How Trump’s healthcare cuts have providers, patients scrambling

Modern Healthcare – Wednesday, September 3, 2025
By Michael McAuliff

John Keating doesn’t think he’d be alive today if he’d gotten sick under President Donald Trump’s “One Big Beautiful Bill.”

His reasons are the same ones keeping healthcare leaders in rural Adams County, Pennsylvania, up at night as they scramble to confront potentially catastrophic consequences from the tax law just over a year from now, when more than $1 trillion will begin disappearing from the healthcare system.

“It boils down to one simple thing,” Keating said in the kitchen of his trailer in Biglerville, about seven miles from WellSpan Gettysburg Hospital, where he goes for care. “If the ‘Big Beautiful Bill’ had been around at the time I had been diagnosed with heart failure, I’d probably be dead now. In fact, I’m sure I’d be dead.”

Keating is 65 now, making him eligible for Medicare. But over the last decade, he has been exactly the type of person healthcare experts warn will lose health coverage because of the Medicaid restrictions Trump signed into law in July while extending his 2017 tax cuts.

Keating was in his 50s when he was diagnosed. He recalls the output from his heart was less than half of what it should have been at the time. The former runner and weightlifter could barely walk 20 feet. He struggled for years as an independent design contractor and couldn’t afford health insurance.

Then Medicaid expansion from the Affordable Care Act of 2010 came along, and he was able to enroll. He became, for the past decade, an exemplar of who the work requirements in Trump’s law target. He was often unable to walk much, let alone work or volunteer 20 hours a week, as the new law will require. Yet he would be deemed an “able-bodied” adult, and stands to lose his benefits.

Even with charity care from the hospital or a community health center, Keating said there’s no way he could afford the $1,800 a month his prescription medications cost. “There are some of those drugs I have to take every single day and never miss or I’m going to end up in the hospital,” he said.

“As soon as I stop taking those drugs, my blood pressure goes up, my heart rate goes out of control and, within days, I would stroke out and die,” Keating said.

The likelihood that people like Keating are going to lose Medicaid coverage when the new work requirements kick in — and will still need medical care — is front of mind for healthcare providers and state officials.

Pennsylvania Secretary of Human Services Dr. Val Arkoosh said there are 15,782 people in Adams County on Medicaid. In the 13th Congressional District, where nearly a quarter of the district’s residents are on Medicaid, the office of Pennsylvania Gov. Josh Shapiro (D) estimated more than 17,000 will lose Medicaid, among 310,000 who stand to lose coverage across the state.

Rep. John Joyce (R-Pa.), who represents the 13th district and won 74% of the vote in 2024, supported the tax bill. In the presidential race, Trump trounced then-Vice President Kamala Harris 72%-27% in the district. Adams County voters favored Trump by a 66%-33% margin.

Arkoosh said the people losing care would be folks like Keating, or a woman the state official and anesthesiologist met, who was working 15 hours a week while helping to care for a sick relative, or even farmers who work for themselves.

“They don’t have a pay stub, right? How do we validate that a farmer has been working 80 hours a month?” Arkoosh said.

Pennsylvania is already focused on these issues, Arkoosh said, and is learning from the ongoing implementation of work requirements in the Supplemental Nutrition Assistance Program that is happening sooner. Officials are talking to providers and advocacy groups across the state about what to expect, as far as officials know.

The tax law gives the U.S. Health and Human Services Department until the end of this year to issue guidance to states on work requirements, and one more year to put them in place.

This leaves healthcare providers facing enormous uncertainty about the scope of what they will encounter, particularly in rural areas like Adams County.

They are trying to control what they can.

AI and robots

WellSpan Health, which operates nine hospitals in south central Pennsylvania, was already aggressively pursuing ways to improve care and cut costs, particularly through technology, executives at the York-based nonprofit health system said.

In Gettysburg, WellSpan Health acquired a pair of robotic surgery machines over the past year that allow doctors to perform more procedures — from appendectomies to knee replacements — more quickly, more safely and with shorter recovery times, said Courtney Fogal, a registered nurse, director of clinical services and operating room manager at WellSpan Gettysburg Hospital.

