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UPI
16-07-2025
- Health
- UPI
Rural health clinics, services at risk with $1 trillion Medicaid cuts
1 of 2 | President Donald Trump shows his signature after signing a new tax and immigration bill during a ceremony at the White House in Washington, D.C. on July 4. The bill cuts nearing $1 trillion from Medicaid. Photo by Kent Nishimura/UPI | License Photo July 16 (UPI) -- The dust has settled on Capitol Hill over the passage of President Donald Trump's legislative agenda bill but healthcare experts continue to prepare for the fallout of more than $1 trillion in Medicaid cuts. The legislative agenda bill is projected to cut more than $1 trillion in Medicaid spending by the federal government over the course of a decade. The cuts stem from greater eligibility requirements such as work requirements and limits on state-imposed Medicaid provider taxes. The Congressional Budget Office estimates that the number of people who are uninsured in the United States will increase by 7.8 million as a result of Medicaid cuts. The loss of Medicaid coverage for patients also means a loss of potential revenue for care providers. The effects will be felt acutely in rural areas, according to studies by the American Hospital Association. Rural hospitals are projected to experience a $50.4 billion reduction in federal Medicaid dollars in the next 10 years. Sarah Hohman, director of government affairs for the National Association of Rural Health Clinics, told UPI that many rural facilities already struggle "on a good day." A mixture of Medicare and Medicaid patients is what helps them stay open. "Clinics' greater concern, when it comes to these reforms, is if the coverage losses pan out as they are estimated, that would mean that they are treating fewer patients that are covered by insurance," Hohman said. "The more you have uncompensated care and individuals not able to pay, your balance gets concerning pretty quickly. That really threatens the financial viability in these areas." An estimated 16.1 million people living in rural communities have Medicaid coverage, according to the American Hospital Association. In sparsely populated states like Montana, Wyoming and Alaska, more than 50% of Medicaid recipients live in rural areas. The association estimates that the reductions in Medicaid spending outlined by the legislative agenda bill will result in thousands of lost jobs and millions in lost revenue. Republican-led states stand to lose the most. Estimates are based on Medicaid spending data from the Medicaid and CHIP Payment Access Commission, a government commission that advises Congress on Medicaid related issues and policies. Wyoming, the least-populated state, is estimated to lose 13,772 jobs over the next decade for every $1 billion lost in Medicaid funding. The state has a population of 587,618 and the job loss would equate to about 2.8% of the population, according to the U.S. Census Bureau. The loss of jobs is projected to cost the state $1.4 billion in economic activity and about $33.5 million in tax revenues. Texas is projected lose the most jobs at 18,178, followed by Louisiana which is slated to lose 16,787 jobs. A loss of revenue and loss of skilled workers creates conditions for closures. "Typically you start to see closures of certain services," Hohman said. "OB[-GYN] closes. That's a very common first kind of service line to go. You might see some other specialty services close, particularly that have really low volumes. Then they try as hard as they can to keep the core emergency services and some beds." For clinics, there are not as many services that can be sacrificed while keeping facilities open. "On the outpatient side that I represent, it can be harder to chip away at it because they don't necessarily have as many service lines as a hospital," Hohman said. "They have to make very tough decisions about whether their facility can continue to exist in those communities." There are about 5,600 rural health clinics located in 47 states. They serve as the main source of outpatient healthcare in their communities, according to Hohman. The legislative agenda bill includes funding for a $50 billion Rural Health Transformation Program. Funding is allotted to $10 billion each fiscal year beginning in 2026 and ending in 2030. The Rural Health Transformation funds are to be awarded to states that apply for the funding to be used. Applications are to include a rural health transformation plan, detailing how the state intends to use those funds. Some permitted uses of funds include improving access to hospitals and other care providers for rural residents, investing in