President Trump recently signed his major budget package, what he calls his "Big Beautiful Bill,” into law.
The bill cuts $1 trillion in Medicaid funding over the next 10 years, and narrows who can be covered by the low-income health care program.
That will leave as many as 189,000 Missourians without insurance, according to estimates from the Center on Budget and Policy Priorities.
And rural Missouri, where more residents rely on Medicaid than in urban areas, will bear a disproportionate impact from the cuts.
Republican Sen. Josh Hawley — who initially voiced concerns with the bill's Medicaid cuts — ended up voting in favor of it after pushing for the inclusion of a $50 billion “rural hospital fund."
But according to Heidi Lucas, the executive director of the Missouri Rural Health Association, those additional funds won’t offset the impact of the Medicaid losses.
“In any other year, if suddenly $50 billion was put into rural health, we would be celebrating, right? That would be a massive victory,” Lucas said. “Unfortunately, this money is just going to be a drop in the bucket for what's needed.”
Lucas added that the state must apply for the funds by the end of this year, and, if allocated, the money can only be used for certain initiatives. That means it can’t replace what was slashed.
Lucas said rural hospitals have long been operating on “razor thin margins,” and Missouri has seen nine rural hospitals close since 2015.
There are 58 hospitals currently open in rural Missouri. Of those, 25 are at risk of closing, according to a report by the Center for Healthcare Quality and Payment Reform.
Now, they’ll face an increased financial burden of uncompensated care — the cost of required medical services for uninsured patients — which will force staff and service reductions, or closure.
If rural hospitals continue to shutter — which Lucas predicts will happen — rural Missourians may have to travel to urban health centers to get care, which could exhaust those resources further.
According to Lucas, these effects will occur over the next several years, with cuts to services occurring before actual closures.
Still, previous hospital closures are a warning of what might come for other rural areas.
Lucas said that aside from protecting residents’ health, hospitals create jobs and encourage community development, which makes them "the lifeline of a rural community.”
“Why would folks want to stay there if they don't have a place to birth the new generation?” Lucas said. “Missouri deserves better.”
- Heidi Lucas, executive director, Missouri Rural Health Association
