Missouri Senator Proposes $1 Million Annual Grants to Save Rural Emergency Rooms

Washington — Senator Josh Hawley is pushing a new federal bill aimed at stopping the wave of rural hospital closures that has left millions of Americans without nearby emergency medical care.

The Republican from Missouri introduced the Rural Hospital Emergency Room Guarantee Act on Wednesday, legislation that would guarantee certain rural hospitals a minimum of $1 million per year for a decade to keep their emergency rooms operational.

"Americans in rural communities across the country are confronted with a concerning shortage of access to emergency medical care," Hawley said in a statement. "In Missouri alone, 12 rural hospitals with emergency rooms have closed in as many years, and those that remain open are struggling to keep the lights on. Congress must act swiftly to protect the necessary emergency care hardworking rural families deserve."

The proposal comes as nearly 200 rural hospitals have shut down nationwide since 2005, creating what Hawley's office describes as "widespread emergency-room deserts." In some regions, patients now drive an hour or more to reach the nearest emergency department.

Missouri has been hit especially hard. Since 2014, a dozen rural hospitals with emergency rooms have closed in the state. Current records show that nearly half of all remaining rural hospitals in Missouri are operating at a loss, with 10 facilities — roughly one in five — facing immediate risk of closure.

Under Hawley's bill, eligible rural hospitals would receive quarterly payments of $250,000, totaling $1 million annually, with the amount adjusted for inflation over the 10-year period. Hospitals could also receive additional funding based on their geographic location, financial circumstances, and patient injury profiles. Facilities deemed at immediate risk of shutting down would qualify for a one-time emergency payment of up to $250,000.

The funding would be administered by the Health Resources and Services Administration, a federal agency within the Department of Health and Human Services. Hawley's office stressed that hospitals accepting the new guaranteed funding would not lose eligibility for any other federal healthcare programs, designations, or grants.

Hawley announced the legislation at a Wednesday afternoon news conference, framing it as a necessary intervention to prevent further deterioration of emergency care access in rural America.