new technology and improving the health care outcomes for rural patients. Hohman and other rural healthcare advocates have called for a program like this for some time, she said, but the language of the bill remains vague. It leaves room for states to interpret what improving healthcare means. "It's more than anything a safety net healthcare fund," Hohman said. "We have a lot of concerns about what that's ultimately going to look like. There's really no requirement that these monies go to facilities directly. They can be used broadly at the state level to help transform their healthcare. It is a little bit of a cushion in the GOP minds but we will kind of believe it more as we see it." Maggie Elehwany, senior vice president of public policy for Argentum, a national trade association serving senior living communities, told UPI she is pleased with one provision that was removed from the bill. Elehwany is the former vice president of government affairs for the National Rural Health Association. A previous version of the bill included cuts to the federal and state matching program, a program that sees the federal government match state spending on Medicaid. "We are pleased to report that we were able to prevent those cuts and other associations certainly lobbied as well," Elehwany said. "That's responsible for our state payments. But we know that states are going to have overall less Medicaid dollars. That could have an indirect impact on seniors and those folks in our communities." The United States is an aging population facing shortages in skilled nursing and facilities for senior care and living. In 2030, for the first time, the U.S. population will include more seniors than children, according to the American Association of Retired Persons. About two-thirds of seniors need some form of long-term care, Elehwany said. "We're not prepared for the housing needs, for the care providing needs, financially we don't have enough people saving for their retirement, let alone for their long-term healthcare needs," she said. To make up for shortages, Elehwany and other senior care advocates called on lawmakers to create a tax credit for individuals who help care for seniors, such as people who provide care to loved ones. It was one provision that they were not successful in getting into the bill. "But we are pleased they adjusted the $6,000 deduction for Social Security," she said. "They means adjusted a tax refund for seniors with limited income so that they would get a significant amount of dollars back. So that's an important provision in there."
Yahoo
08-07-2025
- Health
- Yahoo
Some of those who supported Trump have concerns about what's in his megabill
Some Trump supporters living in rural areas say they have concerns about the impact of President Donald Trump's tax and policy megabill, which he signed into law on Friday. The bill's potential health care impacts, both personally and on their communities, were top of mind for some, while others anticipated a positive impact on business but were wary of the bill's price tag. ABC News spoke with these people after the Senate passed the bill on July 1 but before the House did two days later. Provisions in the bill enacting stricter eligibility requirements for Medicaid could impact finances for rural hospitals, which tend to rely more on Medicaid funding than urban hospitals and often already operate on tight margins. The American Hospital Association called the potential impact on rural hospitals and patients 'devastating.' In the leadup to the bill's passage, Democratic senators working with researchers from the University of North Carolina Chapel Hill compiled a list of 338 rural hospitals that could be at risk of 'financial distress,' 'service reductions' or closure. Some Republican senators, including Sen. Bill Cassidy, R-La., a physician, and Sen. Susan Collins, R-Maine, had expressed concerns about the bill impacting health care providers in their states. In response to these worries, Senate Republicans included a measure setting aside $50 billion over five years in the bill to support these rural hospitals, but advocates and experts say it may not be enough to prevent hospital shutdowns and loss of care. The National Rural Health Association said in a statement that the fund would 'fall short of' offsetting the impact of other provisions. James, a 62-year-old man who lives in a semi-rural area in North Carolina, is on Medicaid and gets Supplemental Nutrition Assistance Program (SNAP) benefits. He said the bill would cut around $300 worth of those benefits for him per month. 