Alabama and the Case for Expanded Rural Health Access
June 9, 2025
As the popular adage goes, “A rising tide lifts all boats.” In the heartland and beyond, no larger tide exists than access to quality health care and wellness treatment. Quality care leads to a healthier workforce, improves quality of life and increases gross regional product (GRP), but per Heartland Forward research, residents of rural areas experience worse health outcomes on average than their metropolitan counterparts. With large swaths of rural areas, heartland states stand to be most adversely affected by disparities in rural health systems.
And several states, including Alabama, are facing these challenges head-on. Amanda Williams, former president of the Medical Association of the State of Alabama, recently said:
“We have a health care issue in Alabama; our life expectancy is shorter, and not only that, we spend more years sick.”
In a 2024 report by data company SmileHub, Alabama ranked 41st in overall health and wellness among all U.S. states. Broken down into seven subcategories, including health and wellness organizations per capita, life expectancy and obesity rate, Alabama ranked in the bottom 50% in all but one. Their lone top-half ranking was public health funding per capita, suggesting the dollars invested are not being used efficiently.
The existence of the care system itself sits in limbo. According to the Alabama Hospital Association, seven rural hospitals have closed in the last 15 years and half of the state’s hospitals are at risk of closing, with 19 qualifying as “immediate risk.” Over one-third of Alabama counties do not have pediatric practices or maternal care facilities, and Alabama ranks 49th in dentists per population (41.6 dentists per 100,000 residents).
Further examination at chronic illness data reveals even more significant cause for concern.. At the Alabama Daily News Legislative Breakfast Series in early May, health leaders met to discuss health care challenges. During the event, Teresa Shufflebarger of the University of Alabama, Birmingham Medical Center, recounted what she had learned from her 2021 work with over 5,000 patients in rural clinics across Alabama:
“7% of those screened had high blood pressure and they didn’t know it; 4% had diabetes and they didn’t know it. More concerning [is that] 11% of those screened had high blood pressure, they know it, and they’re not doing anything about it. That is a stroke that shows up in our hospitals that shouldn’t be there.”
As described by health care professionals serving Alabamians and as shown by Alabama’s health care rankings, Alabama has ample room to improve its health care system.
Beginning the Treatment
Alabama policymakers understand the self-diagnosed rural health crisis and have risen to the challenge of treating it with smart policy.
“When you look at rural health in Alabama, it is a very serious situation that we’re facing now,” said state Rep. Ed Oliver, R-Dadeville, “and we are trying to combat that.”
After delivering this quote, Rep. Oliver proposed HB 46 this legislative session. The proposed bill would expand the state’s existing physician tax credit program through 2030. In the new program, rural physicians would be able to claim an annual tax credit of $10,000 for up to four years, incentivizing qualified professionals to take their expertise to rural areas.
Health and wellness impact all facets of rural life. When hospitals and care facilities close, it becomes harder to educate children, to retain effective members of the labor force and to achieve economic stability. While HB 46 is still pending, it represents a greater conversation in Alabama to support health care needs across the state.
What Does Other Smart Policy Look Like?
At the same session of the Alabama Daily News Legislative Breakfast Series, health care leaders suggested strategies for improving the rural health care system, all aligning with previous Heartland Forward research and recommendations. Click the links below to find our policy recommendations on the following areas, and more.