Advocacy

Medicaid serves as a vital source of health insurance coverage for Americans living in rural areas, including children, parents, seniors, individuals with disabilities, and pregnant women. The One Big Beautiful Bill Act (OBBBA), enacted into law on July 4, 2025 made sweeping changes to Medicaid and the ACA Marketplaces that will result in coverage losses for rural Americans. It is estimated that the combined impact of the Medicaid cuts alone in the OBBBA could decrease spending in rural areas could decrease by $155 billion over 10 years.

“The Senate recently passed the One Big Beautiful Bill Act that would make sweeping changes to Medicaid and the ACA Marketplaces resulting in significant coverage losses for rural Americans. This legislation will limit access to care for all rural patients by ending health care coverage for rural residents nationwide and putting financial strain on rural facilities who care for them. The National Rural Health Association (NRHA) is extremely concerned by the Senate’s cuts to provider taxes and state-directed payments which directly support rural providers and facilities. Further, NRHA is concerned that the Rural Health Transformation Program, dedicated to offset the Medicaid cuts on rural communities, will fall short of addressing the other provisions in this legislation. We urge our partners in the House to reject these massive cuts and protect rural healthcare.”

The National Rural Health Association and Manatt Health are releasing updated data from the report Estimated Impact on Medicaid Enrollment and Hospital Expenditures in Rural Communities, demonstrating the impact of the proposed Rural Health Transformation Fund. The latest Senate legislative text establishes a $25 billion fund for rural health care providers.

Medicaid serves as a vital source of health insurance coverage for Americans living in rural areas, including children, parents, seniors, individuals with disabilities, and pregnant women. Congressional lawmakers are currently considering more than $800 billion in cuts to the Medicaid program, which would reduce Medicaid funding and terminate coverage for vulnerable Americans. The proposed changes would also result in a significant reduction in Medicaid reimbursement that could result in rural hospital closures.

The National Rural Health Association released the following statement in response to the Senate Finance Committee’s reconciliation bill text:

The National Rural Health Association (NRHA) is deeply alarmed by the President’s Fiscal Year (FY) 2026 Budget Request, which proposes the elimination of core rural health programs previously administered by the Health Resources and Services Administration (HRSA), including the Rural Hospital Flexibility (Flex) Program, State Offices of Rural Health (SORH), and the Rural Hospital Stabilization Program. These targeted eliminations come at a time when nearly half of all rural hospitals are operating at a financial loss, and communities across rural America continue to experience persistent workforce shortages, limited access to care, and disproportionate rates of chronic illness.

The House recently passed a reconciliation package that would make sweeping changes to Medicaid and the ACA Marketplaces that will result in significant coverage losses and will further limit access to care for all rural patients by closing rural facilities and ending health care coverage for rural residents nationwide. The National Rural Health Association (NRHA) is extremely concerned by the House’s efforts to limit enrollees’ access to health care coverage through constraining states’ use of provider taxes and state directed payments, apply work requirements, more frequent eligibility redeterminations, and limiting retroactive coverage.

Legislation from the House Energy and Commerce Committee proposes changes to Medicaid that will result in massive coverage losses and will further stifle access to care for all rural patients by closing rural facilities and ending health care coverage for rural residents nationwide. The National Rural Health Association (NRHA) is extremely concerned by the Committee’s efforts to limit enrollees’ access to healthcare coverage through constraining states’ use of provider taxes and state directed payments, work requirements, more frequent eligibility redeterminations, and limiting retroactive coverage.

The National Rural Health Association released the following statement in response to the President’s FY 2026 draft budget proposal: "The National Rural Health Association (NRHA) is extremely concerned about the devastating cuts proposed in the President’s fiscal year 2026 draft budget proposal. The draft budget proposal calls for the elimination of bipartisan, fundamental, and longstanding rural health programs, such as the Medicare Rural Hospital Flexibility program and State Offices of Rural Health, which are essential to ensuring access to care for rural Americans. This will upend rural health care by ending proven programs, leading to a critical underfunding of rural health care and ultimately threatening rural provider stability and patient access. We are urging our rural champions on Capitol Hill to reject these proposed cuts and fully fund the rural health safety net.” – Alan Morgan, Chief Executive Officer

The National Rural Health Association issued the following statement in response to a federal district court in Texas vacating the Minimum Staffing Standards for Long-Term Care Facilities rule.

The decision to rescind over $11.4 billion in Centers for Disease Control and Prevention public health funding presents an urgent crisis for rural America, where the public health infrastructure is already underfunded and overstretched. These cuts come as rural communities prepare for a worsening measles outbreak and battle the ongoing threat of avian influenza, two crises that demand a well-supported, robust public health response.