Sen. Josh Hawley, R-Mo., on Wednesday introduced new legislation aimed at combating America's rural healthcare crisis, telling Fox News Digital that Congress must intervene to keep rural emergency rooms open.
The Rural Hospital Emergency Room Guarantee Act would establish a mandatory 10-year dedicated funding stream administered by the Health Resources and Services Administration. Under the proposal, eligible rural hospitals would receive a guaranteed baseline distribution of $1 million per year for normal emergency room operating expenses, distributed quarterly and indexed for inflation.
Since 2005, nearly 200 rural hospitals have shut down nationwide, creating what Hawley's office describes as "widespread emergency-room deserts." The situation is particularly acute in Missouri, where 12 rural hospitals with emergency rooms have closed since 2014. Records show that nearly half of all rural hospitals in the state currently operate at a loss, with 10 facilities—roughly 20%—at immediate risk of closure.
"Americans in rural communities across the country are confronted with a concerning shortage of access to emergency medical care," Hawley said. "Congress must act swiftly to protect the necessary emergency care hardworking rural families deserve."
Hospitals facing immediate risk of closure would also receive a one-time emergency payment of up to $250,000 under the bill. Affected hospitals receiving the new guaranteed funding will not face negative impacts on their eligibility for any other federal healthcare programs, designations or grants.
What the Right Is Saying
Conservative Republicans have largely welcomed Hawley's proposal as a targeted, time-limited solution that avoids creating new entitlement programs. Supporters argue the legislation strikes a balance between addressing immediate needs and maintaining fiscal discipline by including a 10-year sunset provision.
Sen. Roger Marshall, R-Kan., whose state has also experienced significant rural hospital closures, said the bill represents a commonsense approach to preserving emergency access in underserved areas. "This isn't about bailing out hospitals that made poor business decisions," Marshall said. "This is about making sure farm families and small-town Americans have somewhere to go when they have a heart attack or get in a car accident."
Conservative commentators have praised the legislation's focus on block grants rather than ongoing entitlement expansion, arguing this model gives local communities more control over healthcare decisions. The American Enterprise Institute's Parikh wrote that guaranteed baseline funding with inflation adjustments provides predictability without creating open-ended government commitments.
What the Left Is Saying
Progressive lawmakers and healthcare advocates have broadly supported efforts to address rural hospital closures but argue that targeted funding alone cannot solve the underlying economic challenges facing these facilities. Many Democrats contend that expanding Medicaid eligibility would provide more sustainable relief to struggling rural hospitals, which often serve high concentrations of uninsured and Medicaid patients.
Congressional Progressive Caucus Co-Chair Pramila Jayapal, D-Wash., has previously argued that hospital closures in rural areas disproportionately affect communities where residents lack access to affordable insurance options. "When you have a community where too many people are uninsured or underinsured, the hospital loses money on every patient," Jayapal said during a 2024 hearing on rural healthcare access.
Healthcare advocacy groups aligned with progressive causes note that rural hospitals serving large Medicaid populations face chronic reimbursement rates that fail to cover the actual cost of care. They have called for comprehensive payment reform alongside any new funding mechanisms.
What the Numbers Show
According to data from the University of North Carolina's Cecil G. Sheps Center for Health Services Research, 198 rural hospitals have closed in the United States since 2005. Missouri ranks among the top 10 states for rural hospital closures during this period, with 12 facilities shuttering since 2014.
The Centers for Medicare and Medicaid Services reports that rural hospitals average a -3.8% operating margin compared to +2.1% for urban facilities. Rural emergency departments treat an average of 11 patients per day while maintaining round-the-clock staffing requirements that fixed costs make difficult to sustain.
According to Hawley's office, the $1 million annual baseline distribution would cover typical rural hospital emergency room operating expenses in low-volume settings. The one-time $250,000 emergency payment for facilities at immediate risk of closure represents approximately 2-3 months of average operating costs for a small rural facility.
The Bottom Line
Hawley is expected to formally announce the legislation at a news conference Wednesday afternoon. The bill will need to navigate committee hearings and find bipartisan support to advance in the Senate, where similar rural healthcare measures have stalled in previous sessions.
The proposal faces questions about funding offsets and whether guaranteed payments might reduce incentives for hospitals to improve efficiency or pursue merger partnerships. Supporters counter that immediate action is necessary before additional closures leave rural communities without any emergency care options within reasonable driving distance.
Rural health experts note that the legislation's passage would mark a significant departure from recent federal healthcare policy, which has focused primarily on payment reform rather than direct facility funding. Whether Congress will appropriate new funds or redirect existing resources remains to be seen as the legislative process unfolds.