Oklahoma lawmakers confront challenges for rural health care

Amber Holbein grew up in and around Ada. Her years of education took her as far away as the West Indies for med school, but she always had a passion to serve her hometown community. 

“I was able to see it from a young age,” she said. “Going to the doctor was a 30-minute drive for my family. And getting into a doctor — sometimes it's difficult because there was not very many in our area, so it took us a while to get in. So, I learned from a young age the importance of health care in a small town.” 

As the daughter of a nurse, Holbein follows in her mother’s footsteps, providing care for others. 

She’s been practicing with The Clinic in its Ada offices since 2023. While her specialty is family medicine and has every type of patient, she also works in pediatrics and women’s health. 

Her journey to work in her hometown as a doctor was, in part, made possible through Oklahoma’s Family Practice Resident Rural Scholarship Program. 

“It's an incentive to pay off debt,” Holbein explained. “But also provide service for an area that may not have access to a physician.” 

When she was a resident at OU Health, she was eligible for $1,000 a month to help with expenses. Through Oklahoma’s Health Care Workforce Training Commission, she agreed to match with a rural community in Oklahoma on or before the end of the second year of residency training, according to the commission’s website. 

The program also included spending one month during her third year of residency on an elective rotation in the rural community, and then working in that community for each month the stipend was received, for at least 12 months. 

“I've been very fortunate with the program to place me in a good place, as well as working for a clinic that really does help provide good services through our community,” she said. “And I am fortunate to be a part of that.” 

Holbein’s experience with the program is a reflection of how the state invests in its health care workforce. Lawmakers first created the scholarship program in 1992. 

The primary care doctor Holbein saw as a kid growing up in Oklahoma also participated in the program. 

Despite the program's popularity among doctors, Oklahoma still contends with disparities in rural health care. 

Nearly 1.5 million Oklahomans live in rural communities, U.S. Census data shows.  

61 counties in Oklahoma contain medically underserved communities, according to data from the Health Resources and Services Administration. Those are areas with a shortage of primary care services. 

Rep. Danny Williams, R-Seminole, is currently running an interim study, with two colleagues, examining rural health care challenges in the state. 

“One of the biggest challenges we have today in health care is keeping doctors, nurses and hospitals alive in the rural areas,” he said. 

Williams is partially studying how expanded workforce opportunities, like the program Holbein participated in, could address workforce shortages. Specifically, roles for nurses. 

“If we can recruit kids in middle school, get them prepared, get them to take the right courses, and get them in a vocational school, they can graduate from high school as an LPN,” he said. “We can help to provide some incentives. We keep them in that area. We help educate them. We bring them back to our clinics, our hospitals in that area, and sign an agreement. We’ll say, ‘3 to 5 years, if you’ll help us out.’ And I think there’s a lot of opportunity there to fund and create the graduates we need to help us in rural health care.” 

Other areas of focus include studying how changes in federal support for Medicaid will impact Oklahomans. 

KFF, a health policy organization, analyzed a report from the Congressional Budget Office about how many people would become uninsured as Medicaid cuts take effect across the next decade. It is estimated, by 2034, at least 100,000 Oklahomans would become uninsured. 

According to July data from the Oklahoma Health Care Authority, 1,039,926 Oklahomans are currently receiving the state’s Medicaid program, SoonerCare. 

Rep. Williams and other state lawmakers met with Sen. James Lankford on Monday to discuss the changes. 

“One of the things we talked about was Medicaid, because it’s now 90% paid for by the federal government and 10% by the state of Oklahoma,” he said. “And there are some changes in Medicaid. But that cost sharing is not going to change now and probably won’t for several years, which is a good thing because it’s more predictable for us. But at the same time, there are some other components that are going to be changed in that process, which could affect rural hospitals.” 

However, the “One Big, Beautiful Bill” passed by Congress last month also contained a provision with $50 billion to support rural hospitals across the next 5 years. 

“About $100 million of it will help hospitals in the state, and there’ll be another $100 million to go for grants,” Williams said. “So, there’s going to be some resources in the next few years that are going to help us retool our health care in rural Oklahoma.” 

Lankford’s office confirmed he met with state lawmakers this week but did not elaborate on the exact content of the health care discussion, or if the meeting was convened recently or was a regularly scheduled update. 

But he has previously drawn attention to the timeline for federal Medicaid cuts. 

“It’s not immediate, in fact, it’s one of the things I fought for,” Lankford said in a July interview with News 9’s Scott Mitchell. “Any changes for the state have to have several years. The legislature has got to be able to work through this and figure out how they’re going to be able to do that, and I want to be respectful of that. So I pushed to have a longer delay on this. The provider-tax piece on this won’t hit Oklahoma for 8 years. It’ll be 8 years before that change. And it’s one-half of one-percent of a change. That’s the change in the provider-tax piece. Now, there’s a separate piece that’s also out there that’ll hit us in about 4 to 5 years. And it’s going to be this very gradual change for a small portion of Medicaid recipients that the state is going to have to pick up a bigger portion. Because the state right now is paying some hospitals 175% of the Medicare rate for a certain population of Medicaid, that’s those healthy adults, mostly. So we just said, ‘hey, your Medicare rate and your Medicaid rate have to be the same, but we’ll give you 10 years to make that transition.” 

States will receive applications to go after the money available for rural hospitals and health facilities beginning in early September, according to the Centers for Medicare and Medicaid Services.