Medicaid cuts are putting hospitals like ours at risk

In the heart of rural America, hospitals are lifelines. We are not just places of healing—we are economic engines, trauma centers, mental health support systems, and, increasingly, the only safety net for our most vulnerable neighbors. And yet, at this critical juncture, we face a crisis that threatens our very survival: Medicaid cuts.

For rural hospitals like Washington County Hospital and Clinics (WCHC), Medicaid is not a line item—it is a cornerstone. Roughly one in five Americans relies on Medicaid, but in rural areas, that percentage is significantly higher. In Iowa and many other states, Medicaid covers a disproportionate share of children, seniors in long-term care, and working adults struggling to make ends meet. When policymakers in Washington or state capitals slash Medicaid funding or narrow eligibility, they are not making abstract budgetary decisions—they are turning off the oxygen for rural health care.

Rural hospitals operate on razor-thin margins. Unlike larger urban systems with diversified service lines and philanthropic cushions, we rely heavily on government payers. At WCHC, over 60% of our patients are covered by either Medicare or Medicaid. Private insurance is rare, and charitable donations, while deeply appreciated, are not enough to offset a multimillion-dollar shortfall.

When Medicaid reimbursements fall short of the cost of care—as they routinely do—we absorb the loss. But we can only do so for so long. Cuts to Medicaid don’t just affect our ability to offer new programs or upgrade equipment; they force decisions about whether we can keep our maternity ward open, retain emergency services, or offer mental health care. These aren’t just services—they are lifelines.

Medicaid cuts are often framed as budget-balancing necessities, but they come with an overall cost to the health of the community. When coverage is stripped or access is narrowed, patients delay care until it becomes an emergency. Chronic diseases go unmanaged. Mental health crises deepen. Preventable conditions become fatal. The result is not cost savings—it is cost shifting, often to emergency rooms, law enforcement, and social services that are already stretched thin.

At WCHC, we’ve seen firsthand the difference Medicaid can make. A diabetic patient who receives consistent monitoring and affordable insulin under Medicaid is far less likely to end up in our ICU with kidney failure or sepsis. When we lose that capacity to manage health upstream, we all pay downstream—in both dollars and lives.

What’s happening to rural hospitals is a warning sign for the entire health care system. Since 2010, over 140 rural hospitals have closed, and hundreds more are at risk. The erosion of Medicaid support only accelerates that trend. As rural hospitals close, communities lose not just health care access but jobs, tax revenue, and the very infrastructure that keeps them viable.

This isn’t just a rural issue—it’s an American issue. When a town loses its hospital, the ripple effects touch everything from school enrollment to real estate values to business investment. A nation that allows its rural hospitals to wither is a nation that abandons its heartland.

As policymakers debate budgets, I urge them to remember that Medicaid is not a luxury—it is a lifeline. Protecting and expanding Medicaid is not just good policy; it is a moral imperative. We must invest in the people and institutions that care for our most vulnerable, especially in the places that need it most.

At Washington County Hospital and Clinics, we will continue to fight for our patients, our staff, and our community. But we can’t do it alone. We need state and federal leaders to stand with us—not just in words, but in funding priorities.

Because without Medicaid, the future of rural health care—and the communities we serve—hangs in the balance.