Rural hospitals will have to scale back services or close altogether should the Senate pass President Donald Trump's Big Beautiful Bill, according to a new report from Families USA and rural health providers in West Virginia and Iowa.
The Senate is facing a Friday deadline to vote on the spending bill to meet the goal of getting it done before leaving for a July 4 recess. Senators are reportedly at odds over the Medicaid spending cuts while conservatives want to see more slashed from the budget.
A Senate GOP aide told The Hill, "I think it's highly unlikely at this point that we vote on this thing by July 4. I think there is too much work to do."
While Republicans are looking to jam through the Big Beautiful Bill this week, rural hospitals want lawmakers to reconsider, according to Anthony Wright, executive director of Families USA, speaking during a press conference on Monday.
The Senate version of the bill includes steeper cuts to Medicaid than the projected $715 billion in the House bill that passed in May.
Republicans and Health and Human Services Secretary Robert F. Kennedy Jr. said they are looking to rein in waste, fraud and abuse in Medicaid by ending enrollment for illegal immigrants and healthy Americans.
The financial bottom line for hospitals is that the bill would cause an estimated 16 million people to lose health insurance coverage, according to Wright. This affects all hospital reimbursement but especially hits rural hospital finances. Medicaid is often the highest line item in rural budgets, he said.
A Families USA report looked at the impact of two Medicaid changes that are included in the Senate Finance Committee bill: work requirements and six-month eligibility checks for beneficiaries living in Medicaid expansion states.
Based on these two provisions, if the bill passes, an additional 55 hospitals would have negative net incomes, said Sophia Tripoli, senior director of Health Policy at Families USA. It would leave 380 independent rural hospitals across 26 states at serious risk of closure, she said, citing the report. Rural hospitals would be forced to cut back on care or close altogether.
Among those 55 additional hospitals at risk of closure, two are in Iowa, two are in Maine, four are in Missouri, four are in Nebraska, two are in North Carolina, five are in Ohio and one is in West Virginia.
WHY THIS MATTERS
The bill would impact every West Virginian, said Rich Sutphin, executive director of the West Virginia Rural Health Association. Patients would lose access to care as revenues dwindled to negative margins, he said.
"We're going to see hospital closures," Sutphin said.
Additional beneficiaries in Medicaid expansion states would lose coverage due to the bill's provision of verifying eligibility every six months, said Rhonda Rogombe, Health and Safety Net Policy analyst for the West Virginia Center on Budget and Policy. This wouldn't be entirely attributed to people not meeting verification standards, but because of the additional paperwork.
This happened, Rogombe said, at the end of the Public Health Emergency for COVID-19, during the "unwinding" of coverage and the re-enrollment of qualified individuals. Rogombe was involved in verifying eligibility.
"Additional paperwork, people tend to drown," she said.
Anne Discher, executive director of Common Good Iowa, said nearly 270,000 rural residents in the Medicaid expansion state are covered by Medicaid, including working families.
Rich Whitaker, CEO of the Vera French Community Mental Health Center in Davenport, Iowa, said Community Health Centers would lose funding.
THE LARGER TREND: REPORT FINDINGS
Independent rural hospitals could lose an estimated $465 million in total patient revenue in 2026 due to federal Medicaid cuts, an average loss of $630,665 per hospital.
Independent rural hospitals could lose on average 56% of their yearly net income due to these revenue losses.
Since 2005, 195 rural hospitals have closed nationwide, with an additional 742 rural hospitals at risk of closing.
Email the writer: SMorse@himss.org