Closing Time?
How Trump's and Cassidy's Medicaid cuts put Louisiana’s rural hospitals in peril
If President Trump, Sen. Bill Cassidy, and the other Republicans in Louisiana’s congressional delegation were looking for ways to hurt their most loyal supporters, they have found it in their attacks on Medicaid and, by extension, rural hospitals.
First, let’s be clear: Trump and Republicans slashed Medicaid in the so-called, badly named “One Big Beautiful Bill.” They cut $911 billion out of programs to help the poor, the elderly, and disabled and sick children—all so they could extend huge tax cuts for billionaires.
Trump, Cassidy, and others will deny that, but the truth is that within a couple of years, the damage to vulnerable people will become evident. But most of that comes, conveniently for the GOP, after the 2026 midterms.
So now, Cassidy and others assure us that despite everything you’ve heard about those cuts, the damage they will inflict on average people, and how they will force many rural hospitals to close, is nothing but scare tactics.
But sometimes, scary news is accurate. Sometimes, the threat is real. And often, the people Trump and the GOP hurt are their most loyal supporters who, for some reason, do not understand the party to which they belong despises them and uses them as pawns in their game to divide the American public in the service of the super-wealthy.
Let’s consider first what Cassidy and others say about these Medicaid cuts. Let’s check their assertions. Let’s look at what real experts in the field are saying about these cuts. And then let’s look at the people these cuts will hurt the most.
What Cassidy is saying
I focus on Cassidy because he’s facing reelection next year, he chairs the U.S. Senate Health, Education, Labor, and Pensions Committee, and he’s a physician. Cassidy should know what he’s talking about. If he’s peddling inaccurate information about the bill and his role in its passage, we should judge him even more harshly, not only for violating his oath of office, but also the Hippocratic Oath (do no harm).
In a July 15 telephone town hall with Louisiana residents, Cassidy responded to a question about the Medicaid cuts with obfuscations. (A friend on the Northshore participated in the call and sent me his notes.)
You’ll not be surprised to know that Cassidy downplayed the impact of the cuts. “You’ll hear some Democrats talking about Medicaid,” Cassidy said. “What they’re saying is wrong. If you’re on Medicaid, you’re not going to see a cut, and our focus was to protect patients in the rural hospitals. So, the bill’s a big win.”
That “big win,” Bill, was a victory for billionaires, not people on Medicaid.
According to the non-partisan Congressional Budget Office (CBO), the bill Trump signed into law on July 4, with its massive cuts to Medicaid, will cause up to 11.8 million Americans to lose health insurance.
But there’s more.
“To fund larger tax cuts, the bill avoided extending current subsidies that help make ACA marketplace insurance plans affordable,” said Professor William H. Dow, professor of Health Policy at UC Berkeley’s School of Public Health. “Those subsidies will expire at the end of 2025, leading to premiums that double for many people, which the Congressional Budget Office estimates will cause more than 4 million more people to become uninsured. Along with the Medicaid cuts, and other provisions making it harder for people to enroll in ACA plans even when eligible, the Congressional Budget Office estimates that the total number of uninsured will rise by 17 million people by 2034.”
In his town hall, Cassidy dismissed concerns that these cuts would hurt rural hospitals.
“So, I tell you it’s not true,” he said. “Probably the best person to ask is a hospital administrator from a hospital in Desoto Parish, saying he had been listed as one of those hospitals that’s going to be closed. He put out a statement, ‘No, we’re doing quite well, thank you; We’re open for business.’ So there’s a lot of scare tactics being put in place.”
Let’s check with the experts
“We are fully funded for 2026,” Jeff Reynolds, executive director of the Rural Hospital Coalition of Louisiana, told the Louisiana Illuminator recently. (His coalition represents 49 rural hospitals in 41 parishes.) “I do not see any reductions or anything that would cause a rural hospital to shut down here in 2026, and I really don’t see that occurring in 2027 or 2028 either.”
But in the second half of the ten-year term of these Medicaid cuts, the story changes. “Once we get past 2030, we are gonna need some help in order to avoid any, you know, issues with reduction of services and those types of things,” Reynolds said, seeming to work hard to avoid using the words “hospital closure.”
“When you get five years out,” he added, “I’m very hesitant to predict what will happen because I know there will be a lot of changes.”
This is a point like what Cassidy made in his town hall. “By the way,” he said, “the Medicaid cuts don’t happen, Medicaid reforms don’t kick in, for two years.”
“Medicaid cuts,” you say? Was that a Freudian slip?
