One of the most divisive portions of President Donald Trump’s tax and spending cut bill is the apparent reshaping of Medicaid, which could complicate health care in rural America.

“The 'big, beautiful bill' is anything but beautiful,” said Healthcare Association of New York President Bea Grause. “It’s going to be a catastrophe.”

What You Need To Know

  •  Critics of President Donald Trump's tax and spending cut bill say there will be detrimental impacts on health care in rural America

  •  The nonpartisan Congressional Budget Office reports the plan will cut more than $1 trillion from Medicaid and Affordable Care Act marketplaces

  •  The CBO predicts nearly 12 million Americans could lose insurance by 2034 which experts say could strain hospitals, nursing homes and community health clinics

Most of the Empire State is considered rural. In 2023, according to a report compiled by the Georgetown University McCourt School of Public Policy, about 34% of non-elderly adult New Yorkers living in small towns were covered by Medicaid. It’s why the idea of cutting federal spending on the program is raising red flags across the political spectrum and country.

The nonpartisan Congressional Budget Office reports the plan cuts more than $1 trillion from the program and Affordable Care Act marketplaces. The plan requires able-bodied adults to work at least 80 hours per month until age 65 to qualify. It also caps and gradually reduces the tax states can impose on Medicaid providers.

“Over a million individuals in New York are going to lose their coverage,” said New York Health Plan Association President and CEO Eric Linzer. “It’s going to result in much higher premiums for those who remain covered.”  

The CBO predicts nearly 12 million Americans could lose insurance by 2034. Experts say providing care to more uninsured individuals will strain hospitals, nursing homes and community health clinics financially, rural facilities in particular.

“Hospitals, whether it’s a rural, suburban or urban county, are often the economic centers of their communities,” Grause said. “We expect there will about 60,000 jobs that will be lost.”

Health professionals say in a state like New York, with so much rural area, a reduction or loss of health services would be hard to contend with.

“At a time when everybody is so focused on affordability, this runs in the exact opposite direction and really undermines efforts to make health care much more affordable and accessible,” Linzer said.

Lawmakers on Capitol Hill, aware of the need and risks, worked to cushion the blow on rural facilities. As of Tuesday, the legislation dedicates $50 billion to support these facilities starting in 2026.

“We will continue to fight the provisions that we believe threaten the access to health care for all New Yorkers,” said Grause.

The CBO predicts, overall, it will add more than $3 trillion to the deficit over the next 10 years. Trump maintains the bill holds up several campaign promises and believes the U.S. stands to make “a fortune” and “more” than any of its competitors.