MARY LOUISE KELLY, HOST:
OK, changing gears - the One Big Beautiful Bill that Congress passed last summer is expected to cut more than a trillion dollars from Medicaid over 10 years. Red state lawmakers who worried that cuts that big would shutter rural hospitals inserted special funding for rural healthcare. But as Arielle Zionts from KFF Health News reports, it's not enough to keep critical services open.
JIM WRIGHT: Does he have all the boxes? All the heavy stuff?
ARIELLE ZIONTS: Jim and Carol Wright are moving into a new rental near Rapid City, South Dakota.
J WRIGHT: Well, we've got all the stuff that we need for just living and cooking and also things that I need for dialysis.
ZIONTS: Dialysis is the whole reason the Wrights are here, about 100 miles from their home near Chadron, Nebraska. The hospital there recently closed its dialysis center. Rapid is one of the few places in the region taking new patients. Like most people on dialysis, the 80-year-old retired professor needs treatment three times a week.
J WRIGHT: It's not a matter of, oh, I would like to be there. It's a case that if you don't, you die.
ZIONTS: To reduce the stress and drive time, the couple decided to rent this small house where they'll live on weekdays. Jim's wife, Carol.
CAROL WRIGHT: It's convenient enough, but it's been a big blow.
ZIONTS: Back in Chadron, Nebraska, hospital CEO Jon Reiners says the facility's dialysis center was losing a million dollars a year.
JON REINERS: You watch the trajectory, and the continued loss year over year eventually could threaten everything.
ZIONTS: Most of Chadron's former dialysis patients have Medicare. Reiners said the Federal health program doesn't pay enough to cover costs. Congress included $50 billion in rural health transformation funding in the Big Beautiful Act. Lawmakers added the program to win over Republicans who were worried Medicaid cuts would close rural hospitals. But program rules severely limit states' ability to use the money to keep existing operations afloat.
REINERS: Unfortunately, that comes in the form of new programs.
ZIONTS: So states could start new mobile dialysis units or buy equipment so people can get treatment at home. But the Nebraska clinic just needed money to survive. Reiners said he tried to find a private company to take over, but none were interested.
UNIDENTIFIED PERSON: All right, see you Monday.
LINDA SIMONSON: How was it?
ALAN SIMONSON: OK.
UNIDENTIFIED PERSON: Have a good weekend.
L SIMONSON: How was it today?
ZIONTS: Back in February, Alan Simonson was getting dialysis at Reiners' hospital, a few weeks before the unit closed. Now he and his wife, Linda, are driving more than two hours each way to Scottsbluff. Linda said there were some closer options, but they aren't taking new patients, and others would mean long stretches of road with no place to stop if the Nebraska weather takes a turn.
L SIMONSON: In the winter months, you know, we can start out at Gordon, and, you know, 30 miles down the road, it could be a blizzard.
ZIONTS: It's unclear how many rural dialysis clinics and other services will close because of the big Medicaid cuts, or how the Rural Health Transformation Fund might help. For now, health care providers are trying to find options for their rural patients, like getting dialysis at home or approved for kidney transplants. I'm Arielle Zionts in Chadron, Nebraska.
KELLY: Arielle is with our partner KFF Health News, and this story is part of our ongoing reporting on the rollout of the Rural Health Transformation Program.
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