KFF Health News Apr 15 2026 The sun was just warming the horizon as Mark Pieper left his house near his cattle ranch on a crisp February morning. It's not unusual for the rancher to wake up early to tend to livestock, but at 5:45 a.m. this day his cattle wouldn't come first. For the past 3½ years, three days a week, Pieper has made an early-morning commute to get dialysis at the nearest hospital. Pieper lives outside Hay Springs, which has 599 residents, according to a sign at the edge of town.