The rural parts of Michigan have much simpler economies than more urban ones. This greater simplicity includes the provision of health care. Taken as a whole, health care providers remain, nonetheless, very critical providers of health related jobs and wages for the local economy in a way that isn’t as true of urban areas, even though urban health systems are much larger.
Distances in rural areas and the lack of effective public transportation make personal vehicles, gasoline, and maintenance costs important factors in health care access. I know plenty of people in the rural north of Michigan who have to travel several hours for any significant health interventions and specialist care.
Because unemployment is higher in rural counties, private health care is sparse, and Medicaid plays a significantly greater important role in the provision of health care than in urban areas. The implementation of Medicaid Expansion had a profound effect on rural health care in those states, like Michigan, that chose to use the opportunity.
So, rolling back Medicaid expansion or dropping it all together will produce significant loss of providers, greater distances to access health care, and a major hit for rural economies.
Any reduction in Medicaid through per-capita caps or block granting will also have a much greater impact on rural populations than elsewhere in Michigan.