'It's going to be hard to pay the rent and everything else,' he said. He added that he didn't have family that could help support him, now that his brother has died and his mother was in a nursing home. MORE: How soon will you feel the effects of Trump's megabill? Identifying as an independent, James said he did not vote in 2024 but had liked Trump as a candidate more than Democratic nominee Kamala Harris. 'I thought Trump was the lesser of two evils,' he said. 'But I was wrong … If you want to make the poor people poorer, he's doing real good.' Insurance agent Bryan Shaver, who lives in Hattiesburg, Mississippi, voted for Trump in 2024. Shaver, 62, said he was not worried about the Medicaid provisions in the bill affecting his clients. 'Because they're elderly and they make very little money,' he was confident they would meet the new criteria. However, Shaver said he was 'absolutely worried' that the Medicaid cuts could affect rural hospitals in Mississippi, some of which he had worked with in the past. 'It was extremely difficult for them to take care of who they needed to take care of … it's very difficult for them to survive in Mississippi,' Shaver said. He said hospitals' financial struggles sometimes reduced access to care for the people living around them. 'A lot of the hospitals here can't afford [to provide care for] maternity,' Shaver said. 'For example, a hospital up in Batesville, Mississippi. [Patients] have to drive to Memphis to deliver a baby, and that's kind of ridiculous.' Shaver said he would wait to see how the provisions in the bill would affect voters. If there was a negative impact, he said he hoped Republican lawmakers would 'correct it' or otherwise 'get booted out.' Stephen Caraway, who also voted for Trump, lives in a rural area around 70 miles east of Cincinnati. He said he anticipated a positive effect for himself and his community from the bill. Caraway was appointed to the state's Elections Commission by Ohio Governor Mike Dewine in 2023 and will serve until 2027. 'There are service jobs, a lot of restaurant positions in my part of Ohio, and I absolutely think that no tax on tips or overtime would be great for the middle class and for those employees,' Caraway said. He said he would personally benefit from some of the tax cuts the bill extended. To Caraway, the tightened eligibility requirements for Medicaid seemed reasonable, and he did not buy into worries that the bill would take millions of people off the benefits and potentially hurt rural hospitals like the one he lives near. Caraway's one concern is the effect the bill would have on U.S. debt. The Congressional Budget Office estimates that it would add $3.4 trillion to the deficit over a decade. MORE: Why some economists say the deficit increase in Trump's bill is dangerous 'Regardless of what party was in control, I would tell you that the federal government needs an overhaul, and has needed it for a long time. The only thing that would give me pause is some of those CBO projections,' Caraway said. 'But I believe that those projections can just as easily be incorrect as they can be correct. And I'm going to trust my national leaders to do what is right and be fiscally responsible.'
Mint
07-07-2025
- Health
- Mint
How healthcare cuts in the ‘big, beautiful bill' will affect Americans
After the House narrowly passed President Trump's tax-and-spending-cuts bill, he signed it into law on Friday. The passage of President Trump's 'one big, beautiful bill" has left some hospitals, doctors and patient-advocacy groups reeling. Millions of people will lose health-insurance coverage, and struggling hospitals across the country may have to close, lay off staff or shut down some services, they say. States will also face difficult budget choices as federal funds are reduced. 'The magnitude of these reductions—and the number of individuals who will lose health coverage—cannot be simply dismissed as waste, fraud, and abuse," Rick Pollack, president of the American Hospital Association, said after the House narrowly passed the bill. Trump signed the bill into law on Friday, Independence Day. The act slashes over $1 trillion in healthcare spending over the next decade, mostly from Medicaid, the joint federal and state program that provides health insurance to poor Americans. It is the biggest cut to federal healthcare spending—and to Medicaid—in history. The legislation's health provisions, including work requirements for Medicaid recipients, represent a fundamental shift in the federal government's approach to healthcare for its poorest citizens, both Republicans and Democrats have said. 'This is a much more conservative approach to healthcare," said David Mansdoerfer, a former health official in the first Trump administration. 