Rural health care faces ‘death spiral’ from GOP Medicaid cuts

A doctor from Tomah talks to Pete Buttigieg’s online audiences about cuts in services and longer travel times for life-or-death care.

Rural health care involves much more than Medicaid recipients, and the cuts coming to the program are going to have ripple effects that do serious damage in small communities, according to a family practice physician from Tomah speaking to former US Transportation Secretary Pete Buttigieg.

As part of an ongoing series of conversations that goes to an online audience of millions on YouTube, Substack, Facebook, TikTok and other platforms, Buttigieg has been sharing stories of Americans facing the consequences of cuts to vital services coming from President Donald Trump and Republicans controlling Congress. Buttigieg’s latest episode features Dr. Jill McMullen of Tomah talking about her concerns for the deterioration of rural health care.

UpNorthNews was given the first opportunity to broadcast excerpts from the interview on our weekday radio show, “Mornings with Pat Kreitlow.”

McMullen said hospitals will see plunging revenue when the GOP cuts to Medicaid take effect.

“Rural hospitals really aren’t making money,” McMullen said. “It’s not like it’s a great gig to go into to become wealthy. About half of rural hospitals are working on a negative margin, so they are taking in less money than they’re spending. And then you have fewer and fewer people who have coverage — more of that coverage becomes charity care or unavailable to help with their bottom line.”

“Which could become a death spiral for a rural hospital, right?” Buttigieg responded. “And it means that the sustainability of the hospital just shrinks until the hospital can’t stay open?”

McMullen said hospitals will have to cut services that will affect entire patient populations, not only those who receive Medicaid. 

“So [they will] stop delivering babies, or stop having various specialists, or closing different areas of the hospital,” McMullen said.

And some hospitals will close altogether.  The University of North Carolina Sheps Center for Health Services Research looked at the financial vulnerability of hospitals and identified at least 338 at highest risk for closure once cuts to Medicaid (and to premium subsidies used for the Affordable Care Act) take effect—including three in Wisconsin.

Those closures will impact more than day-to-day patient care and local employment. McMullen points out the life-or-death situations that will become more dire.

“I want people to understand that our rural hospitals are infrastructure, every 30 to 40 miles in general. And so you’re driving on vacation with your family, you have an incident, heart attack, car accident. If there is no rural hospital, that golden hour has now evaporated. Trying to get you someplace to keep you alive.”

Known as BadgerCare in Wisconsin, Medicaid is the federal government’s program to help states provide stable, affordable health insurance for Americans with low incomes or disabilities. The program recently marked its 60th anniversary.