Stacey Gorman, another director of clinical services at the Gettysburg facility who works out of a room affectionately nicknamed “the bunker,” said for the past year the health system has ramped up the use of virtual nursing stations and the artificial intelligence platform Artisight to help nurses focus on patients. Monitoring and bureaucratic work, such as half-hour-long patient discharges, now can be handled remotely, she said.

“They don’t have competing priorities, so they can take as long as they need to to make sure that that patient’s safely discharged,” said Gorman, a registered nurse.

Hippocratic AI’s Ana is another system Gettysburg has embraced, Chief Medical Officer Dr. Paul Dende said. The cuts from the One Big Beautiful Bill raised the urgency of finding solutions, he said.

“It spurred us on to continue to really accelerate that,” Dende said. “We’re just gearing up in anticipation.”

They’re also doing the healthcare administrators’ version of doomscrolling, running the math through spreadsheets and wondering what they may have to sacrifice, or where they might have to spend more.

WellSpan Health Vice President and WellSpan Gettysburg Hospital President Michael Cogliano points to technological advancements the hospital has invested in, such as da Vinci and ROSA surgery robots, with pride. But he acknowledged that lost revenue and a spike in uncompensated care is a threat to sustaining these efforts.

“The costs are rising. They’re not getting any cheaper, right? And the money that we get, of course, is decreasing,” Cogliano said. “It’s a tough equation to manage.”

One avenue for coping with the more Medicaid red tape may have to be hiring more staff just to deal with more patients showing up without health coverage.

WellSpan Health already has case workers who try to link uninsured patients to assistance or work out discounted self-pay plans so they can still afford rent and food, Cogliano said. But new systems are likely to be created to meet the new governmental requirements, and the staff that deals with them could need bolstering, or at least more training.

“It’s important to make it as invisible as possible to our patients so that they can consistently rely on the care that they receive here or at any of our facilities, and so that they don’t have to worry about that,” Cogliano said. “That’s a burden for us, to make sure we’re focused on that, and in the background do all the business.”

Safety-net anxiety

Providers who focus on poorer populations are likely to face worse impacts.

Jenny Englerth, the CEO of York-based Family First Health, a federally qualified health center that serves the area, expressed similar goals as her hospital counterparts. But rural community health center margins are even slimmer than health systems’, and the years since the COVID-19 pandemic have been lean.

Like WellSpan Health leaders, Englerth has been looking at technology and systems that could help her stay ahead of the curve. She’s also considering new lines of business, such as speciality care, that could generate revenue.

Englerth said her goal is to maintain her organization as a fully equitable care provider for any patient, and not get reduced to a second-tier, last resort.

“We don’t want to see ourselves in situations where our sites or our services become second class for people who are less advantaged. But I don’t know that we’ll be able to keep up in the way we’ve been able to keep up to date,” Englerth said.

Since nearly half of Family First Health patients are on Medicaid and many more are on Medicare, a lot of what she must provide is governed by state and federal regulations. That constrains Englerth’s choices. Family First Health can’t drop certain services and must provide uncompensated care even when federal funding is flat or diminished.

Family First Health’s three largest costs are labor, technology and employee health benefits. There isn’t a lot of wiggle room there, but Englerth said she could look at partnering with other groups to bring down insurance costs.

To maintain quality with declining revenue, a likely path would be cutting back at more remote clinics.

“It will be a mix of revenue generation and cost reduction. Can we keep all the sites open that we have now? I don’t know, but who suffers most in that will be our small, rural sites,” Englerth said.

One last option is to keep on pleading with state and federal legislators to soothe the pain the tax law will deliver healthcare providers.

Hospital Association of Pennsylvania President and CEO Nicole Stallings said the state could alleviate staffing shortages and labor costs through loan and workforce retention programs. Updating decades old regulations would help, too, she said.

Providers also can’t let lawmakers forget about other policies the hospital sector opposes, such as proposals to implement site-neutral Medicare payments for outpatient services or to refashion the 340B Drug Pricing Program.

“My biggest fear is that lawmakers don’t understand the significance and the ripple effect that these cuts will have when fully implemented,” Stallings said. “I hope we will utilize this timeline to really mitigate those changes and ensure that we’re providing and protecting access to care in communities.”

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