New Report Finds 80% of U.S. Counties Are Health Care ‘Deserts’
As rural health care providers and hospitals brace for the impact of the budget bill passed earlier this month by the GOP Congress, a new report from GoodRx finds that more than 120 million Americans already live in health care deserts. GoodRx Senior Health Economist Amanda Nguyen spoke with Spotlight about the new research; the transcript of that conversation has been lightly edited for length and clarity.
Amanda, why don’t we start with just a brief description of GoodRx.
GoodRx is the leading platform for medication savings in the U.S and we’re uniquely situated at the center of the health care ecosystem. GoodRx connects health care consumers to health care professionals, payers, PBMs, pharma manufacturers, and retail pharmacies, all to make saving on medications easier. And we’re used by nearly 30 million consumers and over a million health care professionals every year. GoodRx really tries to help consumers save time and money in filling their prescriptions so that they can get the care that they deserve. And since 2011, GoodRx actually helped people save over $85 billion on the cost of their medications.
And the study that we’re going to talk about, I understand, sort of follows up on some previous work on pharmacy deserts?
Yes. In 2021, we did a comprehensive report on the state of health care deserts in the U.S. We have an in-house research team at GoodRx that’s made up of health economists—and I’m a senior health economist—data analysts, epidemiologists and public health experts. And our research team was really built on the principle of fostering a greater public understanding of the issues that people face around affordability and access to health care. This report in 2021 was to basically stake out what are the different areas in which people can lack access to health care infrastructure comprehensively, and how that can be meaningfully translated to health care consumers.
Let’s talk about the most recent work, if you could just walk us through basically what you studied and two or three of the top lines.
In our latest research, we looked at basically how the state of healthcare deserts has changed since 2021, and that’s defined by access to pharmacies, hospitals, and hospital beds, trauma centers, primary care professionals, and low-cost, federally funded health centers. We picked all of those dimensions of health care because that kind of gives you a full view of the health care infrastructure that people would need to be able to access conveniently within a reasonable distance of where they live in order to maintain and treat their health.
Just to interrupt briefly, how is a health care desert defined?
We look at them on each dimension and whether you have access to all of them or some of them. And we found that about one in three Americans lack access to at least one of those dimensions. That could be that they don’t have access to a pharmacy or a trauma center nearby. We found that 8 million people still live in counties where there’s at least four different health care deserts, meaning four of the six different dimensions. And that’s really being driven by pharmacy access getting worse in particular. We saw pharmacy deserts have the sharpest increase across all of those health care categories—since 2021, we found that over 1,300 pharmacies have closed across both urban and rural communities, and that’s pushed the number of people living in pharmacies deserts from 41 to 48 million.
What are the some of the states that have been hit the hardest?
We find that the factors that are particularly correlated with health care deserts are going to be rural low-income areas, areas with lower health insurance coverage and less internet access. We see that both at the county level and the state level. At the state level, we see certain states have the highest proportion of people living in a health care desert and those would be Wyoming, Vermont, Montana, New Mexico, and Alaska. We also found that there’s some pockets of rural counties that have a high level of health care deserts as well, counties like Catron County in New Mexico, Duval County in Texas and Hettinger County in North Dakota all have health care deserts in all services.
I’m guessing that at least a couple of those counties have large native American populations. Were there other demographic groups that are particularly impacted?
I think that in certain states like New Mexico you’ll see that there are some large native populations that are impacted. In the southern states like Mississippi, you’ll see that there are Black populations that are disproportionately impacted. The big drivers are rurality, low incomes and low health insurance rates.
And if lack of access to a pharmacy was the top problem that you found, what was next?
Hospital care comprehensively is another big issue. We looked at several different dimensions of hospital care, such as distance from a hospital and how much capacity does the hospital have. We looked at the recommended level of hospital beds, which can have a big effect on people’s chances of getting adequate care. We looked at the same issues for trauma centers, as in life threatening emergencies, the distance to appropriate trauma care can be a big barrier to people. Clinical literature finds that one hour can make the difference in your survival rate in response to traumatic injury. We found that about 50 million people still live more than an hour from a trauma care center.
On pharmacy deserts, what do you find are some of the main drivers for that phenomenon.
One of the things that we looked at specifically was whether they live within a certain amount of driving time to multiple pharmacies. This is important because not only do your medication prices depend on the pharmacy, but also your pharmacy may or may not have your medication in stock. In previous years, we’ve seen some issues with shortages, like with ADHD or weight loss medications. So, when we see things like pharmacies closing, that’s going to create a spillover effect. You’re either going to have a harder time finding your medication in stock, or, even if your pharmacy doesn’t close, you might face longer wait times.
Obviously, there’s been this big budget bill passed, and I’m interested to get your thoughts on how that will impact this problem.
The new act is going to have a broad impact, not just on the people who rely on Medicaid, but on the entire healthcare system. And so, while you have a lot of people who are at risk of losing their insurance, that could compound with other issues like rising health insurance premiums, staffing shortages, and the financial strain on hospitals and health care facilities. All of which is going to make it more difficult for areas that are already health care deserts to keep facilities open and provide enough care to people. At GoodRx, we continue to be focused on improving access and affordability, which Americans may need now more than ever. And the moment really requires a lot of collaboration from other stakeholders in the system to ensure that people can access the treatments that they’re prescribed.
And if I can just drill down a little bit on the impact on rural hospitals, because I think a lot of people don’t understand how this bill potentially can affect rural hospitals, many of which are already barely staying open. But could you talk about that a little bit?
We’ve done a lot of research around the impact of people not being able to fill their medications and there’s a lot of clinical research showing how that spills over into avoidable care that takes place in the ER and the hospitals. I think that the impact of having even more people who have a difficulty affording their medications is going to compound that effect. Even before the law was enacted, prescription insurance coverage was less comprehensive and more restrictive even across all insurance types. We also did a 2025 report called Coverage with a Catch that showed that all major insurance types impose significant restrictions that delay or block access to medication treatments. And so even with insurance, people are finding it more difficult to afford their treatments. You can imagine that as people lose insurance, it’s going to be even more difficult and that’s going to spill over into people’s health outcomes and put some additional financial strain on rural hospitals.
Anything you’d like to add Amanda?
I just wanted to highlight that our research team works closely with journalists to provide timely data and insights into how Americans are experiencing the health care system. This research is just an example of the research that GoodRx wants to put out there to help people be more empowered to make informed and affordable choices.