'The big beautiful bill would represent a significant mindset change for federal safety-net programs." There will be nearly 8.7 million fewer people covered by Medicaid over the next decade because of the bill, according to an analysis by Manatt Health, a consulting firm that advises states and healthcare providers on Medicaid policy. Other provisions in the bill, including more-stringent requirements for people to enroll and retain health-insurance plans under the Affordable Care Act, also known as Obamacare, are projected to drive up the number of uninsured, healthcare experts said. Many who study healthcare policy say that people who lose insurance, or people who live in rural areas where doctors and hospitals are closing up shop, often delay preventive care, sometimes costing the system more later. Many of the Medicaid policy changes target the 40 states that expanded eligibility for Medicaid to low-income able-bodied adults. Those enrollees will now have to prove their incomes are below a certain threshold every six months to remain on Medicaid, instead of annually, as well as show that they have spent 80 hours a month working, volunteering or attending school. People in the lowest 10% of income distribution in the U.S. stand to lose noncash government benefits such as Medicaid coverage and food stamps worth nearly $1,600 annually on average, according to an analysis of an earlier version of the bill by the Congressional Budget Office. Hospitals say they are big losers under the new legislation. More uninsured people will mean more uncompensated healthcare costs, they say. And many hospitals now face reductions in some supplemental payments that most states have come to rely on to augment low Medicaid payment rates. Over the next decade, Medicaid payments to hospitals will be reduced by nearly $665 billion, an 18.2% reduction, according to analysis by Manatt. Meanwhile, hospitals' uncompensated care costs are projected to increase by upward of $84 billion in 2034, according to an analysis of the bill by America's Essential Hospitals, which represents some 350 hospitals nationwide. That number takes into account lower Medicaid payments and Medicaid payment shortfalls, as well as costs from caring for the uninsured. 'It is a double-whammy. We're going to have many millions more uninsured individuals showing up needing care," said Beth Feldpush, the group's senior vice president of advocacy and policy. 'But at the same time, hospitals won't be able to backfill financial holes." Medicaid payment rates are notoriously low compared with other types of insurance. States have increasingly boosted these rates in recent years through so-called state-directed payments, which can raise Medicaid payment rates to levels comparable with Medicare or even average commercial insurance rates. The bill clamps down on these payments. States that have expanded their Medicaid programs under Obamacare to include more low-income adults would have state-directed payment rates capped at 100% of Medicare rates; states that haven't adopted expansion would be capped at 110% of Medicare rates. The change will reduce federal spending by $149.4 billion over a decade, according to a CBO analysis. Hospitals in about 30 states will likely see reductions in the state-directed payments they receive once cuts go into effect, according to an analysis by KFF, a health-policy nonprofit. State hospital associations said these payments are lifelines for hospitals, many of which operate at or near a loss. Even before the bill's passage, several hospitals across the country laid off employees, froze hiring and tightened spending, citing the impending cuts to Medicaid as a factor. Providence, one of the country's largest health systems, said last month that it had implemented a restructuring plan that would lead to 600 employees losing their jobs. Other hospitals say they are bracing for the changes to come. Our Lady of the Angels Hospital, a safety-net hospital in Bogalusa, La., said it would have to consider closing its doors, and the University of Kentucky said it might have to pause construction on a new building dedicated to caring for cancer patients if state-directed payment cuts go into effect. The cuts may also eat into the earnings of for-profit hospitals like HCA Healthcare and Tenet Healthcare that have enjoyed lucrative boosts to their bottom lines from state-directed payments. The National Rural Health Association said it was worried that the bill's provisions would significantly hamper healthcare access in rural areas. Senate Republicans added a $50 billion relief fund to the bill at the last minute for rural hospitals, but Sen. Susan Collins (R., Maine), who voted against the bill, said it wouldn't be enough to offset the other changes. For insurers, the biggest impact of the legislation is clear: fewer customers. Though Medicaid is a government program, most enrollees get their benefits through insurers that are paid with state and federal money. 