As we enter another week of the Democrat shutdown with no end in sight, it’s worth asking what this fight is really about. Beyond the headlines and the finger-pointing lies a deeper crisis — one that’s been years in the making.
One of the core issues driving the current impasse is the battle over rising health-insurance costs and the unraveling of America’s rural healthcare system. While Democrats dig in to preserve expiring Biden-era Obamacare subsidies and warn about a premium cliff, they are clinging to a temporary band-aid that masks a deeper problem: insurer practices that drive up costs for patients while underpaying hospitals and providers. Instead of prolonging the stalemate, they should work with Republicans to reopen the government and start confronting the real causes of today’s healthcare crisis. By restoring fairness and accountability in the insurance market, we can ensure Americans aren’t paying more for less care and protect our rural healthcare providers.
Chronic under-payments and insurer cost-shifting are driving hospitals to the brink. In Pennsylvania, the warning signs are impossible to ignore. One rural hospital after another is teetering or folding. Earlier this year, the closure of Heritage Valley Kennedy Hospital was blamed in part by lower reimbursement rates from commercial insurers which caused the larger health system to which the hospital belonged to post significant operating losses. Statewide, roughly a quarter of Pennsylvania’s rural hospitals have already seen closures or reductions in service, and many more remain on the brink.
These aren’t abstract statistics; they’re lost community lifelines. Rural hospitals are often the first line of defense in health emergencies and an anchor for local economies. Delaying payments, imposing endless prior authorization requirements, or underpaying for services by insurers can ultimately be the difference between a functioning ER and a boarded-up building. When the hospital closes, the specialists leave. Trauma care disappears. Expectant mothers drive an hour for delivery. And when those services vanish, they rarely return.
Fortunately, accountability can be enforced without expanding bureaucracy. Insurers should compete on service, not on how cleverly they can deny or delay payment. Markets only work when contracts are honored, information is transparent, and bad behavior carries consequences. Rather than scrambling to extend subsidies every few years, Congress should focus on restoring this balance to the health insurance marketplace.
To achieve that balance, Congress must move from rhetoric to results. Lawmakers should enforce prompt-pay rules that compel insurers to reimburse providers within reasonable timeframes — or face penalties — and tighten prior-authorization standards to ensure transparency and timely decisions. They should also require insurers to publicly report denial rates, payment timelines, and network participation data — particularly in rural counties — so regulators and communities can see where the system is breaking down. This would help stabilize rural hospitals, as well as reintroduce competition and accountability into a marketplace that has long rewarded delay over delivery.
This Democrat shutdown should be a wake-up call. Washington can’t keep patching over a failing system with temporary subsidies and calling it reform. Real change means tackling the insurer behaviors driving rural hospital closures and rising premiums head-on. Otherwise, we’ll keep replaying the same fight every few years—while more communities lose their hospitals, and more families pay more for less care.
Fixing the insurance market doesn’t mean growing government, but it does mean holding insurers to the same standard of accountability we would expect from any other business by demanding they live up to the promises they make to patients and providers. As someone who served on the Insurance Committee during my time in Harrisburg, I saw these problems up close. I’ve read the denial letters, met the families who couldn’t find a local doctor, and watched once-vibrant hospitals fade into empty shells.
Rural America deserves better than excuses and bailouts. It deserves a healthcare market that honors work, rewards fairness, and keeps its promises. The time has come for Democrats to end their shutdown and reopen the government to rebuild a healthcare system that works for our small towns and farming communities—not the insurance companies that have been profiting from their decline.
Michael Puskaric is a former member of the Pennsylvania House of Representatives. During his time in office, he served on the Insurance Committee.