President Donald Trump’s signature legislation, the One Big Beautiful Bill Act, could cause tens of thousands of Wisconsinites to lose Medicaid coverage and put some rural hospitals at risk of closing.

The bill, which passed the U.S. House of Representatives in May and is being debated in the U.S. Senate, would extend the 2017 federal tax cuts, increase immigration enforcement spending and make spending cuts on social insurance programs such as Medicaid and food stamps.

The Senate version differs from the House version, and the two bills would have to be reconciled. But both version of the bill include steep cuts to Medicaid that could have effects on Wisconsinites.

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By 2034, the American Hospital Association estimates that more than 30,000 people in rural Wisconsin communities would lose Medicaid coverage, and the state’s rural hospitals would lose $607 million under the House-approved version of the bill. That estimate takes new Medicaid work requirements and other provisions included in the bill into account.

A letter from Democratic U.S. senators, spearheaded by U.S. Sen. Ed Markey of Massachusetts, to GOP leaders in Washington D.C. warned the bill would “have devastating consequences” for rural hospitals. It included a list of 338 “at risk” hospitals across the country that could be forced to close or reduce services, including three in Wisconsin.

The at-risk hospitals in Wisconsin were:

Mayo Clinic Health System-Oakridge in Osseo

Froedtert Holy Family Memorial Hospital in Manitowoc

Aspirus Stanley Hospital

Those three facilities were listed because they had “experienced three consecutive years of negative total margin.”

To compensate for concerns around capping and gradually reducing a tax that states use to fund rural hospitals, the Senate version of the bill added a $25 billion rural hospital fund, NPR reported. That version of the bill still needs to be approved by both chambers of Congress.

Mayo Clinic and Aspirus declined to comment. Froedtert did not respond to multiple requests for comment.

The Wisconsin Hospital Association also declined to be interviewed. But association President Eric Borgerding wrote a recent column in the Wisconsin State Journal about the House version of the megabill, warning it “will have severe and unfair consequences for Wisconsin health care.”

“It creates Medicaid winners and losers, with Wisconsin at the bottom,” Borgeding wrote.

The nonpartisan Congressional Budget Office estimates that nationally the House bill would increase the number of people without health insurance by 10.9 million, because of changes to Medicaid and the Affordable Care Act. The CBO’s estimate includes 58,000 people in Wisconsin who could lose either Medicaid or ACA coverage, according to KFF, a health policy nonprofit.

Even more Americans could lose coverage under the Senate bill. The CBO’s analysis of that version of the legislation found it would leave 11.8 million people uninsured by 2034. It would also add $3.3 trillion to the national debt over the next decade.

‘A really serious shift of risk onto middle class and low income people’

Robin Rudowitz, director of the Program on Medicaid and the Uninsured at KFF, said new Medicaid work requirements in both versions of the bill account for the biggest chunk of the Medicaid cuts and coverage loss.

“That would potentially affect Wisconsin adults without dependent children,” she said. “The bill would require these qualifying activities, work of up to 80 hours per month or another type of work activity, but also requires these mandatory exemptions for certain groups, including parents, individuals who are medically frail, etc.”

KFF estimates that 64 percent of people receiving Medicaid were working either full or part time in 2023.

On a call with reporters this week, Bharat Ramamurti, a senior advisor at the nonprofit American Economic Liberties Project and a former Biden administration official, said work requirements can be especially painful in the event of an economic downturn, when jobs are harder to come by.

“The vast majority of people who will lose their coverage from these provisions should be entitled to coverage because they are working,” Ramamurti added. “This is a really serious shift of risk onto middle class and low income people who rely on the Medicaid program.”

This graphic shows the share of Americans receiving Medicaid benefits who were working as of 2023. Graphic courtesy of KFF

Medicaid reductions would put financial pressure on rural hospitals

Rudowitz said rural hospitals would be affected by provisions in the bill related to the financing side of Medicaid and from lost reimbursement from individuals who would become uninsured under the bill.

According to the American Hospital Association, nearly 50 percent of rural births are covered by Medicaid, while almost two-thirds of nursing home residents in rural counties are covered by Medicaid.

Deliberations over the bill come after one-third of Wisconsin hospitals operated in the red in 2023. Just last year, Hospital Sisters Health System shuttered two western Wisconsin hospitals and a network of clinics. And earlier this year, a ThedaCare hospital in Waupaca closed its birthing unit.

In this Thursday, March 9, 2017 file photo, lab technician Zach Meili works in Denver Health Medical Center’s primary care clinic located in a low-income neighborhood in southwest Denver. David Zalubowski/AP File Photo

GOP Wisconsin lawmakers say House-approved budget bill doesn’t cut Medicaid for those lawfully enrolled

The three at-risk Wisconsin hospitals listed in Markey’s letter are located in congressional districts represented by Republicans. All Republicans in Wisconsin’s House delegation voted in favor of the version of the megabill that passed the House.

The Froedtert hospital in Manitowoc is in U.S. Rep. Glenn Grothman’s district. His office did not respond to repeated requests for comment related to the Medicaid cuts.

The Mayo Clinic facility in Osseo is located in U.S. Rep. Derrick Van Orden’s district. In a statement, Van Orden said the bill he voted for “did not cut Medicaid for individuals lawfully receiving their benefits.”

The Aspirus facility in Stanley is in U.S. Rep. Tom Tiffany’s district. Tiffany said in a statement the House-approved bill doesn’t change current Medicaid funding for Wisconsin hospitals, accusing Democrats of “fearmongering.”

“No one the Medicaid program was designed to help will lose their benefits,” he stated. “The legislation prevents illegal aliens from accessing taxpayer-funded welfare resources and restores 20-hour-per-week work requirements for able-bodied adults without young dependents.

“These common sense reforms will guarantee that Medicaid remains protected and preserved for all vulnerable Americans, including those in rural areas,” Tiffany added.

Rudowitz with KFF said immigrants without legal status are not eligible to enroll in federally funded health care coverage programs, including Medicaid.

“There’s a small piece that allows for some reimbursement to hospitals for serving individuals who have emergencies, but that is not full coverage,” she said. “Undocumented immigrants are not eligible for Medicaid coverage.”

Some states have used their own funding to allow people living in the U.S. illegally to access health coverage. The House-approved bill would reduce Medicaid expansion funding for states doing so, Rudowitz said.

Trump has told lawmakers that he wanted to sign the bill by July 4. On Friday, he backed off that deadline a bit, saying the July 4 goal is “not the end-all” but “we’d like to get it done by that time if possible.”

The Senate voted 51-49 to advance that chamber’s version of the bill late Saturday night. Two Republican senators joined all Democrats in voting against a motion to begin debate on the legislation. Lawmakers in the chamber debated the bill Sunday night. The Senate could vote on the bill Monday.