Declaration to Congress
Results of the Conference on
America’s Rural Healthcare Crisis
Healthcare Providers and Organizations Gathered from
Washington, Wyoming, Alaska, Montana, Idaho, and Oregon
September 12, 2026, Tacoma, Washington.
WHEREAS:
The 46 million people of rural America produce nearly all of our country’s food, energy, natural resources, and recreation. That’s one in seven Americans, spread across 97% of the nation’s land area.
Our small rural communities cannot be productive without healthcare to keep them going, a truly vital resource on which the rest of America depends. Our small-town healthcare providers make our rural areas livable through daily care, emergency services, and as major employers.
Yet, America’s rural healthcare is in crisis. Healthcare needs continue to grow exponentially, while government continues to remove whole sections of one of the foundations for livability in small town America.
Four pressures combine to drive rural healthcare into this trajectory of system-wide failure: provider financial struggles, long distances to reach care, the shrinking healthcare workforce, and growing demand for care.
Mothers cannot get obstetrical care in one-third of our nation’s counties because they have become “maternity care deserts.” Hundreds of obstetrics clinics have closed, so expectant mothers must travel for hours to receive basic prenatal care and to deliver their babies. When any rural health service disappears, travel increases, and risks compound.
For decades, rural healthcare needs have skyrocketed while support has plummeted. Rising care demands include aging residents, treatment of chronic disease, distant emergency services, and behavioral health. Yet, coming federal Medicare cuts will further undermine the health insurance safety net, slashing reimbursements that keep the rural healthcare business model afloat.
Congress included in HR1 $50 billion over five years for the Rural Health Transition Program (RHTP) to put money toward rural healthcare, but that is not enough to make up for HR1 cuts that total $155 billion. Plus, this crisis is not a five-year problem. It will take a sustained commitment to heal problems that have festered for decades.
Enduring solutions for rural healthcare must recognize that rural healthcare is not a smaller version of urban healthcare. Challenges facing rural healthcare providers are different from those facing their urban counterparts. The bulk of RHTP funding has been going toward hospitals, but the best investments in rural healthcare are made at the ground-level: public health and primary care.
Courageous rural healthcare providers try to do more with less but resilience alone will not keep rural healthcare doors open and first responder units functioning. Healthcare is headed for a cliff with the impending massive cuts in HR 1, the so-called “Big Beautiful Bill.” While healthcare is breaking down in both urban and rural America, it is breaking faster in small town America.
THEREFORE we declare that Congress must act to stabilize rural healthcare availability and affordability by collaborating with those who know the rural healthcare challenges and solutions firsthand.
We urge Congress to listen to those who do the hands-on work in rural healthcare: doctors and nurses, NPs and PAs, therapists and social workers, pharmacists, EMTs and paramedics, administrators, and others. We offer you our support to build a sustainable, practical approach for the future of rural healthcare.
Make Rural Healthcare Available
Bolster federal-state coordination with first responders and local disaster preparedness agencies. Expand the work of federal agencies (e.g., DOD, USFS, BLM) to train, deploy, and support staff in support of rural first responder units.
Improve medical education funding, including graduate medical residencies and other training programs that are rural-focused and rural-based.
Work with behavioral health professionals to reverse the woeful level of behavioral health resources available to people living in rural America. Respond high rates of domestic gun violence and suicide in rural areas by adequately funding rural behavioral health.
Remove federal barriers to virtual care so that rural patients can access telemed services whether or not the patient and clinician are in different states. This will help remove the transportation barriers for rural patients who live hundreds of miles from big city healthcare.
Make Rural Healthcare Affordable
Restore funding for federal programs that allow people to purchase insurance at affordable rates. Remove work requirements for healthcare: As rural healthcare providers we know our patients cannot get a job and keep a job without their health.
Fully fund preventive care, including vaccination programs. This will save taxpayers billions of dollars because “An ounce of prevention is worth a pound of cure.”
Expand Medicare to cover all age groups, not just those 65 and older. We need Congressional action to place people over profits by enacting long term universal healthcare financing.
Utilize Science to Prepare for the Next Pandemic
Restore integrity to our federal science, medicine, public health, and healthcare departments, agencies, and institutions. Support evidence-based vaccine science, public education, community partnerships, data monitoring programs, and boots-on-the-ground.
Fund vaccine development and innovative vaccine delivery programs, including new strategies for needleless delivery of vaccines. This will boost vaccination rates and reduce infectious disease burdens in rural America.
Organize for the Long Haul
Establish a standing commission that includes rural healthcare providers to make bottom-up recommendations to Congress for policies and funding to strengthen rural healthcare in America. Focus on reducing paperwork, cutting away the administrative barriers to healthcare, improving efficiencies, and reducing costs.
Strengthen the nation’s Medical Reserve Corps program to recruit, train, and activate volunteer medical and public health professionals—alongside community members—to strengthen public health, improve emergency response capabilities, and build community resilience.
Support for rural communities in developing nonprofit corporations to better support and advance disaster preparedness and public health within their local communities.