisis Spurs New Access Proposal

A Rural Reality Shared Nationwide

Across the United States, rural communities are facing deepening health care shortages—challenges that mirror those recently documented in New York. In August 2025, a comprehensive report from the Office of the New York State Comptroller highlighted the crisis unfolding in 16 rural counties: aging populations, shrinking workforces, long travel distances, and medical provider shortages so severe that many residents have no access to basic care within their own county.

Assemblyman Robert Smullen, who represents parts of the Mohawk Valley and the Adirondacks, is now putting forward a proposal aimed at reversing those trends. While his plan is New York-specific, the underlying issues he seeks to solve reflect a national problem—one that rural leaders from the Hudson Valley to the Pacific Northwest recognize well.

New York’s rural counties make up just 3.8% of the state’s population but span more than one-third of its land area. As a result, even a single missing medical specialty can force families into hours-long travel for routine care. The Comptroller’s report shows that shortages span nearly every medical field, including primary care, pediatrics, dental services, maternity care, and mental health. The extent of the shortages is stark: some counties have no pediatricians or OB-GYNs at all.

“These statistics showcase a staggering lack of health care access for New Yorkers living in rural areas,” Smullen said. “It is unacceptable—and it’s time we do something about it.”

What the New Data Reveals

The Comptroller’s report paints an unmistakable picture of strain:

• Primary Care: Rural counties average 4 primary care doctors per 10,000 residents, less than half the statewide and national ratios.
• Pediatrics: The 16 counties combined have 0.5 pediatricians per 10,000 people—one-fifth of the statewide ratio. Three counties have none.
• OB-GYNs: With an average of 0.4 OB-GYNs per 10,000, many expectant mothers must travel across multiple counties for prenatal or delivery care.
• Dental Health: Dentist-to-population ratios in rural counties are less than half of statewide averages. Hamilton County has no dentists at all.
• Mental Health: All 16 counties are designated mental health shortage areas, with more than 305,000 residents underserved. Rural suicide and self-harm rates remain significantly higher than national urban averages.
• Nursing & Support Staff: While registered nurse numbers are reasonably strong, nurse practitioner and physician assistant ratios lag far behind, limiting alternatives to physician-based care.

These shortages are not unique to New York—they reflect the same challenges documented in rural stretches of Appalachia, the Midwest, the Plains states, and the Mountain West.

Smullen’s Plan: Strengthening Access and Affordability

Smullen’s newly announced proposal focuses on three primary strategies:

1. Expanding Telehealth Reimbursement

Telehealth has become a lifeline for rural communities, especially where broadband is strong enough to support it. But low reimbursement rates discourage providers from offering virtual care. Smullen’s plan seeks to establish reimbursement parity, allowing remote visits to count fully toward a provider’s workload and income.

2. Offering Loan Relief to Attract New Providers

Medical students graduate with high debt loads—often more than $250,000. Rural communities compete against urban centers that can offer higher salaries, larger practices, and more support staff. Smullen proposes new loan relief programs for physicians, dentists, mental health practitioners, and other clinicians who commit to serving in shortage areas.

3. Creating Tax Incentives to Improve Affordability

Tax credits would be offered to providers who open or maintain practices in rural regions. This aims to help offset the financial pressures faced by small, low-volume rural offices and clinics that often operate with limited margins.

Together, these measures are designed to rebuild the rural health workforce while easing the cost burdens that have long discouraged professionals from practicing outside metropolitan areas.

A Call for Rural Equity

For Smullen, this proposal is not simply about improving health care infrastructure—it’s about ensuring fairness for those who live outside major cities.

“There is a clear and present need to address this growing problem on a statewide scale,” he said. “Addressing these affordability and access issues is essential and is a matter of rural equity.”

As rural areas across America confront similar shortages, New York’s proposal may offer a model for other states searching for solutions that can restore access, strengthen local health systems, and ensure that geography is never a barrier to care.