Why a GOP senator says the budget bill breaks Trump's promise
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Does the massive budget bill that Senate Republicans are currently debating keep a promise or break one? It makes permanent tax cuts passed during President Trump's first term and adds some new cuts, which is something Trump ran on. My plan is to make the Trump tax cuts permanent. They are massive tax cuts, biggest ever, permanent.

And to cut taxes even more. But Trump has repeatedly made another promise since he entered office. We're not cutting Medicaid. We're not cutting Medicare. And we're not cutting Social Security. None of that stuff is going to be touched. Nothing. You don't have to. We're going to love and cherish Social Security, Medicare, Medicaid. We're not going to do anything with that. I mean, I have said it so many times, you shouldn't be asking me that question.

Well, the Republican bill pays for some of its tax cuts through hundreds of billions of dollars in cuts to Medicaid spending. The latest report from the nonpartisan Congressional Budget Office estimates nearly 12 million people will lose health insurance if the Senate version of the bill becomes law.

Trump insists the cuts come from eliminating waste, fraud and abuse. Democrats have said they break Trump's promise not to touch Medicaid. Over the weekend, a Republican senator agreed. 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 because the funding's not there... In a blunt floor speech, Senator Tom Tillis of North Carolina attacked the bill hours after he announced he would not seek re-election.

One of Tellis' big concerns was what the bill would mean for rural areas of his state and the hospitals that serve them. He urged his colleagues not to rush it through. How hard is it to sit down and ask the Medicaid office, ask the legislative staff, ask the Independent Hospital Association what the impact is? If there's no negative impact, what's wrong with daylight? What's wrong with actually understanding what this bill does?

Consider this. In rural parts of the country, Medicaid covers one in four adults. What would Republicans' Medicaid cuts mean for them? From NPR, I'm Juana Summers.

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It's Consider This from NPR. Roughly 20% of the U.S. population lives in rural areas. That's the population that Sarah Jane Tribble's reporting focuses on. She's the chief rural correspondent for KFF Health News, and I sat down with her to talk about what the Republican budget bill could mean for health care for people who live in rural areas.

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. 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'd 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. 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. Well,

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 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. 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?

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 Rural Transformation Fund won't just go to rural hospitals. It'll go to 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. The White House put out a fact sheet yesterday making the point that

The bill will not cut Medicaid. The fact sheet calls it a myth that the bill will close rural hospitals. How do you parse those claims?

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, 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 in these rural communities. Right.

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.

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, providers tend to leave the area. Sarah-Jane Tribble is the Chief Rural Correspondent for KFF Health News. Thank you so much. Thank you for having me.

This episode was produced by Catherine Fink and Connor Donovan with audio engineering by Tiffany Veracastro. It was edited by Christopher Antoliana. Our executive producer is Sammy Yenigan. It's Consider This from NPR. I'm Juana Summers.

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