About half of rural voters say the economy is worse now than when President Donald Trump returned to office, and health care costs rank alongside gas prices as their biggest household worry, according to a new survey by The Associated Press and KFF released Wednesday. Two-thirds of rural voters (66%) said they are at least somewhat worried about affording health care for themselves or their families.
The KFF/AP Rural Voters Survey polled 2,241 registered voters living in rural areas, online and by telephone, from August 12 to 24, 2026. Results for the full sample have a margin of sampling error of plus or minus 3 percentage points, with larger margins for smaller groups such as independents.
The findings reach beyond politics. They show rural families stretching budgets across gas, groceries, and medical bills while a growing share say their communities lack enough doctors and hospitals. That combination can delay care for older adults, children, and people managing chronic conditions.
Health Costs Rival Gas Prices in Rural Budgets
Rural voters' worries about affording gas or transportation (67%) and health care (66%) topped concerns about food (60%), utilities (59%), and rent or mortgage payments (46%). The pressure was sharpest for the youngest voters: 77% of rural voters under 30 said they worry about affording health care.
More than half (56%) said it is extremely important for midterm candidates to talk about health care costs, second only to the cost of living. Three in four rated the cost of living in their community as "only fair" or "poor," up from about half in a 2017 KFF-Washington Post survey.
Views of federal health policy lean negative. By 41% to 17%, rural voters said the Trump administration's health policies have hurt rather than helped their own health care costs, while 41% saw no impact. Among the 10% who buy their own coverage, 57% reported a negative impact, which KFF said likely reflects higher ACA marketplace premiums after enhanced premium tax credits expired.
The results are not uniformly negative for the administration. About half (48%) of rural voters approve of Trump's overall job performance, a larger share than among U.S. adults overall in separate AP-NORC polling, and rural voters narrowly trust Republicans over Democrats on health care costs, 33% to 28%. Views on prescription drug costs were split, with 30% positive and 35% negative.
Cost worries may also shape turnout. Rural Republicans who disapprove of Trump's handling of the economy were less likely than those who approve to say they are certain to vote, 59% compared with 79%. Many rural voters said they trust neither party on health care costs, including 59% of independents.
Fewer Doctors, Fewer Hospitals, and a Fund Few Have Heard Of
Nearly half (46%) of rural voters said their area lacks enough doctors, up from 33% in 2017, and 35% said it lacks enough hospitals, up from 21%. About six in 10 (62%) said there are not enough mental health providers. The hospital gap was widest for Black and Hispanic rural voters, about half of whom (52% each) said their communities do not have enough hospitals. Nearly 200 rural hospitals closed or converted between 2005 and 2026, according to the Sheps Center at the University of North Carolina.
Republican leaders have promoted drug pricing efforts and the $50 billion Rural Health Transformation Program created in last year's tax and spending law. Yet 61% of rural voters said they had heard nothing at all about the fund. The same law reduces projected federal Medicaid spending by more than $900 billion, according to KFF, but 59% of rural voters said they did not know enough to say whether it raised or lowered Medicaid spending.
Medicaid touches many rural households. About half (49%) said they or a family member have received Medicaid support at some point, and 92% called the program important to their community. "We need more help affording healthcare for our family," a 54-year-old Republican voter from rural Wisconsin told survey researchers.
Survey Limits and Steps for Rural Families
The survey measures perceptions, not the measured effect of any policy on household bills. A voter's belief that federal policy raised costs does not prove the policy caused the increase, and the poll did not track out-of-pocket spending directly. Rural areas were defined using U.S. Department of Agriculture commuting codes, and the sample combined the SSRS Opinion Panel with a voter-file sample weighted to match the rural registered voter population, according to the survey methodology.
For households feeling the squeeze, the fall enrollment season offers a chance to trim costs. Medicare open enrollment runs from October 15 through December 7, and people who buy their own coverage can compare marketplace plans and check whether they qualify for financial help when enrollment opens. Community health centers offer care on a sliding fee scale based on income, and many rural clinics offer telehealth visits that can cut long drives.
Families should not skip needed care or ration medications to save money without first asking a clinician or pharmacist about lower-cost options, such as generics, patient assistance programs, or a different pharmacy. The next signals will come from the November midterm results and state rollouts of rural health fund awards, which MedicalDaily will continue to track.
Key Questions Answered
What did the KFF/AP poll find? About half of rural voters said the economy is worse than when Trump returned to office, and 66% said they worry about affording health care for themselves or their families.
How was the poll conducted? KFF and the AP surveyed 2,241 rural registered voters online and by phone from August 12 to 24, 2026. The margin of sampling error is plus or minus 3 percentage points.
Which rural voters worry most about health costs? Younger voters stood out, with 77% of those under 30 saying they worry about affording health care. People who buy their own coverage were most likely to report a negative impact from federal policy.
Are rural areas losing access to care? Nearly half of rural voters said their area lacks enough doctors, up from 33% in 2017, and nearly 200 rural hospitals closed or converted between 2005 and 2026.
What is the Rural Health Transformation Program? It is a $50 billion fund created in last year's tax and spending law to support rural health care. Most rural voters surveyed said they had heard nothing about it.
What can rural families do about rising health costs? Compare plans during open enrollment, ask about sliding-fee community health centers and telehealth, and talk with a clinician or pharmacist before skipping care or medication.
Published by Medicaldaily.com
