U.S. hospital capacity shrinking as closures outpace openings.
Building the rural nursing workforce by investing in student support.
Medicare Advantage members facing barriers to Medigap coverage.
U.S. hospital capacity shrinks as closures outpace openings
Why it matters: Hospital closures are reducing inpatient capacity across the country, raising concerns about patient access to care and the healthcare system's ability to meet growing demand.
The big picture: The U.S. healthcare system has lost more than 24,000 hospital beds over the past 15 years as hospitals have continued to close nationwide.
The trend affects both rural and urban communities alike.
What the study found: New research from Harvard University found that rural and urban hospitals have closed at roughly the same rate, challenging the perception that hospital closures are primarily a rural issue.
Why now: The findings come at a time when healthcare leaders are closely monitoring the financial stability of hospitals following passage of the One Big Beautiful Bill Act, which has intensified discussions about the future of hospital funding and access to care.
What to watch: Continued hospital closures could place additional pressure on remaining facilities, potentially affecting capacity, patient access and care delivery in communities already facing healthcare challenges.
The bottom line: A new study suggests hospital closures are not confined to rural America. As the nation loses hospital beds and facilities over time, policymakers and healthcare leaders may need to consider broader strategies to preserve access to care across both urban and rural communities.
Building the rural nursing workforce starts with student support
Why it matters: Rural communities continue to face nursing shortages but expanding nursing program enrollment alone won't solve the problem.
Healthcare and education leaders say strengthening the workforce requires addressing the barriers that prevent rural students from entering and completing nursing programs.
Their conclusion: Workforce development requires a coordinated approach that supports students, expands clinical training opportunities and invests in faculty and preceptors.
What's standing in the way:
Rural students often travel long distances for education and clinical placements, increasing transportation, lodging and other out-of-pocket expenses.
Clinical placements remain difficult to secure, particularly in rural communities where hospitals have limited staffing, services and training capacity.
Nursing faculty shortages continue to constrain program growth, limiting the number of students who can be trained.
Preceptor shortages create additional barriers, as working nurses in rural settings often have limited time and resources to mentor students.
Potential solutions:
Expand train-in-place models that allow students to complete more coursework and clinical training close to home.
Support earn-and-learn pathways, including apprenticeships that combine education, employment and workforce development.
Provide financial assistance beyond tuition, including support for transportation, housing, childcare and clinical-related expenses.
Strengthen partnerships between nursing programs and healthcare providers to increase clinical training opportunities.
Invest in recruiting and retaining nursing faculty and preceptors through incentives, stipends and workforce development programs.
The bottom line: Rural nursing shortages are tied to broader challenges in healthcare access and education.
Leaders say lasting progress will require a systematic approach that reduces barriers for students, expands training capacity and creates pathways for nurses to learn, work and remain in the rural communities that need them most.
Medicare Advantage members face barriers to Medigap coverage
Why it matters: Millions of Medicare beneficiaries may assume they can switch from Medicare Advantage to Traditional Medicare if their healthcare needs change.
New research from KFF suggests that for many, obtaining supplemental Medigap coverage could be difficult or impossible due to pre-existing health conditions.
The big picture: Nearly 74% of Medicare Advantage enrollees, representing about 20.9 million people in 2023, had at least one pre-existing condition that could trigger a denial when applying for a Medigap policy outside of protected enrollment periods.
What's driving it: Federal law guarantees a one-time Medigap enrollment window when beneficiaries first enroll in Medicare Part B.
Outside that period, many insurers can use medical underwriting, allowing them to deny coverage or charge higher premiums based on an applicant’s health history.
By the numbers:
25% had peripheral vascular disease.
24% had chronic kidney disease.
21% had coronary artery disease.
21% had diabetes with complications.
Age matters: The likelihood of having a potentially disqualifying condition increases with age.
Among Medicare Advantage enrollees age 85 and older, 88% had a condition that could lead to a Medigap denial.
State differences: Potential denial rates ranged from 82% in Florida to 59% in Alaska, underscoring significant geographic variation.
The bottom line: The findings highlight an often-overlooked limitation of Medicare Advantage.
While the program offers cost protections and additional benefits, beneficiaries who develop serious health conditions may face challenges transitioning to Traditional Medicare with Medigap coverage later in life.
Policymakers continue to debate whether broader guaranteed issue protections could improve access while balancing the impact on Medigap premiums.
Help shape Arizona's healthcare preparedness priorities
The Arizona Coalition for Healthcare Emergency Response (AzCHER) has launched the 2026-2027 Hazard Vulnerability Assessment and Resource Gap Analysis (HVA/RGA), a critical statewide assessment that helps identify risks, resource needs and preparedness priorities across Arizona's healthcare system.
The big picture: Hospital participation is essential.
AzCHER encourages healthcare leaders to ensure their emergency manager or preparedness lead completes the HVA/RGA on behalf of their organization.
The results help guide preparedness planning, resource allocation, training priorities and statewide initiatives that strengthen healthcare readiness and response capabilities.
Your organization's input helps build a more resilient healthcare system prepared to protect patients, staff and communities during emergencies.
For questions or to learn more, please contact AzCHER at azcheradmin@azhha.org or by calling 602-264-2930.
UPCOMING EVENTS
Oct 16-18 – AzAHQ Quality Journey Course Where are you on your quality journey? Have you thought about seeking certification in quality? This course is designed for healthcare professionals who are interested in learning more about healthcare quality and preparing for certification, and it will review key milestones in the quality journey. Register today.
Thursday, Oct. 22, 2026 – Leveraging System Strengths to Solve Capacity Gaps in Limited-Resource Environments Join the Alliance for Innovation on Maternal Health (AIM) for the final Community of Learning session, discussing strategies for data utilization in low-volume settings. Learn about strategies that AIM participating entities have identified for data review and use for quality improvement in low-volume facilities and environments. Register now.
Friday, Oct. 30, 2026 –Training Transformative Mental Healthcare Teams Conference This virtual session is designed for behavioral healthcare preceptors working with rural and underserved communities. The training will equip preceptors with effective strategies to strengthen the clinical competence, confidence and engagement of experiential learners in behavioral healthcare. Learn more and register.
Wednesday, Nov. 4, 2026 – Strengthening the Rural Nursing Workforce: Transition to Practice as a Statewide Strategy webinar This webinar, hosted by the American Organization for Nursing Leadership, will highlight the Arizona Transition to Practice Program. Karen Ofafa, EdD, MPH, BSN, R.N., vice president of Workforce and Clinical Excellence at AzHHA, will share implementation strategies, sustainability considerations and lessons learned that can inform broader efforts to strengthen the rural nursing workforce. Register now.
Save the date: Jan. 8-9, 2027 – 3rd National Pediatric Disaster Conference The conference, which will be held in Scottsdale, Ariz., will focus on pediatric mass casualty incidents and innovative approaches to strengthening preparedness, response and recovery efforts for children. AzCHER encourages members to save the date and take advantage of this opportunity to learn, connect and strengthen pediatric readiness. Registration details coming soon.
