Trump’s big bill could hurt rural hospitals, be a boon to Minnesota farm country

President Donald Trump’s signature legislation could harm rural hospitals but deliver big tax breaks to farm country.

Minnesota’s four Republicans in Congress have been some of the most vocal supporters of the bill on its way to Trump’s desk, but haven’t said much about how rural Minnesota could be disproportionately affected.

“So much of our rural congressional folks are really, really into this, and yet, I’m having a hard time kind of matching up, how does this benefit our rural constituents?” said Kelly Asche, a senior researcher at the Center for Rural Policy and Development.

Asche said rural Minnesota is home to more people who will be harmed by the bill, including a population of undocumented workers on farms and in the meat processing industry. The four Republicans have focused on how the bill will crack down on undocumented immigrants and beef up resources for U.S. Immigration and Customs Enforcement.

Those who work with rural hospitals, including providers, have warned that those hospitals may bear the brunt of the burden from the Medicaid cuts in the bill. Rural Minnesotans often rely more heavily on Medicaid and those cuts could put more rural hospitals at risk of closing.

Mark Jones, executive director of the Minnesota Rural Health Association, thinks Minnesota Republicans in Congress have done little to articulate the downsides of the bill for rural health care.

“Their message is not from that point of view of keeping the rural hospital operating — and not just the hospital, it’s everything else that goes along with health care in rural Minnesota,” Jones said.

The bill includes a $50 billion rural hospital stabilization fund as a buffer against looming cuts.

GOP U.S. Rep. Pete Stauber, who represents northern Minnesota, said that fund is one of the main reasons he voted for the bill.

“This means that each state, including Minnesota, will receive at least $100 million every year to keep rural hospitals open, support providers, and ensure our rural residents receive the best care possible,” Stauber said. “While many on the left falsely claim that this bill threatens rural health, make no mistake, it does the opposite.”

Stauber was the only Republican in the delegation who responded to the Minnesota Star Tribune’s request about the bill’s impact on rural Minnesota.

In February, 14 Republican state legislators sent a letter to Trump and the state’s congressional Republicans asking them not to make “drastic reductions” to Medicaid funding.

The Star Tribune attempted to reach a dozen of the legislators who signed the letter. Most didn’t respond to requests for comment or declined to comment pending final passage of the bill.

Sen. Paul Utke of Park Rapids said he now supports Trump’s bill and would probably not sign the letter today.

“I fully agree with what they’re doing,” Utke said of congressional Republicans, adding that too many Americans are on Medicaid and that he likes the work requirement provision to get coverage. He also said his constituents support the proposed reductions.

The latest Star Tribune/Hubbard School of Journalism and Mass Communication Minnesota Poll found that about 50% of respondents in greater Minnesota — those outside of the seven-county Twin Cities metro area — support Medicaid cuts. About four in 10 were opposed, and about 10% weren’t sure.

Republican Reps. Dave Baker, R-Willmar, and Danny Nadeau, R-Rogers, said they stand by what they said in that letter.

“I’m not happy with it,” Nadeau said of the bill a day before it passed. “The cuts and the impacts to the work that we’re going to have to do in Minnesota to mitigate the goals that the bill is trying to produce are going to be difficult.”

Because Medicaid is jointly funded by the federal government and the state, the bill’s passage means the state will have to fill in the funding gaps, which are likely to be significant. A special legislative session may be needed to deal with the shortfall.

Minnesota Republicans have zeroed in on how the bill will give tax cuts to farmers.

Though the bill includes some tax breaks that could benefit farms in the short term, Minnesota Farmers Union President Gary Wertish thinks it could hurt farmers in the long run.

“The short-term gain on some small tax relief and commodity titles is not worth what rural America has to lose,” Wertish said.

John Wade, president of Rochester Area Economic Development, has a different take on the bill. He sees it as encouraging for business growth across rural Minnesota. From permanent small business tax deductions to a massive increase in the cap on estate tax exemptions, the bill contains several initiatives small business advocates have long lobbied for, he said.

Wade pointed out farmers are likely to celebrate increased estate tax exemptions and other measures like increased interest deductibility, expanded expensing rules and increased state and local tax deductions when filing federal taxes.

“It’s fairly down in the weeds, but it’s important if you own a family farm,” Wade said.

Wade also said new rural programs meant to incentivize businesses to invest in facilities and infrastructure could be key to boosting biomedical tech companies in southeast Minnesota that want to work with Mayo Clinic.

Yvonne Simon, head of the Blue Earth County GOP, wants voters to give the new law time before they judge it.

Simon thinks dire predictions that rural areas will be harmed are just “a lot of words on pieces of paper,” she said. “I’ll need to see the proof in the pudding.”

Trey Mewes of the Minnesota Star Tribune contributed to this story.