Rural communities are an integral part of Pennsylvania. The health of these communities and residents is in serious jeopardy and, with it, the wellbeing of the entire Commonwealth. Without strong rural communities, our state is weaker. Yet in just days, Congress could dismantle the very infrastructure that helps these communities thrive and stay healthy through support for the federal reconciliation bill, or the One Big Beautiful Bill, that has been approved by Congress. The bill is now under consideration by the Senate.
Medicaid, which provides health coverage for lower-income families, children, veterans, seniors and individuals with disabilities, is being targeted for a staggering $793 billion in cuts in Congress’ budget reconciliation bill. In Pennsylvania, this would devastate Medical Assistance, the state’s Medicaid program that supports nearly half of all birthing services and over half of nursing home residents.
The consequences of these proposed cuts will reverberate throughout every rural community in Pennsylvania. Without health insurance, people will delay or avoid care entirely, leading to worse health outcomes, higher costs for everyone involved—from the individual to the hospital, insurer and state--and potentially a shorter life span. A sinus infection could become a hospital stay. A manageable condition could become a medical emergency. A preventable cancer diagnosis could become fatal.
Rural hospitals serve a high number of Medicaid patients and will be affected by drastic cuts to the programs. Many of these hospitals are non-profit institutions that operate on tight margins. That means that if Medicaid coverage is reduced in rural areas, rural hospitals will provide care for more uninsured patients putting more of them in the red due to higher levels of uncompensated care. When the cost gets too high, they will close, meaning patients will have to travel even further for care and an important economic engine in the community will shutter. This will devastate our rural communities.
The threat does not stop with Medicaid. Other changes in the bill will make health coverage less accessible by eliminating key supports that help families manage the cost of premiums, especially for middle-class families and small business owners who rely on health insurance from the Affordable Care Act (ACA) Marketplace plans.
This bill is not the only attack on the rural public health infrastructure. The President’s 2026 budget proposes to eliminate the State Office of Rural Health, Medicare Rural Hospital Flexibility and Rural Physician Recruitment programs. These initiatives provide essential support—through technical assistance, staffing and resources—to health systems that are already under pressure. Getting rid of these pillars of rural health support would be a gut punch to rural areas, which are already facing health crises and barriers to care.
We must act now. It is up to us — Pennsylvanians — to support and amplify the voices of our rural neighbors, bring their needs to the forefront of policy conversations and fight to protect key health services. We must come together and call on Congress to invest in rural health systems.
Access to health care should never be determined by your ZIP code. The stakes are high, but so is our resolve. Rural Pennsylvania deserves better. Let’s see to it that Congress fights for us.
Donna Greco
Executive Committee, Pennsylvania Rural Health Association