July 30 marked 60 years since the nation’s most popular health care programs, Medicaid and Medicare, were signed into law by President Lyndon Johnson.
Usually, the birthday of these critical programs is an opportunity to commemorate their strong legacy and contributions to the health and economic security of countless Americans. This is especially true in rural areas where jobs are more scarce, poverty more common and access to health care sparse.
But, this year, the birthday of Medicaid and Medicare was more of an occasion for worry than celebration. Recent changes signed into law by President Donald Trump and supported by the whole West Virginia Republican delegation in Washington have strong potential to raise health care costs, take away coverage and drive rural providers like hospitals out of business.
Trump signed the so-called One Big Beautiful Bill Act, a massively damaging piece of legislation that adds over $3.4 trillion to the national debt, on July 4. That huge deficit is largely driven by the trillions of dollars in extended tax breaks and addition of ever-more tax loopholes for corporations that will help the wealthy amass more wealth.
The bill made historically huge cuts to Medicaid to pay for a portion of these tax breaks, an important source of coverage for hundreds of thousands of West Virginians.
The nonpartisan Congressional Budget Office estimates that around 10 million Medicaid recipients will lose coverage under the new law — an estimated 76,438 enrollees in West Virginia are included in that number. Many gained that coverage relatively recently thanks to Medicaid expansion under the Affordable Care Act, which for the first time allowed self-employed contractors, small business people, low-wage workers, veterans and full-time caregivers to get coverage.
Medicaid is jointly funded by our state and the federal governments. In both rural and urban settings, Medicaid provides health care to over 70 million people, or one in five Americans. But in rural communities, Medicaid covers a larger share of the population — one in four people — and plays an even bigger role in the economy since rural hospitals are central to health access and economic activity in these areas. In West Virginia, Medicaid covers 30% of people in rural areas.
For those of us who live in rural communities, the $1.02 trillion cut to Medicaid in the new law will not only cut off access to affordable health care by decimating coverage and forcing the closure of rural hospitals and nursing homes, it will eliminate jobs, deflate economic activity and leave our communities worse off. Seven rural West Virginia hospitals have been listed in this endangered group, many of which are the only source of care for hours in any direction.
People who live in rural communities already experience more health challenges and more poverty than other Americans. They experience higher rates of maternal and infant mortality, chronic diseases, mental illnesses, disabilities and substance use disorders. Demand for Medicaid is also higher because there are fewer jobs and, therefore, less access to employer sponsored health care, as well as more seniors in these areas. Medicaid is the leading payer of long-term care either in nursing homes or home-based care. It’s the leading payer of mental and behavioral health care as well as substance use treatment. And, even with coverage, accessing health care is hard because of long distances, the scarcity of providers, and the closures of rural hospitals in past years.
The truth is that this new law is taking us in a dangerous direction. Given the economic uncertainty in these times, tariffs that are increasing the cost of consumer goods even beyond the already sky-high prices we can’t afford, and the persistent price gouging from drug and insurance corporations, Congress should be expanding Medicaid, not shrinking it.
Every bill that passes into law should prioritize average working people above wealthy households and Wall Street corporations that are already making money hand over fist on the stock market, all while the rest of us are clipping coupons and pinching pennies.
While everyone loves a tax break, the modest tax breaks that will come to working and middle class families under this new law won’t be enough to compensate them for the increased cost of health care or the loss of coverage that many will face.
The ugly truth about this bill is that when it comes to health care, there’s not much to celebrate.