“Democrats don’t like President Trump,” Cassidy added. “They’re doing their best to defeat President Trump and his policies. And so, they’ll say things that aren’t true, imagine that. But if you listen to the hospital administrator(s), they’re disagreeing with that.”
But according to a July 28 report in the New Orleans Times-Picayune by reporter Emily Woodruff:
Hood Memorial [in Tangipahoa Parish] is one of 33 rural hospitals in Louisiana flagged as financially vulnerable if the Medicaid cuts now under debate are enacted. That’s the second-highest number of any state, behind only Kentucky, according to a June letter from Sen. Ed Markey and other Senate Democrats. Nationwide, 338 rural hospitals are at risk.
Among them is Lallie Kemp Regional Medical Center in Independence, Louisiana, a 24-bed critical access hospital with over 40% of patients using Medicaid. If patients lose their health insurance or have to find a way to get to a hospital that is farther away, they will be less likely to seek care until they are really sick.
That might look like putting off preventative screenings like colonoscopies or mammograms, said Dr. John Couk, clinical lead for health care effectiveness at Lallie Kemp, which is managed by LSU Health.
“Rural health care is the crisis,” said Couk. “The big cities are going to have hospitals.”
Unlike urban facilities, rural hospitals typically don’t offer high-revenue procedures like orthopedic and cardiac surgeries, said Walter Lane, a health economist at the University of New Orleans. That makes them vulnerable to even small shifts in Medicaid policy.
The National Rural Health Association, citing a study by Manatt Health, concluded:
Rural hospitals will lose 21 cents out of every dollar they receive in Medicaid funding due to the One Big Beautiful Bill Act. Total cuts in Medicaid reimbursement for rural hospitals—including both federal and state funds—over the ten-year period outlined in the bill would reach almost $70 billion for hospitals in rural areas.
Reductions in Medicaid funding of this magnitude would likely accelerate rural hospital closures and reduce access to care for rural residents, exacerbating economic hardship in communities where hospitals are major employers. As a key insurer in rural communities, Medicaid provides a financial lifeline for rural health care providers — including hospitals, rural health clinics, community health centers, and nursing homes—that are already facing significant financial distress. These cuts may lead to more hospitals and other rural facility closures, and for those rural hospitals that remain open, lead to the elimination or curtailment of critical services, such as obstetrics.
So, Cassidy might cherry-pick reassurance from one administrator, but the assessment of those looking at the big picture is that this bill and its draconian Medicaid cuts will hurt lots of people in rural communities and will put hundreds of rural hospitals in jeopardy.
Who will these cuts hurt the most?
Ironically, the people hurt the most will be those who’ve supported Trump and Cassidy.
Trump carried 40 of the 43 parishes that house Louisiana’s 48 rural hospitals. He lost only three—Caddo, East Carroll, and Madison.
The hospitals in these parishes are lifelines for hundreds of thousands of people who live there, giving them access to a range of preventive care and life-saving treatments.
If you live in Farmerville, Winnfield, Raceland, Many, Rayville, Jennings, Cutoff, Amite, or Franklin, you have access to healthcare in your community. Chip away at that by denying people Medicaid benefits—which will lead to hospital closures because of how much those institutions rely on Medicaid dollars—and you’ve made life immeasurably harder on the people in those communities.
And those communities are filled with Trump’s supporters who will soon lose their health insurance.
Trump, Cassidy, and the rest can say they’re not cutting Medicaid, but the fact that they delayed implementation of the bill's Medicaid provisions until after the 2026 election gives away the game.
If these cuts/savings were so crucial to the health of the Medicaid system, why wait for two years or more to enact them?
The reason is simple: They’re paying for tax cuts for billionaires on the backs of the poor—many of whom are their supporters—and they don’t want anyone to notice until it’s too late to influence their votes.
It’s a heartless, dishonest, and cynical game.
And if you think that any physician who abets such a scheme should not only lose his elected office but his medical license, you’d be correct.
Senator Cassidy voted for this abomination of the bill that will cut Medicaid benefits to many of his constituents in Louisiana starting in the next fiscal year. Senator Cassidy, a physician who practiced medicine before he was elected Senator has denied that Medicaid is being cut. His constituents should deny him reelection as Senator in Louisiana for not telling the truth about these impending Medicaid cuts and the Board of Medicine which licenses MD’s in Louisiana should rescind his medical license for voting for a bill that will do harm to his constituents in violation of his Hippocratic oath as a doctor to’ first do no harm.’
And most of the MAGAs don't understand, and those that do, don't care. I have been totally surprised at the great lack of compassion and any decency his supporters have towards the "least of these." They are as disgusting as Trump and Cassidy.