Pennsylvania’s healthcare challenges are real and widespread, touching all areas of the state.

But they hit rural communities the hardest.

Rising costs, limited access and infrastructure, and staffing shortages are creating critical challenges to care, leading to worse health outcomes for rural patients and straining rural healthcare providers.

As president and CEO of Geisinger, the state’s largest rural healthcare provider, I see these challenges at our locations every day. A significant part of my job is advancing innovative solutions to address them.

These challenges facing rural healthcare are not new, but they are constantly evolving. Now, they’re poised to worsen because of funding cuts from H.R. 1–the budget reconciliation law signed last July.

Many of the law’s provisions are delayed, but communities and providers are already bracing for their impact and looking for ways to do more with less. When the cuts take effect, they could be devastating, particularly for rural communities and the healthcare organizations that serve them.

One small bright spot in the budget reconciliation law is the Rural Health Transformation Program (RHTP). The program provides $50 billion to states–$10 billion annually through 2030–to support rural health transformation efforts. The first round of funding has been issued, with Pennsylvania receiving just over $193 million.

It’s worth putting that dollar amount in context. Pennsylvania has the third largest rural population in the nation. Yet that $193 million is below the $200 million average states received. That disparity isn’t a rounding error–it’s a policy choice that leaves one of the nation’s largest rural populations competing with far fewer resources.

It equates to about $78 per rural resident, according to a KFF analysis. In comparison, New Jersey received about $1,069 per rural resident.

The fact is rural community members will continue to get sick and come to us for care, even if they lose access to their health insurance. The only difference is that we will no longer be reimbursed for the care we provide these patients.

If RHTP funding is intended to offset looming funding cuts, every dollar counts. At Geisinger, we’re projecting revenue losses of up to $188 million annually as a result of H.R. 1 beginning in 2028. In other words, our health system alone stands to lose just about as much money annually as the entire state will receive in RHTP funding this year.

Statewide, healthcare operator losses could climb as high as $7.4 billion in aggregate. The impact would be catastrophic. Per a January 2026 Hospital and Healthsystem Association of Pennsylvania report, “an estimated 12 to 14 facilities could be forced to reduce services or close entirely.”

Again, rural communities will contend with unique challenges and gaps in care in this scenario.

Finding ways to maximize future funding

opportunities

Given the incredibly challenging circumstances, it’s hard not to see this first-year RHTP funding as a missed opportunity to secure more resources to support rural Pennsylvanians.

At Geisinger, we’re eager to be a part of future funding conversations and contribute to a two-way dialogue to identify the right priorities and approaches to make the most of this essential funding for rural communities across the state.

Rural providers rooted in the communities they serve have a deeper understanding of what’s needed to enhance care and outcomes. Direct care organizations can provide invaluable expertise and real-world insights.

We know firsthand what our facilities and our communities need. More robust emergency medical services and emergency room support. Access to trauma care. Recruitment tools that attract–and keep–healthcare professionals in good jobs.

These challenges–and solutions–aren’t new to us. We’ve been pursuing them for years, and we have a head start in knowing what works, what doesn’t, and where to prioritize innovations and funding.

Beyond driving better care and health outcomes, direct providers play a vital role in the communities where they operate. Hospitals and healthcare centers are leading employers and economic engines. They bring good jobs and good employees to rural towns.

Health outcomes — and

communities

— are at risk

Make no mistake: the stakes are real. Without necessary funding and solutions, gaps in care will widen. People will suffer. Hospitals will close. Too many rural areas across the commonwealth are approaching a breaking point.

The reality is, when hospitals close, communities unravel. And people pay the price.

Families living in rural communities across the commonwealth deserve good healthcare. Access to quality care and specialty services aren’t luxuries afforded only to those living in urban or more populated areas. They should exist across all 67 Pennsylvania counties.

Rural communities deserve more than the bare minimum in access and quality. “Good enough” simply isn’t good enough. These communities deserve better, and we’re eager to play our part in elevating healthcare across Pennsylvania’s rural communities.

Dr. Terry Gilliland was named Geisinger’s new president and chief executive officer in 2024. He has extensive healthcare experience and has held senior executive roles spanning healthcare delivery and payer organizations.