Updated July 1, 2025 at 6:25 AM PDT
Republican lawmakers are racing to pass President Trump's sweeping domestic policy bill before Friday.
And one of the obstacles dividing Republican senators? Radically reshaping Medicaid, the joint federal/state health insurance program for more than 70 million low-income and disabled people.
The Senate bill would cut more than $1 trillion from the program and the latest report from the non-partisan Congressional Budget Office estimates nearly 12 million people will lose health insurance if it becomes law. The plan would require able bodied adults to work 80 hours per month until age 65 to qualify for benefits, and would also cap and gradually reduce the tax states can impose on Medicaid providers.
Several GOP senators have raised concerns that the tax is a critical funding stream for rural hospitals. If that income dries up, many hospitals could close.
"Medicaid cuts would place significant financial pressure on hospitals in rural states, where many hospitals are already at risk of closure. In more than half of states, reductions in Medicaid funding for rural hospitals would exceed 20%," according to the National Rural Health Association.
Senate GOP leaders have included a new $25 billion fund to support rural hospitals in the bill to alleviate some of those concerns.
But Sarah Jane Tribble, chief rural correspondent at KFF Health News, told NPR that many health care officials in rural areas say it's not enough. In fact, it's only 43% of what is needed for rural hospitals to offset the cuts coming in the Senate proposal, she said.
"And even worse, that rural transformation fund won't just go to rural hospitals, it'll go to health clinics and federally qualified health care centers, community mental health and opioid treatment centers, too, by their estimates," Tribble said. "So, they really don't think it's enough to offset it."
Tribble has been speaking with people from rural communities and they are worried that the proposed cuts will push rural health care to the brink of collapse. "I'm not hearing good things," she said.
"They're very concerned because Medicaid rates are so high in rural America that these cuts will be very detrimental. They'll cause more hospitals to close. They'll tax rural health clinics," Tribble told All Things Considered host Juana Summers.
The following excerpt has been edited for length and clarity.
Interview highlights
Juana Summers: Give us some details about some of the types of ways in which rural hospitals could be impacted. Like, I guess I'm trying to figure out how these cuts would work and what they would mean for patients.
Sarah Jane Tribble: Well, for rural hospitals, they're specifically already on the line.
More than 150 hospitals have either closed completely or shut down their inpatient beds since 2010, according to the UNC Sheps Center in North Carolina. Another 267 rural hospitals have closed their obstetrics units from 2011 to 2021.
So, these hospitals are already, you know, showing signs of duress underneath the current health system economics, if you will. And really, Congress has acknowledged this over the years, passing a new Rural Emergency Hospital Act a couple of years ago, trying to help shore up these hospitals.
Summers: The White House put out a fact sheet making the point that the bill will not cut Medicaid. The fact sheet calls it a myth that the bill will close rural hospitals. How do you parse those claims?
Tribble: So, when you talk to anybody from, say, Georgetown or some of the other experts out there, they have analyzed the numbers of who's using Medicaid in rural America — say, moms, working-age adults. These are patients of these hospitals.
And if you decrease the number of people receiving Medicaid in rural areas, then you're going to decrease the amount of revenue the hospitals and clinics get because they just have less paying patients.
But also, there are some other provisions in the bill that experts have analyzed as far as work requirements and the provider taxes and state-directed payments. Those all do hit rural America in different ways, especially the expansion states.
Summers: As you pointed out, rural hospitals have been on the decline for years, with many having closed in the last few decades, even more facing risk of immediate closure. I wonder, what does all of this mean for patients? I've heard about how these closures are particularly problematic, for example, for trauma care, cancer treatment.
Tribble: I've done a lot of reporting over the years where I talk to patients who travel long distances for their care. I did a story out of New Mexico where they were setting up telehealth services after a hospital had closed its obstetrics units so patients wouldn't have to drive for every single prenatal visit.
Those are situations that are already sort of on the brink, if you will, where patients are having to drive long distances when they're delivering babies or even for trauma care, where helicopters have to show up and go significant distances to get people to care. And that's because rural hospitals have been closing and rural care, in general, has been declining over the past couple of decades. There's a lot of places where there's just not enough providers in general. And when a rural hospital closes, providers tend to leave the area.
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