Loren Lippincott
Recent polling shows the most important issues to voters in 2026 are healthcare (28 percent), housing (19 percent), food (18 percent) and gas (15 percent). The top concern is understandable considering that healthcare is 17.6 percent of our gross domestic product, meaning nearly one fifth of the nation’s economic output is health related. About $5 trillion is spent annually on healthcare — roughly $14,570 per person.
Nebraska’s healthcare system, particularly its extensive network of rural hospitals and clinics, faces mounting pressures that threaten access to care across the state’s vast landscape. With more than two-thirds of its hospitals located in rural areas — far exceeding the national average — providers operate on thin or negative profit margins and deal with aging infrastructure, loss of essential services, severe staffing shortages and burnout and the lingering ill effects of the Affordable Care Act (Obamacare). Add to that the long distances many must travel for care, and the situation becomes critical.
Recent surveys by the Nebraska Hospital Association show that around 55 percent of hospitals describe their financial conditions as challenging or very challenging, with roughly onethird reporting negative operating margins in recent periods. Average margins have hovered near or below 2 percent in recent years — well below sustainable levels. Rural facilities, which often serve higher proportions of Medicare and Medicaid patients, absorb losses in these cases while facing rising costs for labor, supplies and drugs.
Meanwhile, Medicaid makes up 24 percent of our state budget and 350,000 Nebraskans (18 percent) receive Medicaid benefits. In rural areas, Medicaid services 26 percent of all emergency room visits, 33 percent of all births and 44 percent of all behavioral health and pediatric services.
This financial squeeze accelerates the decline of our aging infrastructure and core services. Hospital bed counts in western Nebraska have dropped sharply, by about 40 percent since 2000 in some rural zones, reflecting consolidation and facility limitations. Specialized units have closed at rates among the highest in the nation. Labor and delivery, behavioral health, long-term care, dialysis and other services have been reduced or eliminated at more than 20 percent of hospitals in recent years. One example is the closure of dialysis services at Chadron Hospital because it could no longer sustain annual losses exceeding $1 million due to inadequate reimbursements. The closure has forced patients into multi-hour drives for treatments. Some facilities have converted to Rural Emergency Hospital status, ending inpatient care to preserve emergency access.
Staffing shortages and burnout intensify the problems. Nebraska faces a projected nursing shortfall exceeding 5,000 positions, with rural regions like the Panhandle experiencing unmet demand rates above 25 percent. Fourteen counties lack a single primary care physician and dozens are designated as medically underserved. COVID-19 exacerbated burnout through intense workloads and residual effects persist, driving up labor costs and turnover significantly since 2020. In addition, EMS and specialty shortages compound the issue, leaving communities reliant on overworked volunteers or limited paid responders.
Meanwhile, Obamacare has caused premiums to increase 80 percent. For a family of four, premiums have increased $12,000 per year, while deductibles have gone up 50 percent resulting in worse care and higher costs.
While Medicaid expansion (adopted later in Nebraska) reduced uncompensated care and improved margins for many rural hospitals by bringing more patients under coverage, other elements and related federal payment policies have contributed to the pressures.
And of course, Nebraska’s vast geography and sparse population multiply every challenge. The average rural resident faces a 130-mile trip to a Level 1 trauma center and 16 percent of mothers travel at least 30 minutes for maternity care, which is double the national average distance. Service losses force even longer journeys for dialysis, specialty care or emergencies, increasing risks from delayed treatment and raising transportation costs.
These interconnected struggles — thin margins limiting upgrades and retention, service cuts lengthening travel times and burnout depleting the workforce — threaten not only health outcomes but also local economies that depend on hospitals as major employers and anchors. Without sustained attention to reimbursement adequacy, workforce pipelines, infrastructure investment and policies that account for rural realities, more communities risk losing the care they need close to home.
Loren Lippincott represents Legislative District 34 in the Nebraska State Senate. Read his column in the Nance County Journal.