JUANA SUMMERS, HOST:
Republican lawmakers are racing to pass President Trump's sweeping domestic policy bill before July 4. One of several key obstacles dividing Republican senators is Medicaid, with hundreds of billions of dollars in potential cuts on the table.
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THOM TILLIS: What do I tell 663,000 people in two years or three years when President Trump breaks his promise by pushing them off of Medicaid?
SUMMERS: That's Republican Senator Thom Tillis of North Carolina speaking on the Senate floor yesterday hours after announcing he would not seek reelection. Rural America is poised to be greatly impacted by these proposed cuts. Roughly 20% of the U.S. population lives in rural areas where Medicaid covers 1 in 4 adults. Here to talk about what could be at stake for those communities is Sarah Jane Tribble. She's the chief rural correspondent for KFF Health News. Hi there.
SARAH JANE TRIBBLE: Hi there. Thanks for having me.
SUMMERS: Thanks for being here. Sarah, just start if you can by telling us a bit about what you have been hearing from people in rural communities across this country about these proposed cuts.
TRIBBLE: Yeah, I'm not hearing good things. They're very concerned, because Medicaid rates are so high in rural America, that these cuts will be very detrimental, they'll cause more hospitals to close, they'll tax rural health clinics. I was sitting next to a CEO of a rural hospital from Colorado. He has a 25-bed critical access hospital, the only hospital between the Kansas border and Denver on the Colorado I-70 corridor. And he had been talking about the cuts and not happy about them. And then we heard about the rural transformation fund that the Senate has been working on to sort of help offset the cuts. And he leaned over and he just scoffed. He just said, that's just not going to be enough. So I think that there's a lot of concern out there in rural America.
SUMMERS: Give us some details about some of the types of ways in which rural hospitals could be impacted. Like, I guess I'm trying to figure out how these cuts would work and what they would mean for patients.
TRIBBLE: Well, for rural hospitals, they're specifically already on the line. We've had more than 150 hospitals that have either closed completely or shut down their inpatient beds since 2010, according to UNC Sheps in North Carolina. Another 267 rural hospitals have closed their obstetrics units from 2011 to 2021. So these hospitals are already, you know, showing signs of duress underneath the current health system economics, if you will. And really, Congress has acknowledged this over the years, passing a new Rural Emergency Hospital Act a couple of years ago, trying to help shore up these hospitals.
SUMMERS: Now, Senate Republicans have proposed adding a $25 billion fund for rural hospitals specifically. But, Sarah, is that enough money to actually bridge the gap in funding that we're seeing here?
TRIBBLE: I'm hearing from the experts and organizations that it is absolutely not. The National Rural Health Association estimates that it's only 43% of what is needed for rural hospitals to offset the cuts coming in the Senate proposal, and even worse, that that rural transformation fund won't just go to rural hospitals. It'll go to, you know, health clinics and federally qualified health care centers, community mental health and opioid treatment centers, too, by their estimates. So they really don't think it's enough to offset it.
I should note that I was talking to the chief lobbyist at the National Rural Health Association this morning. You know, they like the idea of a rural transformation fund because rural America needs that. They need new ways of thinking about how to provide care in rural America, what kind of providers there should be, but it definitely doesn't offset the cuts coming to the program.
SUMMERS: The White House put out a fact sheet yesterday making the point that the bill will not cut Medicaid. This fact sheet calls it a myth that the bill will close rural hospitals. How do you parse those claims?
TRIBBLE: Yeah. So when you talk to anybody from, say, Georgetown or some of the other experts out there, they have analyzed the numbers of who's using Medicaid in rural America - say, moms, working-age adults. These are patients of these hospitals. And if you decrease the number of people receiving Medicaid in rural areas, then you're going to decrease the amount of revenue the hospitals and clinics get because they just have less paying patients.
But also, there are some other provisions in the bill that, you know, experts have analyzed as far as work requirements and the provider taxes and state-directed payments. Those all do hit rural America in different ways, especially the expansion states. So, you know, when I - as a reporter, when I'm parsing it, I call the experts and I ask them questions, and they tell me that it's going to hurt these hospitals and these rural communities.
SUMMERS: Sarah, as you pointed out, rural hospitals have been on the decline for years, with many having closed in the last few decades, even more facing risk of immediate closure. I wonder, what does all of this mean for patients? I've heard about how these closures are particularly problematic, for example, for trauma care, cancer treatment.
TRIBBLE: Yeah. So I've done a lot of reporting over the years where I talk to patients who travel long distances for their care, right? I did a story out of New Mexico where they were setting up telehealth services after a hospital had closed its obstetrics units so patients wouldn't have to drive for every single prenatal visit, right? So those are situations that are already sort of on the brink, if you will, where patients are having to drive long distances when they're delivering babies, or even for trauma care, where helicopters have to show up and go significant distances to get people to care. And that's because rural hospitals have been closing and rural care, in general, has been declining over the past couple of decades. There's a lot of places where there's just not enough providers in general. And when a rural hospital closes, you know, providers tend to leave the area.
SUMMERS: Sarah Jane Tribble is the chief rural correspondent for KFF Health News. Thank you so much.
TRIBBLE: Thank you for having me. Transcript provided by NPR, Copyright NPR.
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