As director of the Center for Rural Health at the University of Arizona, Dr. Daniel Derksen frequently visits rural towns and border communities across the state. And lately, he’s been sensing a shift. While these areas have traditionally leaned conservative, he says people are beginning to question whether proposed cuts to programs like Medicaid, Medicare and other federal health supports align with their needs.
“A lot of the people — even the Republicans, which make up the constituency that got this administration into office — are saying, ‘No, we can’t cut those,’” he said. “These are programs that are often lifelines in these communities. If, for some reason, the expansion population gets reduced or eliminated, we could lose 500,000 people who are currently covered by Medicaid. It’s going to be a shock.”
Health care systems across the country are navigating turbulent times, but few regions are feeling the strain as acutely as Southern Arizona. Apart from the fallout from shifting federal policies, rural physician shortages and access disparities along with rising behavioral health needs are creating a growing list of challenges for the region’s health care leaders.
At the top is workforce development. According to Derksen, Southern Arizona is home to some of the most medically underserved areas in the country. The state’s population is the 14th largest in the nation, but ranks 42nd nationally in the number of primary care physicians per capita. That shortage is felt most keenly in rural and tribal communities, where patients often drive hours for basic care — and where hospitals and clinics struggle to recruit and retain staff.
“We haven’t expanded as rapidly as our population in the number of residency training slots,” said Derksen, who’s been leading a statewide push to address that gap through new community-based graduate medical education (GME) programs. “You want providers ready to practice in smaller communities” — and Derksen says most of his graduates from rural communities are indeed committed to serving the area they grew up in. “We know from the data that they’re more likely to practice in those areas when they finish.”
The problem is that the big city hospitals and care facilities in Tucson and Phoenix generally pay more than the clinics out in the sticks. “You want the training to occur in areas where people are needed, but you also want to align the fiscal incentives for an individual so they can pay off their student loans, you know?” Derksen said.
GME programs deal with this by offering financial incentives to grads to practice in a recognized Health Professional Shortage Area, or HBSA.
“We have a loan repayment program where medical students who agree to go into a high need specialty can get their loans repaid if they practice in one of these high needs areas,” he said. “ But that alone isn’t gonna solve the issue. You have to have a multi-pronged approach for sustained changes to happen.”
Such efforts include “pathway programs” designed to identify students from rural or tribal backgrounds who are more likely to return and serve those same communities. While Arizona recently funded nine such community health-based residency programs, Derksen and others warn that controversial overhauls to federal policy, like the proposed cuts to Medicaid, may undercut their progress.
“If you removed half a million people from having coverage, a lot of our rural hospitals would be forced to close,” Derksen said. “Throwing people off coverage doesn’t save money. It just shifts the cost — and often to those who can least afford it.”
Alongside physical health infrastructure, behavioral health services and housing stability face growing demand and systemic limitations. Southern Arizona’s ongoing opioid crisis has drawn renewed attention to the need for evidence-based treatment options.
Dr. Beth Meyerson, director of the Harm Reduction Research Lab at the University of Arizona, advocates for broader access to medication-assisted treatment (MAT), such as methadone and buprenorphine.
“Access to these medicines will decrease opioid overdose death by 60%,” she said. Yet barriers remain — especially for patients in rural or tribal areas.
“No one in any other health condition has to go to a clinic every day to take their medication,” Meyerson noted. “If your blood sugar’s out of control, you don’t have to go to your doctor or a clinic every day to have someone watch you take your medication to control your blood sugar levels. But we feel differently when it comes to opioid use disorder treatment. It’s all about stigma, and it burdens the patient.”
She argues that outdated regulations force many patients to interrupt their lives — sometimes driving hours daily for treatment — leading many to drop out altogether.
Solutions include newly relaxed federal policies that allow more take-home doses of methadone and the use of telehealth platforms for managing addiction. But implementation is uneven, and stigma remains a potent barrier.
“Some communities still treat opioid use disorder as a moral failing rather than a chronic condition,” Meyerson said. “That affects everything from how patients are treated to whether providers feel comfortable offering care.”
Another stigmatized population — those affected by homelessness — are also facing increased health challenges. The changes in federal funding for affordable housing and wraparound support in Arizona have direct and deeply intertwined impacts on health care, particularly for the state’s most vulnerable populations.
In Arizona, the end of programs like the Arizona Rental Assistance Program (ARAP) and Emergency Rental Assistance Program (ERAP) raises the risk of displacement — especially among seniors and people with disabilities who often require coordinated medical care and housing stability to maintain their health. Without stable housing, individuals are more likely to suffer from chronic conditions like diabetes, hypertension and mental illness, yet are less able to access consistent medical care. And according to the CDC, housing is a key social determinant of health: Homelessness significantly increases the risk of emergency room use, hospitalizations and early mortality.
Tim Kromer, executive director of philanthropy at Catholic Community Services of Southern Arizona (CCS), says the nonprofit has long operated on a model of wrap-around care.
“Catholic Community Services is committed to providing holistic, wrap-around services to the families and individuals we serve,” Kromer said. “This comes in the form of a whole host of services, from behavioral health care, nutrition, childcare, housing, vocational services and more.”
While many organizations are experiencing disruptions to funding, Kromer said that CCS avoided significant cutbacks — so far. “We continue to navigate the changing landscapes of health care and housing with a singular focus on helping the most vulnerable in our community.”
But overlaying all these issues is the uncertainty tied to national health policy. Changes under the new Health and Human Services Secretary Robert F. Kennedy Jr., including the elimination of departments focused on infectious disease and public health research, have unsettled many health care providers.
“We’re all affected by public health cuts of all kinds,” said Meyerson. “When clinics and harm reduction organizations lose funding, they close their doors. When people don’t have access to care, they go to the emergency room — the most expensive and least effective option.”
Derksen echoes the concern, emphasizing the central role of Medicaid in supporting hospitals, clinics and health centers in Arizona. “The single most important thing Arizona did for the sustainability of our health system was expanding Medicaid,” he says. “If that goes away, we’d be in deep trouble.”
Despite the obstacles, health care leaders in Southern Arizona remain hopeful. Technological advances like telehealth and AI are helping stretch resources and improve access in hard-to-reach communities. Community-based models of care — built around inclusion, trust and lived experience — are demonstrating new ways forward.
Crucially, leaders like Derksen, Meyerson and Kromer believe that resilience lies in collaboration: Between health systems and communities, researchers and policymakers, and doctors and the people they serve.
“We’re not here to speak for them,” said Meyerson about the communities she works with. “We’re here to make space for them at the table.”
