SAN ANTONIO — Throughout a rural health care conference here that took place as the U.S. House was finalizing a fiscal year 2026 budget proposal, speakers emphasized that potential moves by the government pose a significant threat to health care funding and access and that hospital leaders and other stakeholders must advocate to protect the health of vulnerable people.

At the 2025 American Hospital Association Rural Health Care Leadership Conference Feb. 23-26, numerous speakers from AHA and other health care organizations said that there are threats of significant cuts to Medicaid — perhaps as much as $880 billion — as well as other legislation under consideration that could put the health care safety net at risk. The speakers called on health care stakeholders to reach out to legislators to emphasize the importance of Medicaid and other programs for the vulnerable and to educate them on how cuts could negatively impact people and communities.

In an opening plenary session, AHA President and CEO Rick Pollack and AHA Board Chair Tina Freese Decker explained that the health and well-being of millions of Americans are at risk.

“What unites us (as health care providers) is that we care for the people in our communities,” said Pollack.

“Our neighbors are counting on us,” Decker said to the audience of about 1,000 who had gathered for the 38th annual rural health conference.

Budget reconciliation
The conference occurred in the lead-up to the House's Feb. 26 vote to adopt a budget proposal calling for about $2 trillion in spending cuts, including some that could impact Medicaid and other key health care programs.

In a Feb. 28 post on AHA's website, Pollack explained that the focus now is on the negotiations around budget reconciliation. The House and Senate are “far apart on several key issues,” he noted in the message. Pollack also said in that missive that this month, Congress must act to fund the government as a continuing resolution expires March 14. And by the end of the month, he said, Congress must address several lapsing health care provisions, including preventing Medicaid disproportionate share hospital payment cuts; extending enhanced low-volume adjustment and Medicare-dependent hospital programs; and extending waivers for telehealth and hospital-at-home services that were enacted during the pandemic.

On March 4, more than 150 hospital and health system leaders took part in an AHA Advocacy Day in Washington to get an update on such congressional activity and then to meet with lawmakers and their staffs.

Pollack said in a release about the Advocacy Day that “with so much at stake in the coming weeks and months, it is vital that we continue to face health care's challenges together speaking as one voice.”

Pressing challenges
The negotiations in Washington take place against the backdrop of increasing challenges for U.S. health systems and facilities and their patients. Throughout the rural health care conference speakers from AHA, its member hospitals and health systems, and partner organizations detailed many different pressures impacting hospitals, particularly those in rural areas.

During plenary sessions, Pollack and others identified the changing health care delivery system, political fractures in the nation, insurance companies putting up barriers to care, government underpayment for health care, supply chain disruptions and workforce challenges as top concerns.

Conference speakers also described other threats to health care access. They discussed how attacks on the 340B drug discount pricing program by pharmaceutical companies and others could put that program at risk. Some speakers explained how the rapid expansion of Medicare Advantage program use by senior adults is posing challenges to rural health care sites when the commercial insurers running those plans curtail enrollees' access to care. Also of concern are so-called “site-neutral” cuts to Medicare payments for hospital outpatient departments. Another top worry is that enhanced premium tax credits for participants of health insurance marketplace plans connected to the Affordable Care Act are set to expire late this year, putting at risk the insurance status of people covered under those plans.

Advocacy priorities
AHA leaders discussed throughout the conference that the association is pressing forward with a comprehensive agenda to get ahead of potential government action that puts vulnerable people at risk.

That  agenda for this year prioritizes these goals:

• Ensuring access to care
• Strengthening the health care workforce
• Advancing quality and health care system resiliency
• Leading innovation in care delivery
• Reducing health care system costs for patient care

AHA is part of the  Coalition to Strengthen America's Healthcare that is undertaking a multimedia campaign in line with this agenda. CHA is part of that coalition as well. The coalition's campaign includes a  television ad explaining how cuts to Medicaid could negatively impact the about 72 million Americans who rely on the program.

Implications of cuts
Pollack and Decker acknowledged during the conference that fighting to protect the health care of vulnerable populations will be a difficult challenge.

“But, we've proven we can do hard things,” said Pollack.

He cited the work hospitals had done to take on the challenges of Ebola, the COVID-19 pandemic, cyberattacks, supply chain disruptions and numerous natural disasters.

He said the current risks to the health care system are “a serious matter.” Many rural hospitals, and especially critical access hospitals, are at heightened risk.

In the case of possible Medicaid funding cuts, Pollack said, some of the nation's most vulnerable community members are endangered, including low-income people, frail elders and babies. The Medicaid program is a virtual lifeline for these populations and for the hospitals that care for them, he said.

Decker said, “AHA will continue to advocate, but we need your support and engagement, we need your voice to be heard. We will work together, and we must fight like heck” to preserve health care funding and access.

For information on AHA's advocacy priorities and for related action alerts, visit  aha.org/advocacy/action-center.