Brown: Trump’s Medicaid cuts will close rural hospitals, accelerate health care crisis in Minnesota

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The budget reconciliation bill under consideration in the U.S. Senate Monday afternoon is neither fiscally conservative nor reform-minded. It’s an expensive slurry of tax cuts for the rich and President Donald Trump’s political grievances. It will raise the deficit, explode the national debt by up to $4.2 trillion and derail the nation’s economy.

The bill is so expansively bad that we must triage its potential impact. So, let’s start with the stuff that might kill people. This bill, if enacted, will smother rural communities by closing small-town hospitals, piling on medical debt and stress and laying off thousands of workers right here in Minnesota.

How? By enacting about $1 trillion in Medicaid cuts amid a $1.1 trillion raid on the Affordable Care Act, Medicare and Medicaid. The thin premise of this legislation is that these cuts will only punish illegal immigrants and poor people sponging off the system, a classic extremist trope, but the reality is that we will all bear the burden of this bill. More paperwork. Less eligibility for care. More uninsured people and medical bankruptcies.

Rural people like me assume some medical risk living where we live, and not just because we own more guns and chain saws. The clinic is farther away. Ambulance rides to the hospital take longer. Serious traumas always involve elaborate transport, even helicopters, something my extended family experienced three times in just the past 10 years. Since we know this about rural life, why would the people who represent rural places consciously make it worse?

That’s a good question for Minnesota’s congressional Republicans, who had the power if not the willingness to negotiate for improvements to this bill. I only know that doctors and leaders at rural hospitals now say the bill will kill health care facilities and imperil human lives, even among those of us who have insurance.

Several studies were conducted to determine the impact of the bill on rural medicine. The total immediate hit on hospitals could be $63 billion in uncompensated costs over the next decade. Democratic senators compiled a list of 338 endangered facilities across the country using some of the research.

Those hospitals include the Fairview Range Regional Medical Center in Hibbing and the Mayo Clinic Health System in Fairmont. Though those are the only two Minnesota hospitals on the list, every hospital in the state will be affected by these cuts.

“Medicaid cuts will impact us in rural Minnesota in a big way,” said Jean MacDonell, CEO of Fairview Range and Grand Itasca Hospital in Grand Rapids, Minn. “They will not only affect our patients who have Medicaid but also put into jeopardy our whole structure. Any cut to any of our reimbursements will affect our ability to survive. This will make us look hard at the services we’re able to offer to the community.”

Here’s why that happens. In our health care system, everyone who needs care is treated when they go to the hospital. Even in America, we don’t turn away the sick and injured because they can’t pay upfront. After the treatment, patients either pay the bill out of pocket, make a claim on their health insurance, or use a governmental insurance program like Medicaid or Medicare.

If insurance companies, the state or federal government or private individuals don’t pay, the hospital eats the cost. That’s happening all over the country, especially in rural areas where patients are generally older and have a lower income. In fact, almost 70% of patients at the hospitals MacDonell runs are on Medicare or Medicaid.

Low reimbursement rates from Medicaid and Medicare were already a big problem. But now that patients might have reduced access to those programs, the hospitals will get even less. Almost 50% of the rural hospitals across the country are running in the red. This bill will make that number much higher.

This hurts everyone, not just poor people or immigrants. All patients, rich or poor, working or not, will suffer because you can’t use fancy insurance at a hospital that doesn’t exist.

You can’t work there, either. Small-town hospitals are typically the largest employer in their region. Fairview Range is bigger than Hibbing Taconite. Grand Itasca is bigger than the Blandin Paper Company. Thousands of people would lose their jobs across the state if hospitals close.

Even rural hospitals that don’t close will lose functionality. A hospital might be able to offer primary care but not specialty care. For instance, in Hibbing and Grand Rapids, patients can currently access OB-GYN, urology and orthopedic services. MacDonell says that could change under this new legislation.

One in three babies born at Grand Itasca is on Medicaid, similar to the ratio at other rural facilities. If they shutter their obstetrics unit, families will need to travel great distances to bring their child into the world. That carries significant medical risks.

“We know, and the data support, that when you have to travel longer distances you have worse maternal and baby outcomes,” said Dr. Katy Johnson, an OB-GYN and chief of surgery at Grand Itasca. “If someone goes into preterm labor and they have to travel for an hour and a half, you lose that time for care. It’s harder to prevent things from happening. Now you need the [neonatal intensive care unit], and that’s expensive.”

The cruelly titled “Big Beautiful Bill” contains many outrages, which will be detailed in coming days. But these Medicaid policies reveal the willingness of Republican lawmakers to prioritize Trump’s haphazard demands above the well-being of their own constituents.

It’s true that the proponents of this bill will have to face voters next year. But that’s no comfort for those who will in the meantime see their rural communities suffer economic and medical destruction. It’s a truly cruel outcome that only makes sense if you enjoy cruelty.