Hi, Kimberly Adams here, taking over the newsletter this week to wrap my first week as the new host of “Marketplace Morning Report.”

I think I may have finally adjusted my sleep schedule for the new shift, and the team had plenty of news to keep us on our toes — inflation data, an escalation in the Iran war causing more swings in the oil markets, plus our big series on how changes in federal policy show up in rural healthcare — and what that means for the economy wherever you are.

I’m so excited to be starting this new role. I’ve been a journalist since I was 16 years old, chasing a local TV news crew down the street to ask for help getting an internship. My career has taken me all over the country, and even a few years reporting in Egypt. But I’ve been at Marketplace longer than any other newsroom, 11 years next month, and have learned so much in that time about the way our economy works, and who it does and doesn’t work for.

I can’t wait to keep up the amazing work the “Morning Report” team has done over the years with David Brancaccio, and I’m looking forward to adding my own flair to the mix. —  Kimberly Adams

In rural communities around the U.S., there are about 700 hospitals at risk of closure, according to the Center for Healthcare Quality and Payment Reform. Twenty-five of them are in Alabama, a state already familiar with that risk, along with what happens to a community when it becomes a reality.

Inside the Thomasville Regional Medical Center, it’s almost as if you’re just walking through on an early morning before it’s about to open. There’s still paper on all the exam chairs, ready for a check-up or doctor’s visit.

In reality, the hospital is frozen in time, and it’s been closed for almost two years. The bright reception areas, brand new surgery facilities, and the only in-house MRI machine for dozens of miles are all empty.

Sheldon Day, the mayor of Thomasville, was our tour guide when we visited the town about an hour and a half north of Mobile. It’s situated in Alabama’s 7th Congressional district, an area with some of the lowest life expectancies in the entire country.

That’s why Day told us Thomasville needs its hospital.

“We have a primary care clinic here with all the bells and whistles. We were the only hospital in the region that did 3D digital mammograms. The only thing you're missing is patients,” he said.

The medical center closed in 2024, less than five years after it opened. The COVID-19 pandemic was a major factor. Like so many hospitals around the country, Thomasville Regional shut down elective and nonessential care, which the mayor said made up something like 75% of the patient volume here.

But when the hospital was open, there were also patients like this one.

“We had a young lady who had a heart condition,” Day said. “Basically, one of her aorta tore, and they brought her here. Any other hospital would not have been able to see what we saw, but because of our advanced diagnostics, they had a surgery team waiting on her as soon as she got to a facility in Mobile, and her life was saved. Today, she’s got two children, active family here in our community, business owners in our community. And that’s just one example. If she had had that last month, while this hospital was closed, she would’ve died.”

Mayor Day has given dozens of tours to prospective buyers and media over the last couple of years, trying to get the hospital reopened.

But the financial headwinds facing rural healthcare in the U.S. are made up of more than just the lingering impact of COVID. And those headwinds are getting more intense because of recent federal policy decisions: cuts to Medicaid, increased work requirements, and disappearing subsidies.

In Alabama, the state hospital association says more than 80% of rural hospitals are operating at a loss.

“Many of the buyers that looked at the facility, they absolutely were foaming at the mouth to buy it,” Day said. “And then they go work the numbers, and they go, ‘Ah, don't think we're going to do it.’“

On the main street of downtown Thomasville, there’s a bakery, a movie theater under renovation, and the Thomasville Sports Hall of Fame. It was there we met Jimmy Duncan.

“They put me in the hall of fame about six, eight months ago,” Duncan said. He was a college football national champion in 1971.

But after his playing days, Duncan worked at the nearby paper mill his dad helped open.

“You see these knees right here?” Duncan asked. “That wasn't from playing football. That was from running up and down that floor, on that cement floor. But the paper mill is pretty tough work, but it was the highest-paying job in the area.”

We also met Charlie Anderson, who’s Thomasville-born and -raised. He brought this hall of fame to life a dozen years ago. But we weren’t just visiting to relive the glory days; we also wanted to talk about healthcare, and the lack thereof in this area.

“Thirty minutes in any direction you want to go, there are paper mill or wood products industries,” Anderson said. “Jimmy can tell you, accidents that happened at mills, you haven’t got two hours sometimes to drive somebody.”

So when the hospital shuts down, as it did here in Thomasville, there’s a hit to community health and to financial health. Alabama hospitals generate about $30 billion a year in economic activity, according to the state’s hospital association.

“I would think it probably also affects new people looking at locating in a place like Thomasville, to think about, ‘If I don't have good healthcare, I might not want to go there,’ “ Anderson said.

This is something that towns across America have to reckon with, as rising healthcare costs and policies at the federal level put the squeeze on healthcare.

One of the reasons we traveled to Alabama was because it’s been almost a year since President Trump signed his big tax and spending law, which many experts predicted would put additional strain on an already thinly-stretched rural healthcare infrastructure.

Over the decades, Dr. Marsha Raulerson, a pediatrician in Brewton, Alabama, has seen firsthand how rising costs and changing policy shape individual health care choices.

We met her on her lunch break one Wednesday afternoon at David’s Catfish House. She’s a pediatrician who’s been working in the area, about an hour and a half northeast of Mobile, since 1980.

And she keeps a list of cases where she says patients’ lack of access to — or ability to afford — healthcare cut their lives short.

“Forty-seven-year-old, died with congestive heart failure related to chronic kidney disease and type 2 diabetes. He was 47,” Raulerson recounted. “He's part of our workforce, right? He's 47. He's part of our future. He’s a father, maybe even a grandfather. And now he's 47 and he's not with us anymore. And it's a loss not only to his family, his children, but to the community.”

According to the health policy nonprofit KFF , changes from the One Big Beautiful Bill Act will lead to a hit of almost $140 billion to rural Medicaid funding over the next 10 years.

Layer that on top of the expiration of COVID-era subsidies for Affordable Care Act coverage, and you end up with lots more uninsured people.

Raulerson said the private market won’t be much of a safety net for the people in her community.

“If you get insurance from your company you work for, you may have a $1,000 deductible for each family member, so people just don't get care,” she explained.

When I was originally applying for my reporter job at Marketplace back in 2015, I submitted part of my application as an audio essay, and used this song to start. I used it as my "pump up" music for years as a way to boost my energy before recording something under a blanket in my apartment in Egypt. Have a great weekend!