More than 46 million Americans rely on rural hospitals as workforce shortages, financial strain and policy changes threaten care close to home

WASHINGTON (October 13, 2026) - The American Hospital Association (AHA) today released a new report warning that access to care is increasingly at risk in rural communities across America as a convergence of workforce shortages, financial pressures and policy changes threatens hospitals' ability to maintain essential services.

The report finds that longstanding challenges, including low patient volumes, workforce shortages, geographic isolation and inadequate reimbursement, are being compounded by Medicaid reductions, the expiration of enhanced premium tax credits and growing pressures associated with Medicare Advantage. Together, these forces are placing additional strain on hospitals that provide care for more than 46 million Americans living in rural communities, increasing the risk of service reductions, hospital conversions and closures.

Key findings highlighted in the report include:

• More than 40% of rural hospitals operate at a financial loss and hundreds are at high financial risk, threatening access to care in communities that often have few or no alternative providers nearby.
• Since 2010, more than 150 rural hospitals have closed or converted, while 331 hospitals have eliminated obstetric services and 448 have stopped offering chemotherapy services, forcing many patients to travel farther for care.
• In addition to longstanding challenges, rural hospitals are contending with significant Medicaid reductions, the expiration of the EPTCs and the rapid growth of MA. These issues are expected to drive up the number of uninsured, increase uncompensated care, reduce hospital revenue, increase hospital costs and further strain already fragile rural hospitals and care providers.

"Rural hospitals are precious pillars of community life, delivering essential care, rewarding jobs and economic stability for millions of Americans," said AHA President and CEO Steve Walsh. "The pressures on rural providers are only intensifying and the warning signs have become impossible to ignore. Through urgent and collaborative policy action, we can protect patients in rural communities and ensure they continue to get the care they need close to home, when and where they need it most."

While rural hospitals continue to innovate and adapt, the report concludes that innovation alone cannot overcome the financial and structural challenges facing rural healthcare and that sustained policy action is needed now to preserve access to care. To strengthen the viability of rural hospitals and preserve access to essential health services, the report recommends key policy priorities:

• Reverse harmful Medicaid cuts.
• Direct Rural Health Transformation Program funds to rural hospitals.
• Modernize and strengthen rural payment models.
• Preserve and expand telehealth access.
• Address harmful corporate insurer practices.
• Invest in the rural workforce.
• Protect access to the 340B Drug Pricing Program.

The AHA's new rural report can be found HERE and the AHA's full rural advocacy agenda can be found HERE.

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About the American Hospital Association (AHA)

The American Hospital Association (AHA) is a not-for-profit association of health care provider organizations and individuals that are committed to the health improvement of their communities. The AHA advocates on behalf of our nearly 5,000 member hospitals, health systems and other health care organizations, our clinician partners - including more than 270,000 affiliated physicians, 2 million nurses and other caregivers - and the 43,000 health care leaders who belong to our professional membership groups. Founded in 1898, the AHA provides insight and education for health care leaders and is a source of information on health care issues and trends. For more information, visit the AHA website at www.aha.org.