S. 4927 · 119th Congress · Read twice and referred to the Committee on Health, Education, Labor, and Pensions.
Federal Fund to Keep Rural Emergency Rooms Open
Rural Hospital Emergency Room Guarantee Act
1 cosponsor
- Sen. Hassan, Margaret Wood [D-NH] (D-NH)
Deep dive July 7, 2026
This bill would create a federal fund to pay qualifying rural hospitals up to $1 million per year to keep their emergency rooms running. Payments could last up to 10 years, from 2026 through 2036, and would rise with medical inflation. Hospitals in greater financial need could receive up to 50 percent more each year.
What to know
- Each qualifying rural hospital could receive up to $1 million per year for up to 10 years.
- Payments would increase each year to keep up with medical inflation.
- Hospitals facing an emergency room closure within 14 days could receive a one-time extra payment of up to $250,000.
- The money can only be spent on normal emergency room operating costs, including staff, not on executives or board members.
- Hospitals taken over by private equity firms would lose eligibility for the payments.
- The bill does not set a total dollar cap, appropriating whatever funds are needed each year through 2036.
Heads up
4 buried provisions
Provisions we flagged do not match the bill's stated purpose, or repeat language from bills that did not pass on their own.
Open-ended mandatory funding with no dollar cap (Section 399V-8(i))
Why we flagged this
The bill appropriates "such sums as are necessary" for eleven years. There is no dollar limit. The total cost is unknown. This is vague wording tied to a large fiscal effect.
Show the exact bill text
Out of any money in the Treasury not otherwise appropriated, there is authorized to be appropriated, and there is appropriated, to the Fund such sums as are necessary for each of fiscal years 2026 through 2036.
Reports cannot be used to remove a hospital from the program (Section 399V-8(f))
Why we flagged this
Hospitals must send yearly reports on their finances and need. But the Secretary is barred from using that information to disqualify them. This limits oversight in a way that is easy to miss.
Show the exact bill text
The Secretary may not use such reported information to disqualify such eligible entity from participation in the program.
Extra payments set by a formula the Secretary writes later (Section 399V-8(c)(2)(B)(ii))
Why we flagged this
Hospitals can get up to 50 percent more each year. The formula is not in the bill. The Secretary writes it later. Terms like "injury need" and "economic conditions" are not defined.
Show the exact bill text
make an additional payment to each such eligible entity in an amount not greater than 50 percent of the amount of the payment made to such eligible entity under clause (i) for that year, to be determined by the Secretary with respect to each such eligible entity pursuant to a formula established by the Secretary by rulemaking
Ban on private equity ownership (Section 399V-8(d)(4))
Why we flagged this
A hospital loses funding if it is bought, even in part, by a private equity, venture capital, or "similarly purposed" fund. "Similarly purposed" is not defined. This could affect many sale or investment deals.
Show the exact bill text
if such eligible entity is acquired, in whole or in part, by a private-equity, venture-capital, or similarly purposed ownership fund, such eligible entity may not continue to participate in the program.
Section by section
Official name of the bill
This section gives the bill its official short title. It states that the law may be referred to as the 'Rural Hospital Emergency Room Guarantee Act.' This is a standard opening section found in most bills. It does not create any rules, funding, or programs on its own.
No one is directly affected by this section alone. It simply names the bill.
This section has no direct tradeoff, as it only establishes the bill's name.
Show the exact bill text
This Act may be cited as the Rural Hospital Emergency Room Guarantee Act .
Rural Hospital Emergency Room Guarantee Fund
This section creates a new federal fund to help rural hospitals keep their emergency rooms open. The government would pay each qualifying rural hospital $1 million per year for up to 10 years. Payments would rise each year with medical inflation. Hospitals with greater financial need could get up to 50 percent more each year. If an emergency room is about to close within 14 days, the hospital can get an extra one-time payment of up to $250,000 that year. The money can only pay for normal ER operating costs, including staff. It cannot go to executives, board members, or other facilities. Hospitals taken over by private equity firms lose eligibility. The fund runs from 2026 through 2036, and participating hospitals still keep all other federal health program payments they already receive.
Rural hospitals that operate 24-hour emergency departments and take part in federal health programs like Medicare or Medicaid. Patients in rural areas who rely on those emergency rooms are also affected.
The fund could help keep rural emergency rooms open, but it requires ongoing federal spending with no fixed dollar cap, since it appropriates "such sums as are necessary" each year through 2036.
Show the exact bill text
Out of any money in the Treasury not otherwise appropriated, there is authorized to be appropriated, and there is appropriated, to the Fund such sums as are necessary for each of fiscal years 2026 through 2036.
Citations
- Congress.gov bill text: link (retrieved 2026-07-07)
Public record
Below is the official voting record from Congress.gov. It is not our analysis.
Source: Congress.gov
This bill has no recorded roll-call vote yet. A roll-call vote records how each member voted by name.
Help keep this free. Support this work.
to get an email when it changes. Part of email alerts, $5 a month.