Why It Matters
Rural hospitals face a financial crisis driving the AHA’s aggressive Q3 2025 lobbying push. Over 69% of rural hospital closures between 2014 and 2024 occurred in non-Medicaid expansion states, while a 2% Medicare sequestration cut alone will cost rural hospitals over $509 million.
The immediate threats are compounding: Medicaid DSH payment reductions took effect October 1, implementing $8 billion in cuts, while CMS proposed site-neutral payment reforms projecting $11 billion in savings over ten years—directly threatening hospital outpatient revenue.
The stakes extend beyond finances to patient access—over 80 rural hospitals closed labor and delivery units between 2022 and 2025, leaving one in four women of reproductive age in rural counties without obstetric access.
By the Numbers
The American Hospital Association spent $5.72 million on in-house lobbying in Q3 2025, deploying a 28-person team exclusively focused on advocacy. This represents the AHA’s continued reliance on internal expertise rather than external firms.
Since 2003, the organization has filed 653 lobbying disclosures totaling over $418 million. Medicare and Medicaid reimbursement appears in all 77 in-house disclosures dating back two decades.
The AHA’s team includes veterans with direct congressional experience. Kristina Merrick Weger spent over a decade in the Senate before joining in 2015. Ashley B. Thompson served as a health policy adviser on the Senate Finance Committee. Recent hires Rachel Elisabeth Jenkins and Devin Andrew Gerzof worked on House Appropriations and Ways and Means committees, respectively.
The Agenda
The AHA is lobbying on healthcare issues critical to hospital financial stability, with primary focus on Medicare and Medicaid reimbursement policies, particularly protecting rural and vulnerable hospitals from payment cuts.
Key advocacy areas include:
- Site-neutral payment reform: Opposing regulatory changes equalizing payments between hospitals and off-campus facilities
- The 340B Drug Pricing Program: Protecting hospitals’ access to discounted drugs subsidizing uncompensated care
- Healthcare workforce development: Addressing nursing and specialty care shortages
- Maternal and behavioral health services: Improving access, particularly in rural areas
- Cybersecurity preparedness: Addressing vulnerabilities impacting rural hospital operations
The organization’s priorities align with active congressional legislation, including the Save America’s Rural Hospitals Act and bipartisan Assistance for Rural Community Hospitals (ARCH) Act.
Between The Lines
Congress is actively engaging with nearly every healthcare challenge the AHA is lobbying on. The House Ways and Means Committee held hearings on Medicare Advantage, where provider complaints about payment delays took center stage—core AHA issues. Meanwhile, senators across party lines are sounding alarms about rural hospital closures, with Tim Kaine (D-VA), Jon Ossoff (D-GA), and Chuck Grassley (R-IA) highlighting financial peril.
However, the AHA faces headwinds: Senator John Kennedy’s Same Care, Lower Cost Act threatens hospital finances through site-neutral payment reform. Democratic senators including Ron Wyden have warned that Medicaid cuts could exacerbate cybersecurity vulnerabilities in rural hospitals, linking hospital finances to national security concerns.
The Bottom Line
Rural hospital closures, newly implemented Medicaid DSH cuts, and proposed CMS site-neutral reforms create an unusually urgent legislative environment. The AHA’s 28-person team is pursuing a consistent playbook: protecting reimbursement rates, preventing site-neutral payment expansion, and defending the 340B program. This advocacy mirrors efforts by major hospital systems, creating coordinated sector-wide pressure. The legislative terrain favors some priorities—bipartisan rural hospital bills—but threatens others, particularly site-neutral policy advanced by Senator Kennedy. The outcome will significantly impact healthcare access in rural America.
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