A time of risk is also a time of opportunity, says Dr. John Rugge, a co-founder of the Health Care Coalition for the North Country.
At risk, according to Rugge, is health insurance for tens of thousands of local residents and as many as 5,000 jobs directly or indirectly related to the delivery of health care to the 10-county Adirondack/North Country region.
That’s a likely consequence – unfolding over the next decade – of recent federal Medicaid cuts, cuts compounded by other changes approved by Congress and by expiring subsidies for working families and small business owners purchasing health insurance through the exchanges.
Nearly 47,000 people in the 10-county region — out of roughly 170,000 currently enrolled in Medicaid — are likely to lose coverage, many within the next two years, according to a report released in March, 2026 by the Healthcare Coalition for the North Country — a group of more than 275 providers, caregivers and community leaders.
The March paper’s authors – retired physicians John Rugge, Chris Hoy and Richard Leach, with contributions from state government veteran Arthur Webb, — warned that changes in federal policy under the Trump administration pose existential threats to the communities of the Adirondacks and the North Country.
“We would become a medical desert,” says Dr. Rugge, who notes that “Medicaid underpins the entire healthcare delivery system in the region, and the wrong cuts would risk major disruptions for local hospitals, nursing homes and medical practices.”
In Warren County alone, roughly one-third of all medical facilities are at least partially funded through Medicaid reimbursements, officials stated.
“Health care businesses are all employers in the North Country, where the health care sector is one of our most important economic pillars,” said retired Glens Falls physician and paper co-author Dr. Richard Leach. “Medicaid cuts will impact all of us, not just the residents actually on Medicaid.”
An opportunity to redesign the region’s health care system
The opportunity presented by the risk of a failing economy, and, of course, by the risk of loss of access to health care, is a chance to redesign the current health care system in the Adirondack/North Country region, and, by extension, New York State, argue the authors of the coalition’s white paper.
“The health care system was broken before Congress approved those cuts in Medicaid,” said Dr. Hoy. “New York State was on its way to achieving the equivalent of universal healthcare, but only by spending more than twice the amount that other states spend. And that did not necessarily improve the quality of care in New York State.”
That being the case, Hoy asks, “Is this an opportunity to take a dysfunctional system and turn it into something more accessible, less expensive and of a higher quality? I think it is.”
Hoy and other members of the coalition are calling for a restructured, locally tailored health system whose focus is on expanding primary care, more conscious collaboration among providers and an increased use of federal funding for rural areas.
At the core of the coalition’s proposal is the creation of a “true safety net” of accessible primary care services extending across the region.
That would include expanding networks of primary care practices, urgent care centers, hospital-based clinics and federally qualified health centers (FQHCs), which are required to treat patients regardless of their ability to pay.
The coalition says such a network would improve access while reducing costs by shifting care away from emergency rooms and hospital stays toward preventive and routine treatment.
“American hospitals are among the most expensive buildings in the world to enter,” said Chris Hoy.
“Availability” — the ability to quickly reach a provider 24 hours a day — was identified by the authors as the most critical factor for residents’ peace of mind, according to the report’s executive summary.
The report highlights three existing FQHC systems — Hudson Headwaters Health Network, North Country Family Health Center and the Community Health Center of the North Country — as central to the strategy.
Expanding those organizations and integrating them more closely with hospitals and other providers could deliver “lower cost, increased accessibility, and higher quality” care, the report states.
FQHCs also offer sliding fee scales, comprehensive services and enhanced reimbursement from Medicare and Medicaid, making them a key tool for serving uninsured and underinsured patients.
Leveraging federal rural health funding
Coalition members say the federal Rural Health Transformation Act, a $50 billion federal investment that will direct $212 million to New York in its first year, could fuel and help fund the redesign of the local health care system.
The $50 billion in funding cannot fully offset broader Medicaid reductions. According to some estimates, federal spending on rural health care will decline by $137 billion over the next ten years. Nevertheless, the report suggests that New York’s share of this infusion of federal funds could rapidly expand primary care networks and make them financially sustainable within several years.
Under a December, 2025 proposal from the New York State Department of Health, the federal funds will be directed toward innovative, sustainable health care organizations and delivery systems, where the funds can have the greatest impact
Beyond expanding healthcare facilities, the coalition has proposed a series of operational reforms aimed at improving efficiency and access.
According to the Coalition, at least a portion of the Rural Health Transformation Act funds could be used to: create new, regional collaborative networks among hospitals and providers that would allow electronic medical records to be shared; establish 24-hour access to health care teams via telehealth, supported by expanded connectivity; train and financially support health care workers by, among other things, loan repayment programs; implement technology such as AI to reduce administrative burdens on providers; and support new services.
The report also calls for stronger coordination of transportation services, a major barrier to access to health care in rural areas, and increased use of community outreach workers to connect residents with healthcare and social services providers.
The coalition has applied for grants to hire a full-time, professional caseworker to assist those in need of services no longer affordable or available to them, Dr. Rugge said.
“Our goal is to connect individuals at high risk of losing coverage with the people who can provide help with food and housing, among other things,” said Rugge.
Once New York State finalizes a plan for the distribution of the federal Rural Health Transformation Act funds, the Health Care Coalition of the North Country will be in a better position to advance its recommendations, members said.
