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A string of rural health clinic closures could be a harbinger of what's to come as medical systems in outlying areas brace for cuts in the Republican budget law and grapple with inflation and workforce issues.

The big picture: Some of the latest closures are in anticipation of the nearly $1 trillion reduction in federal Medicaid spending that will in large part hit starting in 2027.

State of play: Three health clinics in rural Virginia will be consolidated and patient care moved to other facilities, Augusta Medical Group announced last week, in response to the One Big Beautiful Bill Act.

• Curtis Medical Center in Nebraska, the first health provider to cite Medicaid changes as a reason for closing, will shut its doors on Sept. 30, per the Washington Post.
• At least three rural health centers in Maine have announced plans to close this month, Portland's WMTW reported.
• Mayo Clinic last week said it's closing six clinics in southern Minnesota, including in rural towns, and reducing services at a hospital in the area, although a spokesperson told Axios the transition isn't related to the new law.

Zoom out: Nearly 200 rural hospitals have closed or ended inpatient services over the past two decades.

• Almost half of rural hospitals operated at a loss in 2023, according to the American Hospital Association.
• "Rural hospital financing has not worked well for a long time," said Carrie Cochran-McClain, chief policy officer for the National Rural Health Association.

The tax and spending package Congress passed in July is widely expected to add to the financial difficulties in rural areas, where patients are often poorer and older and where there are fewer private coverage options.

• Federal Medicaid spending in rural areas could decrease by $137 billion over the next decade, KFF estimates.
• The law established a $50 billion rural health transformation fund to be doled out to states over five years, in part to assuage Republican lawmakers' concerns. But the amount has been panned as inadequate.

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Senate health committee Chair Bill Cassidy is calling on Health Secretary Robert F. Kennedy Jr. to publicly support the vaccine for whooping cough amid an outbreak in Cassidy's home state of Louisiana.

Why it matters: The move is the latest twist in a closely watched relationship.

• Since the Republican physician provided a key vote in February to advance Kennedy's nomination, he's tried to drive a wedge between Kennedy and President Trump by citing Trump's involvement in Operation Warp Speed and past support of vaccines.

What they're saying: "We can ensure that no child dies from a vaccine-preventable disease," Cassidy wrote in a letter on Friday to Kennedy.

• "I ask that you publicly reaffirm your support for the DTaP vaccine," he added, referring to the vaccine that protects against whooping cough, also called pertussis, as well as diphtheria and tetanus.

The big picture: Cassidy wrote that his state is experiencing "the worst pertussis outbreak in 35 years," and that two infants have already died.

• He also pointed to Trump's recent statement that vaccines "just pure and simple work."

What's next: Cassidy will chair a health committee hearing this week at which former CDC director Susan Monarez will make her first public appearance since the Trump administration fired her after a reported dustup with Kennedy.

The CDC plans to contract with Rensselaer Polytechnic Institute to investigate the debunked idea that vaccines cause autism, according to a notice on a federal contracting website.

Why it matters: Several large studies have already disproven the connection. But Kennedy has continued to promote a possible link.

Zoom in: The CDC late last week posted a notice of intent to award a sole-source contract to the Troy, New York-based private university and asked for a response by Sept. 26.

• The notice did not specify a time frame for the project, or the amount of the contract.
• The CDC isn't asking for competitive bids, but said any responses received from other institutions within 15 days of the notice will be considered.

What they're saying: Rensselaer Polytechnic appreciates the CDC's plan to award it the grant, a spokesperson told Axios in a statement.

• Juergen Hahn, a biomedical engineer and data science expert on the faculty, has made a career studying autism risk factors and biomarkers.
• Hahn is on the scientific advisory board of the Autism Research Institute. Its website states it "recognizes the importance of addressing concerns about a potential link between vaccines and autism," but notes that there has been no validated or replicated study confirming a causal link.

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Each day, over 10 million lifesaving medicines and healthcare products are delivered to patients and providers.

Here’s how: A vast network of healthcare distributors works around the clock — all while operating on the narrowest profit margins in the industry.

Check out this interactive explainer.

People with mental health needs are twice as likely to report difficulties getting needed care as those without issues, according to a new survey of U.S. adults with workplace coverage shared first with Axios.

Why it matters: The findings from the Employee Benefit Research Institute provide more evidence that having health insurance doesn't automatically translate to having access, especially for people with mental health needs.

By the numbers: Just over a quarter (27%) of 3,103 respondents surveyed in March and April said they or someone on their health coverage had a mental health condition.

• But 31% of that cohort said they've been unable to get some form of necessary medical care in the last six months, compared with 15% of those who reported no mental health conditions.
• Those with mental health needs were likelier to encounter doctors who didn't speak their native language and be unable to take time off work or get child care.

Yes, but: The survey shows that employees with mental health needs tend to be more engaged with their health care than those without.

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