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Medicaid faces big cuts; experts warn about potential blow to rural areas

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Thursday, January 16, 2025   

CLARIFICATION: An earlier version of this story noted the Children's Health Insurance Program as a component of Medicaid, before outlining Minnesota data. That version did not make clear that while under the same umbrella, there are differences. An update emphasizes Medicaid and CHIP when noting Minnesota data. (8:45 a.m. MST, Jan. 16, 2025)

In their pursuit of slashing government spending, Congressional Republicans are taking a hard look at Medicaid. But a new report shows how this public health program is preventing care access from further eroding in rural Minnesota and elsewhere.

The incoming Trump administration promises major budget cuts, and a House GOP proposal floats a nearly $2.5 trillion Medicaid reduction. But findings from Georgetown University's Center for Children and Families show people in rural areas are more likely than metro populations to receive health coverage through Medicaid.

Katy Kozhimannil, associate professor in the University of Minnesota School of Public Health, said its providers rely on it, too.

"Medicaid is an absolutely essential source of revenue for those hospitals to keep operating and to provide different types of services and additional training and support for clinicians," she said.

A key Medicaid component is the Children's Health Insurance Program. At 7%, the Georgetown report says Minnesota is among the states with the largest difference in the share of kids covered by Medicaid and CHIP when comparing smaller towns to urban centers. Some House Republicans insist these programs need reform to avoid a fiscal collapse. But skeptics say drastic changes are a way to offset a planned extension of federal tax cuts.

Joan Alker, executive director and co-founder of the Center for Children and Families at Georgetown University, called these budget proposals "horrifying," while suggesting the public might be caught off guard because the program wasn't really discussed on the campaign trail last fall.

"There was complete silence about it, despite the fact that it is the largest source of public coverage by far in the United States," she said. "It's also a very popular program with the voters of all political stripes."

Report authors stress the timing of the proposed cuts is especially bad as rural areas continue to grapple with hospital closures. 120 facilities have either closed or ceased offering inpatient services over the past decade. Many rural hospitals opt to shutter less lucrative units such as maternity wards. And the experts say Medicaid covers a majority of pregnancy care in smaller communities where these units still operate.

Disclosure: Georgetown University Center for Children & Families contributes to our fund for reporting on Children's Issues, Health Issues. If you would like to help support news in the public interest, click here.


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