Episode #15 Deep Dive – Rural Hospitals Feeling the Pressure
A deep dive into this week's episode of Paging America
Agriculture Secretary Brooke Rollins – Let’s put Medicaid beneficiaries to work in the farm fields
Agriculture Secretary Brooke Rollins says that immigrant farm workers who are deported could be replaced by Medicaid beneficiaries needing to satisfy new draconian work requirements, presumably by picking fruits and vegetables in summertime farm fields.
Here’s her quote:
“We must be strategic in how we are implementing the mass deportations so as not to compromise our food supply. Ultimately, the answer on this is automation, also some reform within the current governing structure, and then also, when you think about it, there are 34 million able-bodied adults in our Medicaid program, there are plenty of workers in America.”
Some facts to put this into context:
64% of adults ages 19-64 covered by Medicaid already work and nearly all the others are not able to work because they're disabled, in nursing homes, etc.
According to the U.S. Bureau of Labor Statistics, agricultural workers usually do their tasks outdoors in all kinds of weather. Most work full time, and some work more than 40 hours per week.
Two-thirds (66%) of agricultural workers in the U.S. are noncitizen immigrants. The USDA estimates that roughly half of them are undocumented.
(By the way, RFK, Jr. wants you to know there are no cuts to Medicaid in the Trump budget bill: “First of all, there’s no cuts on Medicaid. There is a — there’s a diminishment of the growth rate of Medicaid, which is bankrupting our country.”)
Trump’s budget bill and the demise of rural hospitals
More than 300 rural hospitals may close because of the bill, according to research conducted by the University of North Carolina’s Sheps Center for Health Services Research. The research was done on behalf of Senate Democrats and revealed in a letter to Republican leadership:
In order to understand in greater detail how rural communities could be impacted by health care cuts contained in the reconciliation package, we requested the attached data from the Sheps Center on the financial vulnerability of rural hospitals and potential impacts on their viability. These hospitals have been identified as at-risk hospitals based on financial data, including: whether the hospital has been unprofitable for the last three years; whether the hospital is at risk of financial distress relative to peer hospitals; and whether the hospital serves a disproportionately high share of Medicaid patients… Altogether, 338 hospitals either experienced three consecutive years of negative total margins, serve the highest share of Medicaid patients or both.
Since many of the provisions of the Trump budget bill don’t kick in for months and years, hospitals believe they can fight to keep them from being implemented:
The One Big Beautiful Bill Act that Trump signed on the 4th of July will take a $340 billion bite out of hospital budgets over a decade to pay for tax cuts and other Trump priorities. Then again, maybe it won’t.
That’s because Congress delayed implementation of the most devastating of those cuts till 2028, and hospitals, their armies of lobbyists and many allies on Capitol Hill are already gearing up to use the next two and a half years to persuade lawmakers to rescind them.
And 2028 is not only an election year, but a presidential one.
“Are they really going to want to cut rural hospitals in an election?” asked Chris Mitchell, head of the Iowa Hospital Association. “We’re going to talk to our delegation early and often about the impact of these cuts and how looming cuts down the road impact how hospitals run in the interim.” [...]
Lawmakers are likely to hear more in the coming months about the impacts on their local hospitals. The industry has always been a powerful one in Washington since hospitals care for lawmakers’ constituents and also employ many of them.
Dig Deeper
The Hill: Rollins suggests Medicaid recipients can replace deported farmworkers
KFF: Understanding the Intersection of Medicaid and Work: An Update
Bureau of Labor Statistics: Agricultural Workers
KFF: Potential Implications of Immigration Restrictions on the U.S. Agricultural Workforce
USDA: Farm Labor
The Hill: RFK Jr.: ‘No cuts on Medicaid’ in ‘big, beautiful’ law
The Senate Democrats’ Letter on Rural Hospitals is HERE
POLITICO: The megabill’s Medicaid cuts shocked hospitals, but they may never happen