The Rural Policy Research Institute - RUPRI

03/19/2026

The RUPRI Health Panel releases a new brief -

The Importance of Long-Term Services and Supports to a High-Performance Rural Health System: Demographic, Policy and Economic Challenges

Prepared by the RUPRI Health Panel: Alva O. Ferdinand, DrPh, JD; Mark Holmes, PhD; Alana D. Knudson, PhD; Jennifer P. Lundblad, PhD, MBA; A. Clinton MacKinney, MD, MS; Timothy D. McBride, PhD; and Keith J. Mueller, PhD (Chair)

The long-term services and supports (LTSS) system is an important element of a high performing rural health system. The purpose of this Policy Brief is to assess the potential for transforming the LTSS system while it faces considerable challenges driven by demographic, economic and policy forces. The policy forces include the potential impact of planned expenditure reductions to Medicaid over the 2026-2034 period, with intended as well as unintended effects. Clickhttps://rupri.org/wp-content/uploads/LTSS-Brief-by-Health-Panel_FINAL.pdf to read full brief.

12/02/2025

Congratulations!! Dr. Whitney Zahnd, assistant professor of health management and policy and deputy director of the RUPRI Center for Rural Health Policy Analysis, was named the 2025 recipient of the Iowa Rural Health Association (IRHA)’s Jerry Karbeling Award. This annual award honors exceptional rural health leaders who demonstrate outstanding advocacy, innovation, and commitment to improving health and well-being across Iowa’s rural communities. Named in memory of Jerry Karbeling, a visionary leader and tireless advocate for rural health, this award recognizes individuals who exemplify the spirit of collaboration, service, and leadership that strengthen Iowa’s rural health system and advance IRHA’s mission. She received the award on November 20th ( National Rural Health Day) as part of IRHA’s annual conference.

11/19/2025

Mueller live in studio - IPR News, River to River. November 2025
What federal cuts to Medicaid mean for Iowans' healthcare
A discussion on how federal cuts to Medicaid will impact Iowans and rural healthcare.

River to River is a conversation about the news with an Iowa perspective. Together we dig into the story behind the headlines - we talk with newsmakers and a diverse range of experts to find out how the news affects you. We take on challenging topics, explore issues from all sides, and foster conver...

11/14/2025

Keith Mueller was recently cited in the Daily Iowan, "Iowa’s rural hospitals brace for impacts from Medicaid changes".

Grace Nelson, a third-year University of Iowa student from Sioux City, Iowa, was diagnosed with spinal muscular atrophy at 18 months old and has been a powered wheelchair user since she was 3. Nelson uses a personal care attendant for 14 to 18 hours a day, seven days a week — a program paid for...

10/07/2025

The October 2025 episode of RHIhub's podcast features an interview with Dan Shane, Associate Professor with the RUPRI Center for Rural Health Policy Analysis. We examine opportunities for applying technological advances in rural health and human services, potential challenges, and future avenues of....

10/01/2025

New policy brief - Health Insurance Coverage in Rural and Urban Areas in the U.S., 2023

This brief outlines the health insurance status of people in the United States, by residence (rural and urban) in 2023, with additional breakdowns by age groups.
Full brief -https://rupri.public-health.uiowa.edu/publications/policybriefs/2025/Health_Insurance_Coverage.pdf

07/03/2025

New rural policy brief from the RUPRI Center.
The Impact of High Hospital Fixed-Cost Ratios on Rural Populations.https://rupri.public-health.uiowa.edu/publications/policybriefs/2025/Impact%20of%20High%20Hospital%20Fixed-Cost%20Ratios.pdf
This brief focuses on rural hospitals with high fixed-to-total-cost ratios and describes characteristics of
those hospitals and the communities they serve. The brief extends a recent RUPRI Center analysis1 of
whether hospitals in rural areas have higher fixed-to-total-cost ratios, a characteristic that has
implications for financial stability under different payment models. We describe how this measure
varies across the United States, the demographic characteristics associated with hospitals at different
ratio levels, and the share of nonmetropolitan hospitals that have Critical Access Hospital (CAH) or
Low-Volume Hospital (LVH) designations.

05/28/2025

NRHA Annual Conference 2025 - Congratulations to Drs. Mueller and Sharma for receiving an award for article of the year at the awards banquet. https://www.ruralhealthresearch.org/publications/1642

Photos from NRHA's 2025 Rural Health Awards Banquet at NRHA's 2025 Annual Rural Health Conference Thursday, May 22 at the Atlanta Marriott Marquis.

01/10/2025

Mueller shares areas to watch for 2025
Keith Mueller, director of the Rural Policy Research Institute, recently shared some of the major issues that he'll be tracking as a policy analyst and researcher focused on rural health services in 2025. (Becker's Hospital Review)

Becker's asked pharmacy executives from hospitals and health systems across the U. S. to share the areas they're focusing on for 2025.

01/09/2025

New policy brief from the RUPRI Center -
Medicare Advantage Enrollment Update 2024
https://rupri.public-health.uiowa.edu/publications/policybriefs/2025/2024%20MA%20Enrollment%20Update.pdf

Key Findings:
• Medicare Advantage (MA) enrollment now exceeds 50 percent of eligible beneficiaries (enrolled in both Part A and Part B) in metropolitan counties (56.1 percent); at the
current rate of growth, nonmetropolitan enrollment is expected to exceed 50 percent (currently 48.1 percent) next year, in 2025.

• While the annual rate of MA growth continues to exceed the rate of growth in total Medicare eligible beneficiaries, it has moderated somewhat from previous years.

• Much of the growth in nonmetropolitan MA enrollment has been in plans using local preferred provider organizations (PPOs), accounting for a majority of MA enrollees innonmetropolitan counties since 2022.

11/18/2024

Congratulations to Tyler Ust "CEO to know". Tyler was a research assistant for the RUPRI Center when he was a graduate student at the University of Iowa Health Management & Policy.

Becker’s Health Review has named Tyler Ust (MHA20), CEO of Sanford Health Thief River Falls, to the 2024 edition of its “90 critical access hospital CEO’s to know.” This annual list recognizes leaders who excel in expanding services, recruiting and retaining top providers and building key partnerships to ensure their hospitals remain vital to their communities.

Becker’s Health Review has named Tyler Ust, CEO of Sanford Health Thief River Falls, to the 2024 edition of its “90 critical access hospital CEO’s to know.” This annual list recognizes leaders who excel in expanding services, recruiting and retaining top providers and building key partnershi...

11/15/2024

The RUPRI Health Panel, consisting of six of the foremost rural health experts from across the country, is celebrating 30 years of nonpartisan policy analysis. Members reflect on the Panel's history – and their ongoing commitment to representing rural communities and perspectives in national healt...