On behalf of the Arizona Rural Health Association (AzRHA) and the National Rural Health Association (NRHA), we are writing to emphasize the critical importance of federal funding-including grants, Medicare, and Medicaid-to rural hospitals, federally qualified health centers (FQHCS) and Rural Health Clinics (RHC)s., where much of the population faces economic hardship and resides in medically underserved areas. Federal funding plays a vital role in ensuring access to quality healthcare for these communities. 

What’s At Stake for Medicaid?

In short, the House resolution passed last night proposes $880 billion in funding cuts from programs under the Energy & Commerce Committee’s jurisdiction. While Medicaid isn’t the only program in this category, it is by far the largest. If the Senate agrees with the House’s plan, we can assume the bulk of the $880 billion in cuts would come from Medicaid. What this looks like exactly has yet to be determined. There have been several Medicaid changes floated by House Republicans, though not yet put into draft legislation. Proposals include mandatory work requirements, scaling back the financial incentive for the Medicaid expansion in 40 states and imposing per capita caps on individual Medicaid enrollees.

What’s Next?

Senate and House leadership must now reconcile their different budget resolutions before crafting legislation that specifically proposes Medicaid cuts. After that, the Senate Finance Committee and the House Energy & Commerce Committee must draft the actual policy changes to Medicaid necessary to generate truly huge savings.

This could take weeks, or months. Every day along the way is an opportunity to reach out to your elected officials to demand they oppose significant cuts to Medicaid.

How Can I Take Action?

If you have five minutes free:

Customize and send a letter to your elected officials and share this link to colleagues, family, and friends: https://thenationalcouncil.quorum.us/campaign/107658/

If you have 15 minutes free: Pick up the phone and dial your elected officials or send an email. Use the below resources:

	Phone number	Share your Thoughts
Senator Mark Kelly DC office	(202) 224-2235	Share Your Thoughts
Senator Ruben Gallego DC office	(202) 224-4521	Contact
Rep David Schweikert District 1 DC office	(202) 225-2190	Contact
Rep Eli Crane District 2 DC office	(202) 225-3361	Contact
Rep Yassamin Ansari District 3 DC office	(202) 225-4065	Contact
Rep Gregory Stanton District 4 DC office	(202) 225-9888	Contact
Rep Andy Biggs District 5 DC office	(202) 225-2635	Contact
Rep Juan Ciscomani District 6 DC office	(202) 225-2542	Contact
Rep Raύl Grijalva District 7 DC office	(202) 225-2435	Contact
Rep Abraham Hamadeh District 8 DC office	(202) 225-4576	Contact
Rep Paul Gosar District 9 DC office	(202) 225-2315	Contact

Share messaging on your social media:

If you have 1 hour free: In-person or virtual meetings with staff from your elected officials’ offices are invaluable. Contact the National Council to help coordinate next steps.

https://thenationalcouncil.quorum.us/campaign/107658/

The Medicaid program is a lifeline for the rural hospitals, providers, and patients. Medicaid cuts will close rural hospitals. Since 2010, nearly 190 rural hospitals have shuttered their doors or stopped inpatient care.¹ Public payers, including Medicare and Medicaid, comprise a larger share of hospital services in rural areas, making rural hospitals more vulnerable to cuts in these programs. Medicaid funding is critical for sustaining rural healthcare systems, including hospitals, clinics, community health centers, and long-term care facilities. Right now, almost half of all rural hospitals across the country are operating with negative margins, meaning that any reductions to Medicaid funding would force many facilities to reduce or eliminate essential services, delay much-needed equipment upgrades, or close their doors entirely. Data shows that Medicaid expansion is strongly associated with improved rural hospital financial viability and substantially lower likelihoods of closure in rural markets.² When a rural hospital closes, not only does the community lose access to vital health care, but a major employer and community lynchpin ends, affecting the economic health of the larger community.

Any cuts to the Medicaid program will disproportionately affect rural communities. Rural Americans rely on Medicaid coverage with about 20% of non-elderly adults and 40% of children living in rural areas enrolled in Medicaid and CHIP.³ In almost all states rural areas have higher rates of Medicaid enrollment than metropolitan areas.⁴ Cuts to Medicaid would shift health care costs onto rural families, many of whom already struggle with financial instability. Medicaid cuts would force families to face higher out-of-pocket expenses, leading many to delay or forgo necessary treatments. This burden would worsen health outcomes, especially for those managing chronic conditions like diabetes, heart disease, and cancer. When a hospital or clinic closes in a rural area residents must travel further to receive basic or emergency care. Right now, rural residents already travel on average two times further to access healthcare compared to their urban counterparts.⁵ Cutting the Medicaid program will cause greater access challenges for rural Americas.

Further, any cuts to one part of the healthcare system will shift costs elsewhere, which makes sweeping Medicaid cuts a serious concern for rural providers. Rural populations are older, tend to rely more on public coverage, and are more likely to be low-income, unemployed, and under- or uninsured.⁶ This means that on average, over 70% of rural hospital revenue comes from public payers – Medicare, Medicaid, and the Marketplace.⁷ Loss of coverage under any of these payers means an increase in uncompensated care that rural providers cannot sustain. NRHA further urges Congress against any cuts to the Medicare program, which aids in keeping rural providers afloat. Maintaining public payers, like Medicaid, supports strong rural health infrastructure that is critical to the future of rural areas. Thank you for your work on behalf of rural Americans.

¹ Rural Hospital Closures, N.C. Rural Health Research Center, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill https://www.shepscenter.unc.edu/programs-projects/rural-health/ruralhospital-closures/. ² Zachary Levinson, Jamie Godwin, Scott Hulver, Rura Hospitals Face Renewed Financial Challenges, Especially in States That Have Not Expanded Medicaid, KFF, Feb. 23, 2023, https://www.kff.org/health-costs/issue-brief/rural-hospitals-facerenewed-financial-challenges-especially-in-states-that-have-not-expanded-medicaid/. ³ Joan Alker, Aubrianna Osorio, & Edwin Park, Medicaid’s Role in Small Towns and Rural Areas, GEORGETOWN CENTER FOR CHILDREN AND FAMILIES, Jan. 15, 2025, https://ccf.georgetown.edu/2025/01/15/medicaids-role-in-small-towns-and-ruralareas/. ⁴ Id. ⁵ Marvellous Akinlotan, et al., Rural-Urban Variations in Travel Burdens for Care: Findings from the 2017 National Household Travel Survey, SOUTHWEST RURAL HEALTH RESEARCH CENTER, July 2021, at ⁵, https://srhrc.tamu.edu/publications/travel-burdens-07.2021.pdf. ⁶ Vann Newkirk & Anthony Damico, The Affordable Care Act and Insurance Coverage in Rural Areas, KFF, May 29, 2014, https://www.kff.org/uninsured/issue-brief/the-affordable-care-act-and-insurance-coverage-in-rural-. ⁷ Zachary Levinson, et al., Key Facts About Hospitals: Rural Hospitals, KFF, Feb. 19, 2025, https://www.kff.org/key-factsabout-hospitals/?entry=rural-hospitals-rural-discharges-by-payer.