Rural healthcare is likely to be severely affected by provisions in President Donald Trump’s “One Big Beautiful Bill” Act, which was signed into law on 4 July 2025. Cuts to Medicaid will disproportionately affect rural areas as a higher proportion of rural residents are Medicaid recipients. In addition, cuts to provider taxes, which help finance the state’s share of Medicaid, will reduce financial support to rural providers and facilities (McKinley, 2025). Cuts to state-directed payment programmes could further reduce provider payments. If reductions in the number of insured patients and lower provider payments lead to financial distress for healthcare providers, it would result in reduced service availability and hospitals closing, further lowering access to care for rural residents (Egan & Luhby, 2025).
As part of the bill, Congress provisioned USD 50 billion for a “Rural Health Transformation Program”, intended to offset the effects of Medicaid cuts on rural communities. States that provide a plan for “rural health transformation” will receive funding from a pot of USD 10 billion per year from 2026 through 2030 (Hohman, 2025). Many believe that these funds will be insufficient to cover the losses from other provisions in the bill (McKinley, 2025). The National Association of Rural Health Clinics states that it is unclear if facilities will receive a portion of the funding (Hohman, 2025).