The current upheaval in federal government spending cuts isn’t just a bureaucratic headache in Washington — it has ripple effects felt far beyond the nation’s capital. For people in rural areas, layoffs have already impacted health care. And proposed federal funding cuts might have an even greater impact. That’s because many rural communities rely on federal funding to keep the doors of hospitals and clinics open.

Last fall, Bobbie Nicoliadis was on the once-a-week bus that travels from Christmas Valley to La Pine, Oregon, through the outback. The regular riders one this bus are close-knit. “This bus, we are like family,” Nicoliadis said. “It’s a great group of people.”

Nicoliadis was making the 130-mile round trip to get a blood draw at La Pine Community Health Center. On average, rural patients travel twice as far to health care. Bus driver Debbie Warren said it’s part of rural living.

“Doctor’s appointments are a long ways away, but there’s peace and quiet. You can see the antelope play,” she said.

This weekly bus service is reliant on government funding. It’s just one of many health services that could disappear with federal cuts. Rural community health clinics are also feeling threatened.

One clinic that relies on federal funding is Asher Community Health Center in Fossil, Oregon. Fossil is a town of less than 500 people, situated in the high desert. It’s so remote the Census Bureau doesn’t even categorize it as rural, but rather “frontier land.”

Asher Community Health is the only provider in this area, serving 1,200 patients a year. CEO Teresa Hunt said that funding is essential.

“Without the federal money for being a federally qualified health center, there’s no way that we’ll be here,” Hunt said. 

If the clinic loses funding and closes, its patients will have to drive more than three hours over winding mountain passes to get care. “It would be devastating for the people that live here,” said Hunt.

Federally qualified health centers are a key part of rural health care, especially for low-income people. 

“We’re designed to take care of the underserved, we’re the primary care safety net for a community,” said K.C. Bolton, CEO of Aviva Health. Aviva is a community health clinic in rural Douglas County, Oregon. It serves about 18,000 patients a year with the help of federal funding. 

Last month, Bolton started worrying he might not have access to federal service area competition grants that were already promised to the clinic. He tried to withdraw the remaining balance.

Apparently, he wasn’t the only one. The federal portal from the Health Resources and Services Administration crashed.

“Think of it kind of like a run on the bank. Everyone’s trying to draw off the system and overloaded the system,” said Bolton. “We’re all thinking the same thing. Let’s get ahead of this.”

Bolton was eventually able to withdraw the $3 million of grant funding early. 

That grant represents about 8% of Aviva Health’s annual budget. Meanwhile, Bolton is even more worried about possible cuts to Medicaid, which covers more than half of Aviva’s patients. “We’re kind of like the ER for outpatient care. We won’t turn folks away based on their ability to pay,” said Bolton.

Nationally, about 47% of children in rural areas use Medicaid or Children’s Health Insurance Program.

The Republican-backed congressional budget resolution proposed $880 billion in health service cuts over 10 years, including Medicaid.  

Carrie Cochran-McClain, chief policy officer at the National Rural Health Association said that already strapped rural clinics will feel these proposed cuts deeply.

“These are facilities that literally have zero days cash on hand to operate.”

Cochran-McClain said rural health care providers are already scrambling, trying to get federal employees on the phone. She said cuts to federally staffed clinics like the Department of Veterans Affairs and Indian Health Services could shift pressure elsewhere. And in rural areas, community health clinics will have to pick up the slack.

“Those costs have to go somewhere. And frequently they end up being shifted to other parts of our health care system, which then, in turn, kind of raises costs across the board, which is kind of a never-ending spiral,” Cochran-McClain said.

That could mean that federal funding uncertainties threaten to spiral rural health care facilities out of existence altogether.