Rep. Tina Pickett, R-Towanda, is pictured during a conversation on the House floor.

Bipartisan legislation has been introduced in the state House of Representatives to require a board-certified or board-eligible physician staffing a hospital emergency room at all times.

House Bill 2265, introduced recently by Rep. Tina Pickett, R-Towanda, and Rep. Paul Takac, D-State College, would amend the state’s Health Care Facilities Act to require that every hospital emergency department in Pennsylvania be staffed at all times by an on-site, board-certified or board-eligible emergency physician. Pickett, Republican chairwoman of the House Insurance Committee, represents Bradford County, which is losing the emergency room at Bradford Regional Medical Center.

“Emergency medicine requires rapid, high-stakes decision-making – often without any prior knowledge of a patient’s medical history,” Pickett and Takac said in their co-sponsorship memorandum.

“Board-certified and board-eligible emergency physicians have specialized training to manage undifferentiated and high-acuity conditions. While the most common practice in Pennsylvania is to have a physician on-site, state statute does not currently require a physician to be physically present in the emergency department at all times, meaning some hospitals rely on tele-emergency departments staffed by non-physician practitioners with physicians only available electronically.”

Indiana passed a similar law in 2023 as part of a comprehensive health care bill that includes reforms to physician credentialing and prior authorization, among other items. The language proposed by the Indiana American College of Emergency Physicians and passed into law requires a hospital with an emergency department to have at least one physician on site and on duty who is responsible for the emergency department at all times.

Emergency departments, particularly in rural areas, face significant staffing and resource challenges, the Indiana chapter of the ACEP said when the proposal became law. South Carolina passed its version of the bill in May 2025 while the Virginia version of the legislation was passed in 2024.

“This legislation would ensure that whenever a Pennsylvanian enters through the doors of an emergency department, a highly trained emergency physician is immediately available,” Takac and Pickett wrote. “Recognizing the staffing realities of small rural hospitals, the bill includes a narrow exception allowing the Department of Health to permit alternative physician staffing if a facility demonstrates low patient volume and documented recruitment challenges.”

That exception may be used often in rural Pennsylvania, whose hospitals face increasing financial pressures. It was announced this month that the Bradford Regional Medical Campus is closing its inpatient unit and emergency department while LECOM is acquiring the Bradford Regional Medical Center (BRMC) campus, including The Pavilion, the 95-bed skilled nursing facility.

A January report by the Hospital and Healthsystem Association of Pennsylvania found more than a dozen Pennsylvania hospitals could be at risk of closing over the next five years without policies to align hospital payments with their cost for providing care, a report by a national consulting firm found. The analysis by Oliver Wyman, commissioned by The Hospital and Healthsystem Association of Pennsylvania, finds that operating a hospital is more challenging in Pennsylvania than elsewhere, largely because the commonwealth lags behind peer states in adequately funding hospital care. Fewer than half of the state’s hospitals are operating with sustainable margins –37% are operating with a loss– and 25 have closed statewide in the past decade.

Without intervention, as many as 12-14 more hospitals could close over the next five years, adding 22 minutes to Pennsylvanians’ average drive to the nearest hospital and costing $900 million in lost wages due to job losses, the report projects. Rural hospitals are especially at risk as they serve a greater share of Medicare, Medicaid, and uninsured patients.

“Without timely, targeted state support, many Pennsylvania hospitals will struggle to maintain existing services or make the necessary investments in workforce, technology, and infrastructure that Pennsylvania needs,” the report notes.

The report identifies actions to improve Medicaid reimbursement, reform medical liability rules, and streamline administrative requirements as the greatest opportunities for state policymakers to help stabilize hospitals.

While federal cuts enacted through last year’s reconciliation bill will significantly worsen hospital reimbursement, the report finds that Pennsylvania hospitals are already at risk due to chronic underfunding. Medicaid reimbursement in Pennsylvania is 11 percentage points lower than the national average. The state’s Medicaid program — which provides health coverage for nearly 1 in 4 Pennsylvanians –already pays hospitals only 71 cents, on average, for each dollar they spend providing care to enrollees.

“This expert analysis underscores the urgent need to safeguard access to the care communities depend on,” HAP President and CEO Nicole Stallings said. “We cannot have healthy, vibrant, and competitive communities in Pennsylvania without strong, financially stable hospitals. HAP stands ready to work with policymakers to ensure hospitals can sustainably serve their communities.”

HAP is advocating for investments in the 2026-2027 state budget to better align hospital payments with the cost of providing care.

Additional findings from Wyman’s report include:

– In addition to their structural deficit, Pennsylvania hospitals are strained by the highest per-resident cost of medical liability payouts in the nation ($43), a projected shortage of 22,000 nurses by 2028, and outdated hospital regulations.

– Pennsylvania hospital and health system average bond ratings (A for systems, BBB+ for hospitals) are much lower than the national median (A+ for systems, A- for hospitals), signaling greater distress.

– Collectively, Pennsylvania hospitals are absorbing a $3.3 billion shortfall between operating expenses and net patient revenue. By 2030, without improved funding, Pennsylvania hospitals’ collective margin is projected to decrease from 2.9 percent to between -3.3 percent and -10.8 percent.