Pennsylvania officials and hospital groups warn that there could be dire consequences for Medicaid recipients when the tax and spending bill proposed by President Donald Trump becomes law.
The One Big Beautiful Bill Act promoted by Trump was narrowly passed by the House on Thursday, which forwarded it to Trump for signing.
The bill would cut safety-net programs including Medicaid and SNAP, lower federal taxes for some, put more money into border security agencies and the Pentagon, and add nearly $3.3 trillion to the deficit over a decade, according to estimates from the Congressional Budget Office.
Some Republican lawmakers and Trump administration officials have denied that the controversial bill slashes Medicaid, but the budget office, Democratic leaders and hospital groups say that Medicaid would in fact be cut for some of the 70 million low-income and disabled Americans who rely on the program, resulting in more people seeking care in the emergency room and hurting rural hospitals.
Looking at the numbers
Gov. Josh Shapiro’s office said that the proposed changes to Medicaid could strip health coverage from more than 300,000 Pennsylvanians, drive up health care costs, and put rural hospitals out of business. Nearly 144,000 Pennsylvanians who receive SNAP could also lose their access to critical food assistance, he said.
This week, Shapiro, officials from his administration and rural health leaders spoke at Wayne Memorial Hospital in Wayne County to talk about what they called the “devastating effects” the proposed cuts would have on rural Pennsylvanians and health care providers.
Shapiro’s office said that so-called state-directed payments would be necessary to bring average Medicaid reimbursement for Pennsylvania hospitals to 82 cents on the dollar. Without them, that average drops to 53 cents on the dollar.
Statewide, the Senate’s state-directed payment provisions alone translate to a roughly $4.5 billion cut to Pennsylvania hospital payments over the next decade, Shapiro said.
Shapiro’s office broke down the estimated cuts by Pennsylvania congressional district. If the bill passes, in Rep. Dan Meuser’s 9th District there would be 17,967 who lose Medicaid coverage and 8,185 who lose SNAP benefits. In Rep. Ryan Mackenzie’s 7th District, 17,519 would lose Medicaid coverage and 6,096 would lose SNAP benefits. And in Rep. Rob Bresnahan’s 8th District, 21,637 would lose Medicaid coverage and 11,572 would lose SNAP benefits.
Meuser, Bresnahan and Mackenzie, all Republicans, voted in favor of the bill.
In addition to losses of health care access and coverage, the legislation would cost Pennsylvania an estimated 526,000 jobs and $71 billion in lost economic impact over the next decade, Shapiro said. He based that on the American Hospital Association’s analysis of state-by-state economic impacts using estimates of state allocation of cuts in the House-passed bill and estimates of additional losses from the Senate provisions.
Gov. Josh Shapiro, shown at Sterman Masser Potato Farm, Sacramento, in May, joined rural health leaders this week at a hospital in Wayne County to talk about what they called the "devastating effects" the proposed Medicaid cuts would have on rural Pennsylvanians and health care providers. (MATTHEW PERSCHALL/MULTIMEDIA EDITOR)
PA Lawmakers react
After the bill’s House passage, Meuser said in a statement that the legislation strengthens Medicaid.
“It includes common-sense work requirements for able-bodied adults without dependents, removes individuals who are ineligible under the law from the rolls, and, beginning in October 2026, it ends the federal cost-share for states that choose to include illegal immigrants in their Medicaid programs — taking serious steps to address waste, fraud and abuse in the program,” he said.
“It also delivers support for rural healthcare, creating a $50 billion fund to help rural hospitals and ensure continued access to care. We’re making Medicaid more sustainable, more accountable, and more focused on delivering real results for seniors, the disabled, and low-income families.”
Bresnahan said the bill will ensure continued Medicaid coverage by eliminating corruption.
“We also protect and strengthen Medicaid by cracking down on the fraud, waste and abuse that are driving the program toward collapse,” he said. “This ensures Medicaid is there for seniors, people with disabilities and vulnerable families, not for those who can work but refuse to do so.”
Alisha Hoffman-Mirilovich, executive director of Action Together NEPA, a political advocacy organization, condemned the bill and the members of the House and Senate who voted to pass it, specifically Bresnahan.
