Rural Americans have historically relied on Medicaid more than people in densely populated areas.
Future Medicaid reductions could hurt children with disabilities
Parents of children with disabilities say that Medicaid reductions in “One Big Beautiful Bill” directly affect their child’s well-being.
Penny Blue was walking home in 2013 as she climbed the stairs at Union Hall, Virginia, when a blood vessel burst into her brain.
“When that happened, I actually felt a pop in my head,” she told USA Today. After sitting down and calling an ambulance, she quickly arrived towards the hospital 15 minutes’ walk away, where she was stable. She flew by helicopter to Roanoke Memorial Hospital, where she was in intensive care for 13 days.
If the same thing happens again, Blue may not be so lucky.
If a rural hospital down the road is closed, the nearest hospital is at least an hour away in Roanoke. The 65-year-old said she saw statistics on survival and quality of life potential and told her she had to go that far. They’re not good.
“Time, minutes, seconds, whether you live or die, and if you live, if you live, the quality of your life is different,” Blue said.
Her concern is not idle. A rural hospital like the one nearby, she was already struggling financially before President Donald Trump took office in January. However, the GOP tax and expenditure bill, signed into law on July 4, has made the issue much worse, and could speed up closures across the country, according to hospital executives and healthcare professionals.
Trump says he’s only reducing Medicaid, the government insurance program for the elderly, and “waste, fraud and abuse” from people with disabilities. But these cuts force the state to compensate for state fund disparities when they are already cash-bound or allow rural hospitals to close.
“The federal government has put us in a very painful position,” Democrat Colorado Sen. Dylan Roberts told USA Today.
Risk rural health care
Rural Americans have historically relied on Medicaid more than people in densely populated areas. Additionally, rural healthcare providers and facilities often require Medicaid refunds to stay open.
Advocacy groups estimate that 700 rural hospitals (about one in three) and many rural clinics and nursing homes are at risk of closures over the next few years. Estimates from KFF predict that cuts to federal Medicaid spending, approved by the new law, will exceed $155 billion in rural areas over the next decade.
A map created by advocacy groups shows that most of these at-risk hospitals and clinics are located in Republican-owned House districts.
Without any outward indications of how close she had come to die over a decade ago, Blue is frustrated with politicians who tell people in rural communities not to worry about hospitals and clinics that could be shut down due to their decisions.
“I told someone (don’t) not to panic in the aneurysm… count every second,” Blue said.
Cuts and closures have already begun
Reductions to Medicaid and SNAP will not be fully effective until after the 2026 midterm elections, but the healthcare system has often budgeted a year or two in the future, and has already begun closures.
In southwest Nebraska, the McCook-based community hospital said Trump signed the bill and closed the clinic in Curtis, which is about 900 towns, would cite financial challenges, including Medicaid cuts.
The hospital is also considering whether more people will choose to go without health insurance when some premiums skyrocket this fall.
The law ends the enhanced premium tax credits of Obama-era Affordable Care Act. This means that the 24 million people who are insured through the Affordable Care Act market will almost certainly see their costs skyrocket.
“There are a lot of hospitals in rural and low-income areas that have been running for a long time with very slim margins, and we’re seeing the hard-working people this year starting this year,” said Democrat Sen. Chris Murphy.
An analysis of hospital financial vulnerability conducted by the University of North Carolina’s Cecil G. Sheps Health Services Research Center for Health Service Research has identified the largest figures in Kentucky, Louisiana and California.
On August 7, Providence Health System announced plans to close clinics, treatment and rehabilitation programs across two Washington counties, citing “multiple pressures,” including state and federal Medicare, Medicare cuts, and higher costs from inflation and tariffs.
“These headwinds will only be enhanced if the reductions to the critical safety net programmes included in the recently passed HR1 are also known as the One Beautiful Bill Act,” the Healthcare System said in a statement.
Federal Fund
In response to bipartisan concerns about the future of rural hospitals, the Senate added $50 billion in funding for the new “rural health transformation program.”
The fund distributes $10 billion a year for five years, with half split evenly across states that apply. The Centers for Medicare and Medicaid Services are authorized to distribute the rest.
The law doesn’t require money to go to rural hospitals only, but some of the nation’s largest medical groups say it’s not enough to cover Medicaid cuts, an increase in uninsured numbers and new restrictions on payments.
Republicans in the White House and Congress say the fund will protect rural hospitals.
“Rural hospitals are fine,” Sen. John Tune, a Republican from South Dakota, told Fox News “A Talk to Martha MacCallum and Martha Macalum on July 9th.”
What can the state do?
Colorado state senator Roberts said his rural members are always on the verge of what will happen if their clinics and hospitals close. He focuses on mental health, dental and other specialized clinics in the poorest and most rural areas of his district.
“It’s going to hit everyone and many of these clinics were already operating on margins before this bill was passed, so they certainly fear that they’re going to be next,” he said.
In Craig, Colorado, a community of 9,060 people is moving from coal mines to a more diverse economy.
“If there’s no hospital, people won’t stay. It’s important to make sure that such communities can be migrated and that they can remain a vibrant place,” Roberts said.
The local hospital closed its obstetric practices with OB/Gyn a few years ago. This means that women have to drive for an hour and give birth to a Colorado steamship. Roberts said he told him the hospital was considering closing other practices.
To stop the expected bleeding, Colorado has established a provider stabilization fund for $25 million over the next two fiscal years.
“It’s going to help, but it’s never going to be made up,” Roberts said, up to $800 million Medicaid the state expects to lose every year.
Michigan Senate Budget Committee Chairman Sarah Anthony said the future of rural hospitals is part of the “coldness” and “tension” of the last two-hour committee hearing. Michigan expects the cuts to pierce $5.6 billion in rural Michigan budgets over the next decade, she said.
The state is already working on many of the responsibilities the federal government has given them.
“As a state legislator, there’s not enough world to fill that hole.”
“What can the nation do to alleviate harm? There’s really not much,” she said.
Community-wide issues
Dennis Paraschack, a retired nurse in township in Plains, Pennsylvania, is closing hospitals, clinics or nursing homes.
“Having that country hospital in the area is a real lifesaver,” she said.
Politicians who are talking about using cuts to trim waste and abuse from Medicaid may not be thinking about the “disastrous situation” that those cuts mean for nursing homes, Paraschack said. Medicaid is the largest payer for long-term care facilities, paying more than 60% of nursing homes nationwide.
When rural nursing homes close, patients often have to move in with families who have no skills or training to provide watch care to people at the end of their lives, she said.
Paraschack said that the community loses local hospitals, which puts more stress on hospitals in other areas. They will be more crowded, patients will skip care until health issues become more severe and difficult to treat, and remaining health providers will have difficulty recruiting staff, Parashac said.
“It really has a snowman effect,” she said.
