Republicans dismiss warnings on Medicaid cuts, uncompensated care

Modern Healthcare – Monday, June 23, 2025
By Michael McAuliff

Hospitals have beseeched Republicans not to leave them bearing the financial burden of the more than $1 trillion in healthcare cuts they hope President Donald Trump signs into law by Independence Day.

The message doesn’t seem to be breaking through, based on interviews last week with several GOP senators, some of whom seek even steeper spending reductions.

Sen. Ron Johnson (R-Wis.) suggested the hospital sector is exaggerating.

“Hospitals are rolling in the dough,” Johnson said. “I would also say to anybody who’s designed their business model depending on federal government funding: Get a new model.”

Sen. Rick Scott (R-Fla.), former chair and CEO of the for-profit Nashville, Tennessee-based health system now known as HCA Healthcare, likewise cast doubt on the notion that removing more than $1 trillion from the healthcare system would have a negative effect on hospitals.

“I used to be in the business,” Scott said. “People say, ‘Well, my hospital is not doing very well,’” he said. “Give me the financial statements. I’ll be glad to go through them.”

The hospital industry naturally sees things differently.

The One Big Beautiful Bill Act of 2025 would cause health systems to confront $443.4 billion in additional uncompensated care costs over 10 years, according to estimates published Friday by America’s Essential Hospitals, which represents safety-net providers.

That’s because the bill’s cuts to Medicaid, the health insurance exchanges and other programs are projected to result in 10.9 million people losing health coverage, according to the nonpartisan Congressional Budget Office’s analysis of the House-passed version of the legislation. The Senate Finance Committee draft may lead to even greater coverage losses.

Those patients won’t stop going to the hospital. They just won’t be able to pay for their care, and providers already struggling financially can’t afford to shoulder the financial burden, Laura Kaiser, president and CEO of nonprofit St. Louis-based SSM Health, said during a news conference the Catholic Health Association of the U.S. hosted last Tuesday.

“We’ve been pretty good at kind of sucking it up to date. We can’t do it anymore. There’s no additional hidden funds somewhere, monies that we’re all going to suddenly find,” Kaiser said. “We are doing our best based on the mission and the dignity of each person that we serve. But it’s simply not an equation that works.”

It’s a circumstance most lawmakers say they don’t want, but when asked how providers should cope with it, GOP senators had little to suggest.

“I don’t know the answer to that. There’s a lot of problems to work on here,” said Sen. Josh Hawley (R-Mo.), who backs most of the bill but has expressed misgivings about provisions that would limit the provider taxes states use to help finance their share of Medicaid costs.

Republican senators mainly invoked the talking points Trump and congressional GOP leaders repeat: emphasizing waste, fraud and abuse; bemoaning undocumented immigrants getting benefits; and insisting that cutting Medicaid doesn’t hurt anyone on Medicaid.

Some Republican senators suggested the cuts wouldn’t be a problem in their states. GOP Sens. John Boozman (Ark.) and Jerry Moran (Kan.) declined to talk about Medicaid cuts and provider finances. Others ignored the question. A few said cuts should go further, but that there should be a way to protect rural hospitals.

“We don’t want to cut anybody’s benefit,” said Sen. Shelley Moore Capito (R-W. Va.). “This president said that. I’ve said that. But we’ve got to have a system that’s preserved for those who deserve it and are qualified for it, and we’re trying to weed the ones off that aren’t.”

Sen. Mike Rounds (R-S.D.) simply denied that uncompensated care would rise. “I don’t believe that that will be the case, unless you’re talking about undocumented people,” he said.

Under the House version of the bill — which calls for relatively smaller Medicaid cuts than the uncompleted Senate measure — South Dakota hospitals would lose $500 million over 10 years, according to an analysis the left-leaning Urban Institute and the Robert Wood Johnson Foundation published June 13.

Sen. Tommy Tuberville (R-Ala.) said his state would be fine because it did not broaden Medicaid eligibility under the Affordable Care Act of 2010.

“If you did Medicaid expansion, you’re going to have some problems,” Tuberville said. “We in Alabama didn’t expand, so there’s not going to be cuts in ours, and we don’t have as many people on Medicaid.”

The Urban Institute-Robert Wood Johnson Foundation report projects that Alabama hospitals would lose $2.1 billion under the House bill.

Finance Committee ranking member Ron Wyden (D-Ore.) said his GOP colleagues are ignoring a crucial fact: Hospitals are required under the Emergency Medical Treatment and Active Labor Act of 1986, or EMTALA, to treat and stabilize any patient who presents at an emergency department, regardless of ability to pay.

“The dominoes start falling. Under EMTALA, somebody has a medical crisis and needs care — they go to the hospital. Nobody can pretend that that doesn’t ripple through the community,” Wyden said. “If you get so much of that, you have real questions about whether you can keep your doors open.”

Several Republicans conceded that providers in rural areas may need support to deal with the consequences of the healthcare cuts. “There are problems with rural hospitals,” Johnson said.

Johnson and Scott are among those angling to add some form of rural hospital relief fund to the bill. “It’s a legitimate concern, what is happening to rural hospitals in this country,” Scott said.

Sen. John Hoeven (R-N.D.) also expressed interest in targeted assistance to rural providers. “There’s very strong support in our caucus for rural hospitals,” he said.

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