“We are especially disappointed in freshman Congressman Rob Bresnahan,” Hoffman-Mirilovich said. “Rep. Bresnahan repeatedly promised to vote against any bill that guts benefits for the people in his district. And yet, he voted to do just that every single time it was up for a vote. His ‘yes’ vote on the bill’s final passage this morning is the last straw — he can no longer claim that he cares about his constituents losing care.”
Outcry from healthcare professionals
Hospital and Healthsystem Association of Pennsylvania President and CEO Nicole Stallings spoke earlier in the week about the bill, warning that the Medicaid cuts included in the budget reconciliation bill would cause people to lose health care coverage and destabilize Pennsylvania hospitals and communities.
“This legislation puts health care access, jobs, and economic competitiveness in jeopardy, especially in our rural communities,” she said in a statement.
“More than half of the commonwealth’s acute care hospitals are operating in the red because payments already do not reflect the actual cost of providing care. They cannot absorb a cut of this magnitude, and some will have no choice but to reduce services or close.”
This week, M. Michael Peckman, director of communications and community engagement for Lehigh Valley Hospital–Schuylkill, said that his health system was “closely monitoring the legislation and the impact the proposed cuts could have on the communities we serve. We will continue to provide the best possible care to patients, regardless of their ability to pay.”
St. Luke’s University Health Network referred questions to HAP, while Geisinger Health System declined comment.
During Shapiro’s event at Wayne Memorial Hospital, Dr. Debra Bogen, the state Secretary of Health, also said the proposed changes to the Medicaid program would have grave consequences for health care across Pennsylvania, from hospitals to individuals in both urban and rural communities.
“When people do not have health insurance, they are forced to forego preventive care and rely on emergency care,” she said. “This, in turn, leads not only to worse health outcomes, but also increases uncompensated health care services, increases insurance premiums, and increases health care costs for all Pennsylvanians — on top of contributing to overcrowded emergency rooms.”
“All of us know someone — whether it’s ourselves, a friend, loved one, or a neighbor — who Medicaid has helped. But no matter how you personally get your health care coverage, Medicaid is vital to protecting the health of your community,” said Department of Human Services Special Adviser Sara Goulet.
‘Shredding of social safety net’
The impact of the current federal proposal would not end with Medicaid cuts, Shapiro’s office said. The bill does not extend enhanced premium tax credits available to Pennsylvanians who purchase health insurance through Pennie, Pennsylvania’s official health insurance marketplace, officials said.
These tax credits have made coverage more affordable than ever, and if they expire on schedule at the end of this year, it will also risk health insurance for an additional 270,000 Pennsylvanians, adding to the risk to hospitals and an increase in rates of uninsured and/or uncompensated care, officials said.
“The enhanced premium tax credits help individuals — including Pennsylvanian farmers, small business owners and families — afford quality insurance coverage and help our rural hospitals keep their doors open with the steady reimbursement for care that they need,” said Pennsylvania Insurance Commissioner Michael Humphreys. “Congress’ proposed cuts to Medicaid and failure to renew these vital tax credits put Pennsylvanians at risk of losing critical access, putting lives and livelihoods in jeopardy.”
Among the groups criticizing the bill’s passage Thursday was the Pennsylvania Policy Center, with the center’s executive director Marc Stier calling the legislation “morally and economically bankrupt.”
“There is the shredding of the social safety net — deep cuts to Medicaid, the ACA, and SNAP — that will bring physical pain, economic distress, and thousands of premature deaths to the people of Pennsylvania and the United States,” he said.
He also said the bill was damaging to work to address climate change, shifted more income and wealth to the ultra-rich and wealthy corporations through tax breaks, increased the deficit and made deep cuts in federal support for schools.
Pennsylvania Democratic Party Chair Sharif Street was also critical of the bill.
“House Republicans just showed the American people exactly who they work for and it’s not working families,” he said.
“By passing this Big Ugly Bill, they’ve made their priorities painfully clear: tax breaks for billionaires, cuts to essential services and a relentless assault on the progress we’ve made. This bill is a raw deal for Pennsylvania.”