Potential cuts in the Republican's 'One Big Beautiful Bill Act' may endanger healthcare access for as many as 277,000 residents in Kentucky.
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The proposed Republican budget reconciliation bill, known as the One Big Beautiful Bill Act, currently under consideration by Congress, includes substantial cuts to Medicaid and other safety-net programs. These cuts, if enacted in 2025, could have a significant impact on rural healthcare, particularly in areas that heavily rely on Medicaid funding.
The Congressional Budget Office estimates that the bill would reduce federal Medicaid and CHIP spending by about $990 billion over ten years, leading to the loss of health insurance for 16 million Americans, including 277,000 in Kentucky alone. In rural counties, where access to healthcare services is often limited, these cuts could exacerbate existing challenges.
Key provisions of the bill, such as work requirements, more frequent eligibility checks, and immigration-related eligibility restrictions, are designed to reduce Medicaid enrollment. These requirements could be particularly burdensome for rural populations, who may face socioeconomic and logistical challenges in maintaining continuous health coverage.
The bill also establishes a new rural health fund within the CHIP statute, but this fund is separated from CHIP itself and may not be sufficient to offset the broader cuts and access losses in rural areas. Hospitals and providers in rural counties often rely heavily on Medicaid reimbursements and uncompensated care payments related to Medicaid and uninsured patients. The cuts, along with restrictions on provider payments and state funding options, are anticipated to strain rural hospitals financially, potentially increasing uncompensated care burdens or leading to reduced services.
Moreover, emergency room payments for immigrants in Medicaid expansion states could shift costs onto local providers or counties, further straining rural healthcare systems.
Six Nobel laureate economists have signed an open letter opposing cuts to safety-net programs in the budget reconciliation bill, warning that the measure would add $5 trillion to the national debt. Josh Bivens, the chief economist at the nonprofit Economic Policy Institute, predicts that if the bill passes "as is," there will be a significant increase in uncompensated care.
Bivens also notes that the bill would result in a direct transfer of income from vulnerable families to the richest Americans, with tax cuts for those making over $1 million per year amounting to $70 billion. The GOP bill aims to fund Trump administration priorities, including more immigration raids, border wall construction, and extending tax cuts passed in 2017.
In conclusion, the proposed Republican budget reconciliation bill could have substantial negative effects on Medicaid coverage and uncompensated care pressures in rural counties. The bill's provisions, such as work requirements, eligibility restrictions, and Medicaid cuts, could lead to millions of Americans losing health insurance, increasing uncompensated care in rural hospitals and clinics, and worsening health care access and outcomes in these communities.
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