'From a health insurer's perspective, that's a lot of business to lose," says Cynthia Cox, a vice president at KFF, a health-research nonprofit. The industry impact will be heaviest among companies with a focus on Medicaid. Among the largest are Centene, which has nearly 13 million Medicaid enrollees, Elevance Health, UnitedHealth Group, Molina Healthcare and CVS Health's Aetna. 'Revenue and profits will be pressured," said Sarah James, an analyst with Cantor Fitzgerald. A Wellcare location in New York City, part of Centene Corp., one of the largest Medicaid insurers. The cutbacks to Medicaid will come on top of blows to another key insurance market—Obamacare marketplace plans. Federal subsidies that help people pay for Obamacare plans are set to shrink next year, and the new legislation doesn't fill the gap. Along with other Trump administration changes to the rules for Obamacare plans, the reduction in subsidies is projected to reduce the number of people with coverage by another 5.1 million if Congress doesn't extend them. In Obamacare and Medicaid, the shrinking rolls are likely to create another headache for insurers. When people drop out of insurance markets, the healthier ones are often the first to go. That leaves a sicker, more costly pool of customers for insurers, which then seek to get paid more to cover those expenses. They demand higher premiums, either from state Medicaid agencies or from Obamacare customers. Nationally, states will have roughly $1.3 trillion dollars less in federal and state funds to spend on Medicaid over the next decade, according to Manatt. Most of the reductions—93%—will be in states that have expanded Medicaid to cover able-bodied adults. One of the biggest impacts will come from the bill's crackdown on so-called provider taxes, which states levy on hospitals and other healthcare providers to trigger federal matching funds. Most hospitals receive back more than they pay in taxes through higher payment rates via state-directed payments and other mechanisms. Currently, the taxes are capped at 6% of healthcare providers' net patient revenue, but will be reduced to 3.5% in expansion states. In non-expansion states such as Florida and Texas, tax rates will be frozen in place up to the 6% maximum on the date the bill is signed into law. Healthcare workers last month protested the Medicaid cuts proposed in the bill that President Trump signed Friday. The taxes have been criticized as a gimmick that exploits federal taxpayers without requiring states to put any skin in the game. President Obama twice proposed clamping down on provider taxes, including in his 2013 budget, which would have reduced the maximum rate to 3.5%. States use provider taxes to fund state-directed payments to hospitals and other providers. Some, such as North Carolina, have also designed the taxes to fund their Medicaid expansions. On a percentage basis, red and purple expansion states will be hit hardest since many of them tend to rely heavily on provider taxes, says Avi Herring, a Manatt managing director. Montana faces a 21% reduction in state and federal funds; Arizona, Kentucky and Virginia are each looking at reductions of about 18%. The largest blue states, which tend to have more generous Medicaid programs, face far bigger dollar cuts, though they are somewhat smaller proportionally. California is expected to see a 13% reduction. New York's spending will be reduced by nearly 9%. Write to Dominique Mosbergen at Joseph Walker at Liz Essley Whyte at and Josh Ulick at
Wall Street Journal
06-07-2025
- Health
- Wall Street Journal
How Healthcare Cuts in the ‘Big, Beautiful Bill' Will Affect Americans
The passage of President Trump's 'one big, beautiful bill' has left some hospitals, doctors and patient-advocacy groups reeling. Millions of people will lose health-insurance coverage, and struggling hospitals across the country may have to close, lay off staff or shut down some services, they say. States will also face difficult budget choices as federal funds are reduced. 'The magnitude of these reductions—and the number of individuals who will lose health coverage—cannot be simply dismissed as waste, fraud, and abuse,' Rick Pollack, president of the American Hospital Association, said after the House narrowly passed the bill. Trump signed the bill into law on Friday, Independence Day.
