Beyond the Politics: What a Trillion-Dollar Healthcare Cut Means for Our Community
Congress has passed the budget reconciliation act known as the One Big Beautiful Bill Act (OBBBA). The bill includes much more than just budgetary items and is considered quite controversial by many on both sides of the aisle. Among the disputed elements are significant changes to Medicaid. Let's look at the anticipated impacts of these changes.
The OBBBA cuts Medicaid and the Affordable Care Act (ACA) by about a trillion dollars over the next 10 years. According to the nonpartisan Congressional Budget Office (CBO), this will threaten the physical and financial health of tens of millions of Americans and will reverse many previous gains in healthcare access. An estimated 12 million citizens will lose coverage through the ACA alone by 2034.
Some are expected to lose Medicaid access as the result of implemented work requirements. This provision will most impact states that have expanded Medicaid. Since Texas is among the 10 states that haven't expanded Medicaid, work requirements in all their complexity will not be a focus here beyond noting that work requirements are controversial and expected to exclude many from Medicaid access due to extensive paperwork requirements and gaps in the broader understanding of who is able-bodied and capable of working regularly.
Rural Areas Face Greatest Impact
Experts universally agree the OBBBA's changes to Medicaid will most damage rural areas because they typically operate with thinner financial margins and have greater difficulty attracting healthcare providers. These provisions include the cap placed on already low Medicaid payment rates and the mandated restriction of the use of provider taxes (which are used to supplement Medicaid's low payment rates). The outcome will be less money paid to hospitals, nursing homes and other medical providers. According to experts in the field, less income for healthcare providers translates to less staffing, fewer services provided and additional closures.
The OBBBA also mandates increased copayments for some Medicaid recipients. Studies show low-income individuals often forgo care to avoid premiums, so this is expected to result in worsening health outcomes as well as higher medical costs for Medicaid recipients when they must eventually seek services. The predictions of healthcare experts for the quality of healthcare in rural America as a result of these increased financial challenges range from dismal to catastrophic.
Estimates are that 1.4 to 2 million Texans could lose their healthcare coverage due to Medicaid cuts in the OBBBA. Hospitals and nursing homes, particularly in rural areas, will struggle most with closures anticipated. Currently there are already 74 counties in Texas without a hospital. The health risks to those living in counties without a hospital are already higher and will multiply should neighboring rural counties or communities lose their hospitals as well.
Local Numbers
So what do the numbers look like for this area? Texas had over 4 million Medicaid recipients in 2024, or about 15% of the state's population. These recipients are spread out over 85% of Texas geographically. Texas will lose millions of dollars in Medicaid income over the next 10 years, creating increased physical and financial burdens for millions in the state. In Fayette County, as of February 2025, 17% of Fayette County residents (children, adults and seniors) were enrolled in Medicaid. Fayette County's population in 2024 was 25,488, so approximately 4,333 Fayette County residents are at risk of losing Medicaid assistance. This means most of us almost certainly know and care about someone who is at risk.
Conclusion
This news is concerning, but it is not partisan. Statistics shared are exclusively from either government reports or nonpartisan sources. Those interested in learning more are encouraged to do additional research on this issue. Two good places to start include KFF, one of the leading health policy organizations in the US (https://www.kff.org/medicaid/) and Georgetown University’s report which shows county-level information on Medicaid recipients in Texas (https://ccf.georgetown.edu/2025/02/06/medicaid-coverage-in-texas-counties-2023).