Medicaid cuts in Trump’s Big Beautiful Bill could cripple some of Arizona’s rural hospitals

WASHINGTON – Large cuts to Medicaid in the massive tax and spending plan that Republicans are finalizing could deal a major blow to Arizona’s rural hospitals, threatening services for tens of thousands of residents.

The version that narrowly passed the Senate Tuesday would lop $930 billion over the next decade, the biggest cut in the program’s history.

The impact wouldn’t be confined to those forced off the state-federal program, because lost revenue from those patients would make it harder for some facilities to stay open.

“What it’s going to do to rural health care in Arizona is destroying it,” said Neal Jenson, CEO of Cobre Valley Regional Medical Center in Globe, 70 miles east of Phoenix and the seat of rural Gila County.

About a third of Cobre Valley’s patients are on Medicaid, he said, and “anytime you jeopardize a third of your payer base, you will have a significant impact.”

Vice President JD Vance cast the tie-breaking vote on the “Big Beautiful Bill” after three Republicans revolted. The House version also passed by a single vote, with two GOP defections. The House will return from recess early to vote Wednesday on the Senate’s changes.

“I think it will be easier in the House than it was in the Senate,” President Donald Trump told reporters Tuesday while visiting a migrant detention center in Florida.

He wants the bill on his desk by Friday and had threatened to support challengers to any Republican who opposed it.

But some House Republicans remain uneasy, among them Rep. Juan Ciscomani, R-Tucson.

C.J. Karamargin, a senior advisor, said Saturday – before the Senate vote – that Ciscomani does not approve of the provider tax reduction and other Medicaid cuts in the Senate bill which would “greatly and negatively impact Arizonans.”

Karamargin emphasized that Ciscomani opposed those provisions when the House debated the bill.

The House plan, approved May 22, would cut $800 billion – enough to put five Arizona hospitals at risk of closing, according to an analysis from University of North Carolina researchers.Those five are Page Hospital in Page, Winslow Memorial Hospital in Winslow, Copper Queen Community Hospital in Bisbee, Carondelet Holy Cross Hospital in Nogales and Cobre Valley Regional Medical Center in Globe.

In Arizona alone, rural hospitals stand to lose $1.2 billion over 10 years under the Senate version, according to estimates from the National Rural Health Association.

Even those rural hospitals that stay open could be forced to cut back. People with private insurance would also face delayed emergency care or long drives for maternity care and other services.

“It’s not just for Medicaid patients,” said Ann-Marie Alameddin, president and CEO of the Arizona Hospital and Healthcare Association. “It’s for all patients.”

The Senate vote came after 27 hours of debate over the weekend and overnight Monday. Republican Sens. Thom Tillis of North Carolina, Susan Collins of Maine and Rand Paul of Kentucky voted no.

The Medicaid cuts were a sticking point for Tillis and Collins and some other Republicans who ended up going along with the party. Paul objected to the massive expansion of deficit spending.

To appease some holdouts, GOP leaders beefed up a rural hospital relief fund from $25 billion to $50 billion.

But that is at most two-thirds of what Arizona hospitals stand to lose, according to the National Rural Health Association estimates.

Democrats have been hammering Trump and other Republicans over the proposed cuts.

“Where do women who live in the area go to have a baby?” Sen. Mark Kelly, the Arizona Democrat, said recently, calling cuts to Medicaid “a big mistake.”

A hospital in Pinetop-Lakeside in rural northeast Arizona told him it would have to close its obstetrics and gynecology services, he said, meaning that women in that area would “have to travel two or three hours to have a baby.”

Medicaid cuts would hit rural hospitals especially hard because so many of their patients rely on the program: 36% of working-age adults in rural Arizona compared to 17% in urban areas, according to research from Georgetown University.

Alameddin said rural hospitals are already struggling because Medicaid underpays providers – 88 cents for every dollar spent on Medicaid patients, according to 2020 estimates from the American Hospital Association.

Most hospitals rely on patients with private insurance to break even.

But rural hospitals don’t have enough of those patients to make up the difference, Alameddin said.

Arizona’s Medicaid program, known as the Arizona Health Care Cost Containment System (AHCCCS), serves about 2,156,000 people, including 754,600 children, 194,040 seniors and 172,480 people with disabilities, according to KFF.

The state receives $17.9 billion in federal Medicaid funding annually.

Since 2010, two rural hospitals stopped offering in-patient services in Arizona and two others closed, for a loss of 135 beds.

Nearly half of all rural hospitals operate at a loss, said Carrie Cochran-McClain, chief policy officer at the National Rural Health Association, so in terms of reliance on Medicaid funds there is “very little wiggle room.”

Each of the five hospitals identified by the UNC researchers lost money for the past 3 years.

All five are considered Critical Access Hospitals—a designation created by Congress after hundreds of rural hospitals closed in the 1980s. Closures at such hospitals would have an outsized impact because the next nearest hospital is at least 35 miles away.

Many are also the largest employer in a region, Alameddin said, and they are the “primary access point for health care for everybody in that community.”

Jenson said Cobre Valley loses more money on obstetrics than on any other service, but it’s a 90-minute drive to the next nearest hospital with obstetrics.

“I’m not going to put mothers on the highway,” he said.

The proposed Medicaid cuts would make the “maternal health desert” in rural Arizona even worse, said Daniel Derksen, director of the Center for Rural Health at the University of Arizona.

One Senate provision caps “provider taxes” that every state but Alaska levies on hospitals and other providers. States use the revenue to finance their share of Medicaid and they can trigger higher federal reimbursements through higher provider taxes.

The cap would cut the reimbursement for Arizona and other states by hundreds of billions of dollars, according to the CBO.

The Senate parliamentarian stripped that provision last week but GOP senators found a way to sidestep her ruling.

The Senate GOP plan hinges partly on that savings to offset tax cuts.

Other provisions would make it harder to enroll or stay on Medicaid, including an expanded work requirement.

The measure is likely to play an important role in the 2026 midterms.

Republicans will cite the tax cuts and other elements as a major achievement.

Democrats also view the bill as a political boon.

A fund-raising email blasted out Tuesday afternoon warned that “17 million people will lose health care coverage, and 5 million are at risk of losing food assistance” under the bill.

The party’s House campaign arm has been attacking Ciscomani and two other Arizona Republicans it hopes to topple next year over their support for the bill: Reps. David Schweikert of Fountain Hills and Eli Crane of Oro Valley.

“Their vote will have devastating consequences for Arizona families and hospitals – and voters will hold them accountable,” said Lindsay Reilly, spokesperson for the Democratic Congressional Campaign Committee.

This article was originally published on Cronkite News