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Geographic deserts, provider shortages, and the supply of care — who can reach a clinician, and who cannot.
14 studies on this desk
- America's medically underserved areas are a map drawn last century
HRSA's map of America's medically underserved areas is old: of the 4,148 active MUA/MUP designations, 72.1% were made before 2000, the median dates to 1994, and 1,074 — one in four — share a single founding date in November 1978. A designation carries no expiration; it stays until withdrawn.
2026-06-16 · 9 min - What Medicare actually uses: service penetration and caseload, 2025
Across 24 Medicare service categories, only one — preventive health — reaches more than half of fee-for-service beneficiaries (53.6%); the median reaches under 6%. The load is uneven: 2,303 labs serve 15.6 million beneficiaries, 6,754 apiece, while physical therapists average 40. CMS publishes this utilization map as the demand-side mirror of market saturation.
2026-06-16 · 9 min - Medicare's largest value-based program is a long tail with a heavy head
The Medicare Shared Savings Program looks broad — 511 accountable care organizations for 2026, holding 15,329 participant organizations. But its weight sits in a small head: the largest 10% of ACOs hold 43.5% of all participants, the smallest half just 11.8%, and the full-risk Enhanced track carries 71.0% of the network.
2026-06-16 · 8 min - Most U.S. health-care shortage areas are a single facility, not a community
Only 2,300 of America's 21,133 designated Health Professional Shortage Areas — 10.9% — are whole geographies. The rest are facilities and populations: 14,538 (68.8%) are a single site such as a rural clinic, health center, tribal program, or prison, and 4,295 (20.3%) are a named population group.
2026-06-16 · 9 min - Where the uninsured land: coverage at America's community health centers, 2024
66.2% of the 32.4 million patients at America's community health centers were uninsured or on Medicaid in 2024. But the mix flips by state: Texas centers reported 33.6% of patients uninsured against 29.8% on Medicaid; California centers, 10.1% uninsured and 72.0% on Medicaid.
2026-06-15 · 11 min - Where Medicare providers cluster: home health and DME market saturation, 2025
In Los Angeles County, 1,847 home health agencies serve Medicare's fee-for-service population — the most of any U.S. county, at 2.12 per 1,000 beneficiaries, nearly ten times the national rate of 0.22. CMS publishes this market-saturation map for program-integrity monitoring, not as proof of fraud.
2026-06-15 · 10 min - Who opts out of Medicare: a behavioral-health story, 2026
Of the 56,117 clinicians on CMS's Medicare opt-out list, 60.9% belong to five behavioral-health specialties — psychologists, social workers, mental health counselors, marriage-and-family therapists, and psychiatrists. The largest single year was 2024, when 15,978 opted out, two-thirds of them therapists Congress had just made Medicare-eligible.
2026-06-15 · 9 min - Most of Medicare's posted revalidation deadlines are already past due, 2026
Of the 261,878 Medicare enrollments CMS has assigned a revalidation deadline in its May 2026 Revalidation Due Date List, 217,968 — 83.2% — carry a due date already in the past, the oldest from July 2023. A revalidation date is an administrative control, not a fraud or eligibility signal.
2026-06-15 · 9 min - America's care deserts are rural: two-thirds of U.S. health-care shortage areas
Two-thirds of America's active health-care shortage areas are rural: 13,999 of the 21,133 designated Health Professional Shortage Areas — 66.2% — sit in rural communities, against 6,069 non-rural ones. The rural skew holds across primary care (66.0%), mental health (65.3%), and dental health (67.4%) alike, spanning 25,281 federal designations in 60 jurisdictions.
2026-06-14 · 10 min - Medicare Part D drug spending by state: where the dollars concentrate
California prescribers drove $21.26 billion of Medicare Part D drug cost in 2024, the most of any state — followed by New York at $18.17 billion, Florida ($16.84 billion), and Texas ($15.75 billion). The four largest states alone account for nearly a third of the program's $226.74 billion in drug spending.
2026-06-12 · 10 min - Hospice Provider Availability by State: 6,943 Medicare-Certified Providers, 69% For-Profit
6,943 Medicare-certified hospice providers operate across 51 U.S. jurisdictions; 69% are for-profit. California alone holds 31% of all national certifications with an 83% for-profit rate, while New York lists just 40 hospices at 7.5%. Every figure traces to the CMS Care Compare Hospice dataset (yc9t-dgbk) with signed provenance.
2026-06-06 · 10 min - Hospital Price Transparency Enforcement: 11,440 CMS Actions Since 2021
28 civil monetary penalties, 2,993 warning notices, and a complete 5-year federal enforcement record — every action CMS has taken against non-compliant hospitals under the Price Transparency rule. Texas leads with 1,175 enforcement actions; 2025 was the peak year with 5,432 actions. State-level breakdowns and reproducible methodology from CMS data.
2026-06-06 · 10 min - County-Level Nursing-Home RN Staffing Deserts
Across 1,362 U.S. counties with at least three reporting nursing homes, 550 (40%) staff registered nurses below the 0.55 federal hours-per-resident-day floor. A ranked, county-level analysis built on CMS Payroll-Based Journal staffing data — every county traceable to a cryptographically signed snapshot.
2026-06-03 · 12 min - A March spike in Medicare enrollment deactivations thinned provider supply in shortage areas
Medicare enrollment deactivations in PECOS ran 28% above the trailing-twelve-month average in March 2026 — and the spike was not uniform. Deactivations in HRSA-designated shortage areas grew 41% against trend, versus 19% elsewhere. The places least able to absorb a departure lost providers fastest.
2026-04-28 · 6 min
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