In the wake of Congress’ passage of President Donald Trump’s tax cut and spending bill, experts and advocates warn that it could have dire consequences for Alabama’s tenuous rural healthcare situation.

The 900-page bill, dubbed “one big beautiful bill,” passed by Republican majorities in Congress over united opposition from Democrats, cuts federal spending for Medicaid and for the Supplemental Nutrition Assistance Program, or SNAP.

The savings are intended to offset the extension of tax cuts from Trump’s first term, new tax breaks for individuals and businesses, and increased spending on defense, immigration enforcement, and border security.

Proponents of the bill, like Rep. Rex Reynolds, R-Huntsville, chairman of the Alabama House Ways and Means General Fund committee, say these are “much needed corrections.”

But Alabama Arise, a group which advocates for policies that benefit people in poverty, says the bill will be another drawback for the state’s struggling rural hospitals.

“In total, nearly 200,000 Alabamians could lose health coverage as a result of policy changes like these,” Alabama Arise executive director Robyn Hyden wrote in a recent release.

“Those coverage losses likely will increase hospitals’ uncompensated care costs and make health care even less accessible in rural areas.”

Hyden added that “fourteen rural hospitals in our state have closed since 2010, and more than 20 others are at risk of closing.”

“When a hospital or clinic closes, it closes for everyone, regardless of their insurance status,” she wrote.

Medicaid expansion

Rep. Shomari Figures, D-Mobile, and other state legislators have tried addressing the state’s rural healthcare crisis during the legislative session, proposing solutions like improved tax credits for rural hospitals and establishing a tax-deductible fund to support rural hospitals, which have both passed the House chamber.

But instead of considering Medicaid expansion, which lawmakers and experts have said is a solution that would bring more substantial support to rural hospitals, Trump’s bill makes around $600 billion in cuts to Medicaid nationwide.

When Montgomery’s Jackson Hospital filed for bankruptcy earlier this year, officials stated that in 2023 alone the hospital spent over $45 million on the care of uninsured patients, according to a previous report from AL.com’s Savannah Tryens-Fernandes.

“This [Trump’s] budget plan…will remove the additional $619 million in federal incentives for the first two years of Medicaid expansion that Alabama left on the table,” Hyden wrote.

“That increases the chances that our state will continue to refuse to expand Medicaid, leaving hundreds of thousands of our neighbors stuck in the health coverage gap with no options to afford life-saving care.”

Wide reaching impact

In a recent interview with Alabama Political Reporter, Louise Norris, the lead writer for healthinsurance.org—an independent source on the Affordable Care Act and Medicaid policy, said that the ramifications of this bill will extend far beyond the state’s rural areas.

“In areas where rural hospitals close, you still have that ripple effect out to all the other hospitals because the patients who were going to those hospitals that end up closing—or nursing home, or skilled nursing facility—the still need care, so obviously there’s an extra burden on those patients to get to the next closest facility,” she said.

“But then there’s extra strain on those facilities because they have to absorb additional patients. So, it’s not just an issue of ‘are you in a community where facilities close or are you not?’ because of the ripple effect.”

Where do we go from here?

Sen. Greg Albritton, R-Atmore, who chairs the General Fund committee in the Alabama Senate, said last month that there is still not a full understanding of everything the bill does because some of it depends on new federal regulations that will be written.

“We won’t know that for another year,” he said.

But he added that he does not expect many to lose coverage because of the bill.

“The overall picture, I believe, is Alabama is going to be in fairly good shape,” he said.

“The doom and gloom I don’t think is going to hit the fan.”

It will take a few years for some provisions of Trump’s bill to take effect in full.

In that time Alabama Arise said its members and supporters will “continue urging our state’s congressional delegation to reverse this bill’s harmful provisions.”

“We also will continue working at the state level to advance public policies to improve the lives of Alabamians marginalized by poverty,” the release reads.

“That includes advocacy to close our state’s health coverage gap, to right the wrongs of our state’s upside-down tax system and to ensure that all Alabamians have the resources they need to survive and thrive.”