For rural and lower-income Americans, staying healthy will become more time-consuming, experts say, with longer drives and wait times for doctors following Walmart's decision last month to exit the primary care business.

Walmart announced on April 30 that it would close all 51 Walmart Health centers in five states and shut down its virtual health care service because it was “not a sustainable business model.”

The move marked a sudden shift for the giant retailer, which had said the previous month that it planned to expand its virtual 24/7 health care – which includes video, chat and calls – and its brick-and-mortar health centers, which were open during the same hours and days as its stores and staffed by primary care physicians and licensed nurse practitioners.

The shift also reflects bigger economic challenges in health care, which is struggling with low government reimbursements for primary care, a shortage of nurses and doctors, and soaring costs for supplies and labor, experts said.

What happens to those Americans now?

For patients in rural areas or areas with limited resources served by Walmart, the closings will mean difficulty finding health care in the near term and traveling longer distances once they do, said Hal Andrews, chief executive of healthcare consulting firm Trilliant Health.

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"People will have to go back to driving to a big city," Andrews said. "Going to the doctor will take an entire day. We’re going backward.”

When Walmart entered primary care in 2019, it said it could provide many Americans with close and easy access to primary care, including dental, vision and mental health since 90% of Americans lived within 10 miles of a Walmart store.

However, Walmart found that affordable care was not affordable for providers, even for a retail giant known for squeezing out a profit from low-margin businesses like groceries.

"Primary care margins are small, similar to grocery margins," Andrews said.

It was a "difficult decision, and like others, the challenging reimbursement environment and escalating operating costs create a lack of profitability that make the care business unsustainable for us at this time," Walmart said.

Those economics lay bare the challenges of running a health care business, said Brian Marks, University of New Haven senior lecturer of economics and business analytics. “It’s problematic and suggests we need to reexamine the primary health care delivery system.”

Only the company's vision centers and pharmacies, which weren't part of Walmart Health, will now stay open, Walmart said.

Who’s most directly affected by Walmart Health’s closing?

Walmart ran most of the centers in rural, low-income and underserved communities in Arkansas, Florida, Georgia, Illinois and Texas. These areas will suffer the most from the closings, Trilliant's Andrews said.

People who came into the clinics often had not seen a primary care physician in two or three years or a dentist in five years, Marcus Osborne, Walmart’s former vice president of health and wellness transformation, told CNN in 2020. Some patients saw a mental health counselor for the first time.

Closings:Walmart will close all 51 of its health centers: See full list of locations

If Walmart can’t make it, who can?

Even Walmart, with its financial might, couldn’t attract enough health care workers amid a labor shortage, or find a way to make a profit by providing convenient, affordable primary care, experts said.

“It’s a terrible sign that Walmart, the top Fortune 500 company, can’t or decided not to” continue, Andrews said.

Other contenders in retail primary care have struggled too.

Walgreens said last month it would close 160 VillageMD clinics across the country, and Amazon in February announced job cuts at its One Medical primary care and Amazon Pharmacy units.

CVS, meanwhile, said it’s expanding its Oak Street Health clinics specializing in primary care for seniors, though it closed some of its MinuteClinics for nearly all ages earlier this year.

Why Walmart Health closed, and others may struggle

All these companies face similar financial hurdles that will likely lead to consolidation in care clinics, said Web Golinkin, a former health care CEO and author of "Here Be Dragons: One Man’s Quest to Make Healthcare More Accessible and Affordable."

“We’re flashing yellow lights here,” he said.

Where will Americans go for primary care?

No one can predict the future, but many experts believe virtual care, or telehealth, will become a larger part of care.

Telehealth may still be a financial struggle for companies, some warn. Walmart Health encompassed brick-and-mortar clinics and telehealth, but the company closed both, they noted.

During the pandemic, Americans were pushed toward virtual care, and “it will be part of health care forever, said Michael Botta, co-founder of Sesame, a health care marketplace connecting patients with providers.

Sesame, a Costco partner, offers discounted 24/7 virtual primary and mental health care. It also offers checkups with standard labs and in-person visits.

Sesame says it doesn’t accept insurance so it doesn't rely on reimbursements and can offer patients low, transparent prices. Patients can pay per visit with an individual provider or join its subscription model for ongoing care.

Andrews is a telehealth skeptic. For mental health, telehealth works because people feel comfortable speaking at a distance, but most patients prefer personal interaction in a physical exam, he said.

As a business, telehealth may prove challenging as well.  

“Other than an iPhone and wifi, there are no barriers to entry,” Andrews said. “No one can build a competitive moat around it.”

Instead, he sees primary care shifting back to offices and hospitals, with immediate care clinics available in densely populated areas where the economics are better.

None of that helps rural, low-income, underserved communities Walmart left behind, he said.

To ease the ongoing health care worker shortage, the University of New Haven's Marks sees regulations changing to allow non-physicians like nurse practitioners and physician assistants to provide more services.

But until all this happens, Marks said get used to “increased wait times.”

Medora Lee is a money, markets, and personal finance reporter at USA TODAY. You can reach her at [email protected] and subscribe to our free Daily Money newsletter for personal finance tips and business news every Monday through Friday morning.