Texans depend on hospitals in their communities for timely and local access to healthcare and are increasingly relying on telehealth services. However, 70% of Texas counties are considered rural, and the healthcare facilities in many rural areas experience challenges such as limited workforce and resources, provider shortages, and a remote geographic location.

Many patients who access hospitals use public programs such as Medicare and Medicaid. Hospitals who rely on these public programs are vulnerable to payment cuts when federal funds are threatened, which puts small and rural healthcare providers in jeopardy.

Insufficient access to primary care and other essential services in Texas leads to poorer health outcomes for Texans and increases the likelihood of more expensive treatments.

Rural hospitals have been closing at incredible rates. From 2005 to November 2020, 176 rural hospitals nationwide have closed, 24 of which were located in Texas.1

The COVID-19 pandemic has heightened the importance of access to hospitals and telehealth for protecting and serving the healthcare needs of Texans.

What does this mean for the real estate industry?

Hospitals are essential to a community’s health and well-being as healthcare providers and as employers and investors in the community. They are economic anchors for rural communities, and the loss of rural hospitals can result in business closures, population decline, and reduction in the sales tax base which impacts other community services.

Access to healthcare facilities boosts communities’ attractiveness to buyers, makes it more likely that residents will stay, and increases options for real estate buyers and investors seeking livable communities.

Texas REALTORS® position

Our association supports the development and funding of hospitals and health care facilities in our rural communities.

We also support innovative telehealth treatment options that allow for expedient and safe care to be provided to patients who cannot access in-person care facilities.

Legislative outlook

We expect lawmakers to make healthcare access for all Texans a priority during the legislative session.

Historical perspective

The Texas Legislature has made great strides over the years to increase healthcare access, work toward making healthcare more affordable for Texans, and pass pro-consumer healthcare legislation.

Most recently, new laws from 2019 essentially ended the practice of surprise medical billing and its negative impact on consumers, increased transparency of freestanding emergency rooms in Texas, and increased access to telemedicine and telehealth services, especially in rural communities.

In the 2020-2021 state budget, lawmakers approved more than $100 million to help rural hospitals, demonstrating their dedication to supporting Texans in these areas.


  1. “176 Rural Hospital Closures: January 2005-Present (134 Since 2010),” NC Rural Health Research Program. The Cecil G. Sheps Center for Health Services Research, University of North Carolina,