To hear Republicans tell it in the spring, the only people who would notice the $1 trillion cut to Medicaid in President Donald Trump’s “big, beautiful bill” were fraudsters, grifters and cheats.
“They’re looking at waste, fraud and abuse. But we’re not cutting Medicaid,” Trump told “Meet the Press” in May as Congress debated the bill.
By July, congressional Republicans passed deep cuts to Medicaid, food stamps, and other safety net programs to pay for tax cuts, increased defense spending, and immigration crackdowns.
U.S. Rep. Buddy Carter, the Republican from Pooler who chaired the House subcommittee that recommended the health care cuts, had the same message in an interview with “Politically Georgia” as he kicked off his Senate campaign in the spring.
“We’re not kicking anyone off Medicaid,” he said. “The Democrats are fearmongering.”
Credit: Arvin Temkar/AJC
Credit: Arvin Temkar/AJC
Carter said the fraud was coming from people who were getting Medicaid benefits from two states at once or “able-bodied people” who shouldn’t have been on the rolls at all. “We need to make sure we save that program, and we can do that,” he said. “We can cut waste, fraud and abuse.”
Not only did Carter support the Medicaid cuts in the bill — he said he would have liked to see the cuts go deeper in the program that covers half of all births, 70% of nursing home patients and 2 in 5 children in Georgia.
But just months after the bill passed, and years before the most drastic cuts are scheduled to go into effect, the looming changes are already being felt by entire rural communities, whether patients there are on Medicaid or not.
That’s because rural hospitals in Georgia say the federal health care spending cuts in the bill, along with scheduled cuts to Affordable Care Act subsidies, are forcing them to make difficult choices now they never wanted to contemplate.
Those choices are affecting all of the patients they serve, no matter what kind of insurance they are on, as hospitals evaluate cutting local services or closing altogether.
The first Georgia hospital to announce a significant budget shortfall was Evans Memorial Hospital in Claxton. The 49-bed facility in Carter’s southeast Georgia district was named “Hospital of the Year” in 2022 by Hometown Health, a rural health association.
But CEO Bill Lee said Evans Memorial expects cuts to federal spending will leave the hospital with a $3.3 million hole in its budget in 2026. The most likely place to start to make up the difference would be cuts to its new intensive care unit.
Lee spoke at a press tour of the hospital arranged by Democratic U.S. Sen. Raphael Warnock. But the hospital leader said his decision to speak out wasn’t about partisan politics.
“This is about relevance and survivability,” he said.
Credit: Adam Van Brimmer/AJC
Credit: Adam Van Brimmer/AJC
“Survivability” was the same goal at St. Mary’s Sacred Heart Hospital in Lavonia when it announced two weeks ago that it will close its labor and delivery unit by the end of October. Among several reasons the hospital pointed to for its decision were the congressional cuts to Medicaid.
Along with the Mother-Baby unit at the hospital, St. Mary’s said it will also discontinue its local OB-GYN services and transfer them all to Athens, about a 45-minute drive away.
The changes don’t just mean doctor appointments will be harder for pregnant women to get to. A local pregnancy center staffer told the AJC’s Michelle Baruchman they’re afraid of what it will mean for women’s health and safety without a labor and delivery unit in the area at all.
“Our fear is there’s going to be highway deliveries. There’s going to be women on the side of the road having babies and no prenatal care.”
St. Mary’s Hospital sits in U.S. Rep. Mike Collins’ district. Like Carter and all of the Republicans in Georgia’s House delegation, Collins voted for the “big, beautiful bill” too, as did U.S. Rep. Andrew Clyde, R-Athens. But Clyde only supported the bill after opposing it over a gun rights issue.
Credit: Nathan Posner for the AJC
Credit: Nathan Posner for the AJC
Like Carter, Clyde said the cuts to Medicaid should have been deeper, arguing it should serve only the most vulnerable, namely mothers, children, older adults and disabled people.
But who uses an intensive care unit in Evans County more than older adults and people with disabilities? And who relies on a labor and delivery department in rural Franklin County other than women and babies? No matter what kind of health insurance people in those counties have, their access to critical services in their communities could be gone for good.
Fear of closures like the ones in Georgia was the reason some Republicans pushed to include a $50 billion rural health care fund in the bill to bolster rural hospitals. But that’s just a fraction of the nearly $140 billion of federal cuts expected to hit rural areas across the country from the bill.
The conventional wisdom around the “big, beautiful bill” when it passed was that it would mostly have political upsides for Republicans, since the popular tax cuts in the measure were front-loaded, while the cuts to Medicaid were delayed until after the midterm elections.
But hospitals plan their budgets years out, so delaying the Medicaid cuts didn’t mean delaying the reality of rural Georgians being hurt, no matter their health coverage, even before the cuts take effect.
Time will tell us more about who will really get tossed off the Medicaid rolls, other than the grifters, fraudsters, and cheats, once proof-of-work requirements go into effect at the end of 2026. But at the moment, it looks like the most fraud, waste and abuse that the “big, beautiful bill” has revealed is the sales job that came with passing it in the first place.
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