Why It Matters

California’s hospitals need immediate federal intervention as 41 percent of the state’s rural hospital are in financial distress. This follows a nationwide trend. A mandatory 2 percent Medicare sequestration costs rural hospitals more than $509 million annually, while the "One Big Beautiful Bill Act" threatens to push 1.8 million rural Americans off Medicaid by 2034.

Prior authorization delays from Medicare Advantage plans create operational crises, and physician shortages persist despite congressional momentum on GME expansion. The California Hospital Association’s fourth quarter lobbying agenda represents an urgent effort to prevent hospital failures and preserve patient access.

By the Numbers

The California Hospital Association reported $520,000 in fourth quarter 2025 lobbying expenditures, conducted entirely through in-house staff. Anne Nicoll O’Rourke, a veteran healthcare lobbyist with over two decades of experience, serves as the sole in-house lobbyist.

CHA has been active in federal lobbying since August 2003 with approximately $24.6 million in total expenditures across 119 filings. O’Rourke has worked on 80 of those filings. While Foley & Lardner LLP has been CHA’s primary external partner since 2017 ($1.1 million total), the organization engaged Crane Strategies LLC in 2025 for specialized work on the "One Big Beautiful Bill Act."

The Agenda

CHA focused on rural hospital sustainability, physician workforce expansion, and Medicare payment issues:

Key legislative priorities:

Broader Context

Rural hospitals face unprecedented crisis, with nearly half operating in the red nationwide. The "One Big Beautiful Bill Act" projects 1.8 million rural residents losing Medicaid by 2034, while Medicare sequestration cuts cost rural hospitals $509 million annually.

Congressional momentum builds on physician workforce expansion, with 400 new Medicare-supported residency positions already distributed. Prior authorization denials affect nearly 50 million Medicare Advantage determinations annually, directly impacting hospital cash flow that CHA’s prompt-pay legislation seeks to protect.

Between The Lines

Bipartisan congressional focus on rural hospital sustainability intensifies. Representatives Miller (R-OH) and Sewell (D-AL) reintroduced the ARCH Act, while Senators Capito (R-WV) and Padilla (D-CA) reintroduced the PEAKS Act that CHA explicitly endorsed.

A July 2025 House Ways and Means hearing examined Medicare Advantage prior authorization challenges. The Medicare Advantage Prompt Pay Act advances with bipartisan support, with CHA listed as an endorsing organization in a press release from Senators Blackburn (R-TN) and Cortez Masto (D-NV).

Competitive Landscape

CHA’s priorities align with major health systems nationwide. UPMC pursued nearly identical targets: rural hospital support, GME funding, telehealth expansion, and prior authorization reform. The American Hospital Association has explicitly supported the Resident Physician Shortage Reduction Act, indicating unified sector backing.

State-level hospital associations from Illinois to Washington pursue comparable advocacy, suggesting coordinated industry-wide pressure on shared financial sustainability issues rather than isolated strategies.

The Bottom Line

CHA’s $520,000 lobbying investment in the last quarter of 2025 targets active bipartisan legislation addressing hospital financial pressures. Leveraging veteran lobbyist O’Rourke and specialized external counsel, CHA’s advocacy reflects unified hospital industry pressure on Congress regarding healthcare payment and workforce challenges as rural closures accelerate nationwide.

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