Floor Remarks by Senator Chuck Grassley of Iowa
Senate President Pro Tempore
“The Success of the Rural Emergency Hospital Program and Opportunities for Improvement”
Thursday, October 16, 2025
[Maintaining the] quantity and quality of health care in rural America is a constant responsibility of most senators, because every senator, even if you come from a high-population state, you still have a lot of rural areas.
So, one of the things that I’ve been interested in is keeping hospital services available in rural areas, even if they have a hard time keeping their beds [as] part of their hospital.
So, in December 2020, I was proud to sponsor and to pass into law the voluntary Rural Emergency Hospital (REH) program under Medicare. CMS implemented this program three years later in 2023.
The Rural Emergency Hospital program allows rural hospitals to voluntarily right-size their health care infrastructure while maintaining essential medical services for their rural communities.
It gives these hospitals the flexibility to operate without hospital inpatient services while still retaining a 24/7 emergency department, ambulance services, outpatient services and more.
To date, 42 rural hospitals in 17 states have transitioned to a Rural Emergency Hospital model, and, hence, are still operating.
Some states are still working to establish the necessary hospital licensing flexibility so that they can participate in this program.
Rural Emergency Hospitals have been beneficial for many rural communities, and I want to give you three examples.
In Friend, Nebraska, going to [the] Rural Emergency Hospital model has “meant a lifeline” for that community.
In Union Springs, Alabama, the Rural Emergency Hospital model has allowed their hospital “to remain open instead of leaving a void in that community.”
In Scotland, South Dakota, their Rural Emergency Hospital will “enhance local health services.”
I will submit a longer list of examples of how Rural Emergency Hospitals have benefited rural communities to date. I look forward to more rural hospitals converting in the near future.
Given it’s been five years since the program became law, I would like to better understand the challenges of rural hospitals and [what] communities face when considering Rural Emergency Hospital programs.
So, I’m pursuing getting that information because I am committed to ensuring the Rural Emergency Hospital [program] remains a viable tool for rural hospitals and their communities.
I recently sent letters to existing Rural Emergency Hospital CEOs and other rural health care leaders to get this information.
I look forward to their feedback and continuing to strengthen rural health care. And I will keep my constituents in Iowa and my Senate colleagues so informed.
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