The Hill
04-07-2025
- Health
- The Hill
How Trump's megabill will impact health care
The massive tax cut legislation passed by the House and Senate this week will dramatically upend health care in America. The legislation, now on its way to President Trump, was never framed as a health bill, but it will mark the biggest changes to U.S. health policy since the Affordable Care Act (ACA) was passed in 2010. The bill's provisions will impact patients, doctors, hospitals, and insurers, as Republicans partially paid for it by cutting more than $1 trillion from federal health programs. The bulk of the cuts are coming from Medicaid. As a result, changes are coming that will affect how people qualify for and enroll in the program that covers more than 70 million low-income and disabled Americans, as well as how they can maintain coverage. 'No matter how often repeated, the magnitude of these reductions — and the number of individuals who will lose health coverage — cannot be simply dismissed as waste, fraud, and abuse,' American Hospital Association president Rick Pollack said in a statement. 'The faces of Medicaid include our children, our disabled, our seniors, our veterans, our neighbors, and friends. The real-life consequences of these reductions will negatively impact access to care for all Americans.' Almost 12 million lower-income Americans would lose their health insurance by 2034, according to the Congressional Budget Office (CBO), blunting the significant coverage gains made under the ACA. The cuts were deep enough to give some Republicans in both chambers pause, but in the end, only two GOP House members and three senators voted against the bill. It passed the Senate 51-50, and the House 218-214. Here's how the bill could impact Americans: By design, the group that would be hit the hardest are people whose income is between 100 percent and 138 percent of the federal poverty level (roughly between $32,150 and $42,760 for a family of four) who gained insurance when their states expanded Medicaid. The most significant change will be a first-ever requirement for adults under age 65 — including low-income parents of children older than 14 — to prove they work, volunteer or go to school at least 80 hours a month. States will need to develop and launch systems to verify individuals' work status at least every six months, beginning in December 2026. Health experts and advocates warn that a blizzard of red tape and administrative hurdles will strip people of needed health care, even those who would normally be eligible. GOP lawmakers say they are fine with those consequences, even those who have said they oppose cutting Medicaid benefits, because the requirements will only target the 'able-bodied' people who should be working but choose not to. Groups such as the disabled, pregnant women and people who are in prison or rehabilitation centers would be exempt from the requirements. Those people, Republicans say, are the truly needy. But someone who qualifies would need to prove they are exempt, which would require submitting the correct forms and documentation — in the correct order — at the time they apply for Medicaid and after they are already enrolled. Outside of work requirements, the legislation requires states to do an extra eligibility check on Medicaid enrollees starting in 2027. Checking every six months opens the possibility of a person losing coverage mid-year. The bill will also require people with incomes above the poverty line to pay out-of-pocket copays for most Medicaid services, like lab tests or doctor visits. States will be allowed to charge up to 5 percent of a person's income per year, though some Democratic-led states may opt for a smaller amount. Primary care, mental health and substance abuse services are exempted, and prescription drugs would only have a nominal copay. The bill could also limit the number of clinics available to patients who need abortions, even in states where it's legal. It targets Planned Parenthood without explicitly mentioning the organization by banning federal Medicaid funds from going to clinics that offer abortions. Nearly 200 Planned Parenthood health centers in 24 states across the country are at risk of closure, the organization said. More than 90 percent of those closures would occur in states where abortion is legal. The legislation will make it more difficult for people to sign up for and afford health plans on ACA exchanges. It will limit eligibility for premium subsidies to people living in the U.S. who are not eligible for any other federal insurance program. It will also bar most immigrants and lawful permanent residents from receiving the subsidies. The bill will require real-time verification of eligibility before a person can receive those subsidies to help afford premiums. Currently, anyone who purchases a subsidized plan can begin using it almost immediately. The state or federal government has 90 days to determine eligibility. But under the new bill, people won't have access to cheaper premiums until they are deemed eligible. In addition, people who sign up for ACA coverage during some special enrollment periods will not be eligible for subsidies. The bill will also end automatic reenrollment ahead of the 2028 sign-up period, meaning enrollees will need to update their income, immigration status and other information each year. According to health research group KFF, 10 million people were automatically reenrolled in ACA plans in 2025. The GOP bill could pose a major problem for rural hospitals, and subsequently the patients who rely on them. Changes to state-levied provider taxes would reduce spending by nearly $191 billion over a decade, according to the CBO estimate. An analysis of an earlier version introduced in the Senate by the National Rural Health Association and Manatt Health found the legislation generates $58 billion in Medicaid cuts over the next ten years for rural hospitals. The bill that passed includes a five-year, $50 billion rural health relief fund, but provider groups say it's a band-aid compared to the overall cost of the cuts. Hospitals would see a spike in uncompensated care and overcrowding of emergency rooms. 'Millions of Americans will see their health care coverage vanish through burdensome Medicaid work requirements and other eligibility changes throughout the bill. Hospitals across the country have been destabilized, affecting their ability to serve patients and their communities. We are in a crisis,' said Bruce Siegel, president and CEO of America's Essential Hospitals, a group that represents hospitals serving primarily low-income patients. 'Widespread coverage losses plus weakened hospitals is a recipe for disaster, and patients will pay the price.'
