August 19, 2025
Throughout the nation, rural hospitals will shut, and the empty cities will mirror the quiet halls the place docs and nurses as soon as rushed to heal.
A decade in the past, when the Republican-led Montana legislature first handed Medicaid enlargement, I traveled to virtually each one in all our state’s rural hospitals upfront of our legislative session. I nonetheless bear in mind a city corridor assembly in Choteau, which has a inhabitants of simply 1,700 folks. The hospital administrator shared that 43 p.c of the folks strolling by means of the hospital’s doorways lacked insurance coverage; the chair of the County Fee advised these attending that in the event that they misplaced their hospital, they’d lose the city.
Quick-forward to 2025. There at the moment are much more Republicans in our state legislature, but Medicaid’s reauthorization handed this yr by larger margins. The associated fee-shifting of uncompensated care, the place these of us with insurance coverage cowl the prices of these with out—often on the emergency room, the place it’s costliest—has considerably decreased. Preventive care, together with breast and colon most cancers screening and diabetes and hypertension therapy, continues to deal with well being issues on the entrance finish, fairly than when it’s already too late.
And whereas over 100 rural hospitals have shut their doorways within the final decade, not a single one shut down in Montana.
But, simply earlier than the Fourth of July, as Congress headed into recess, DC Republicans voted to undo all of that tough work. Now they’re house for the summer time, going through the very communities whose hospitals and healthcare they simply voted to place in danger.
Republicans voted to kick hardworking Montanans off Medicaid. They voted to threaten the agricultural hospitals our communities depend on and to make healthcare costlier and fewer accessible.
In brief, Republicans voted to make our healthcare worse.
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Senator Steve Daines defended his vote on Fox Information, asserting, “We’ve received to take able-bodied males who’re laying [sic] on the couches at house and get them again to work and off of Medicaid.”
The issue is, these people don’t exist in my state. Based on the Montana Healthcare Basis, 94 percent of Montana adults on Medicaid are employed, disabled, caregivers, or college students. The remaining 6 p.c of working-age adults comes out to simply below 9,000 folks. Even when all 9,000 of these folks had been simply “laying on couches”—and they aren’t—Daines nonetheless voted to remove medical health insurance from an estimated 31,000 people, greater than 3 times the variety of unemployed adults on Medicaid.
And make no mistake, what hurts one in all us in Montana hurts all of us. If our neighbors lose their medical health insurance, all of us would possibly lose our hospitals
Based on one evaluation, the Medicaid cuts will price Montana hospitals more than $2.2 billion over the following 10 years, cash they will’t afford to lose.
When rural hospitals shut, there aren’t any alternate options for our residents. They need to drive additional or not get care in any respect. On prime of that, the hospital is usually the most important employer in a neighborhood, and people hospitals present good-paying jobs, from nurses to docs to upkeep workers. When the hospitals depart, Montanans might need to comply with, forcing them to decide on between their households close by and the careers they love. After all, this received’t be restricted to Montana—these similar scenes will play out in each state throughout the nation.
Will Republicans pay on the poll field for making healthcare worse? They definitely may—KFF discovered that a majority of adults nationwide opposed the invoice after listening to it will scale back funding for native hospitals. Maybe unsurprisingly, Democrats and independents opposed the invoice even earlier than being advised it will harm hospitals, with 85 p.c and 71 p.c respectively holding unfavorable views. Nonetheless, non-MAGA Republicans additionally opposed the invoice, with 51 p.c having unfavorable views, rising to 64 p.c unfavorable after listening to that it harm hospitals like those we’ve been combating to guard right here in Montana. Even self-identified MAGA voters couldn’t abdomen the harm to native hospitals, transferring from 78 p.c favorable to 55 p.c unfavorable, a devastating indictment from Trump’s most devoted supporters.
Even the Republican politicians ramming it by means of perceive how offended their constituents are going to get. They wrote the regulation to verify the worst impacts received’t land till after the midterm elections. They added a fund to help rural hospitals for 5 years. They added extra paperwork and bureaucratic pink tape to Medicaid, however had it begin in December 2026, a month after the mud settles from the midterm elections. Because the outdated saying goes, “You’ll be able to put lipstick on a pig, however it’s nonetheless a pig.”
These Republican-led assaults may assist flip states like Montana again to purple—and even stable blue—however Democrats want to start out their messaging now, and they should preserve it going. Democrats have to guarantee that each voter is aware of why their hospital might shut down. Each voter must know why their sister, brother, aunt, or cousin needed to transfer throughout the state to maintain working as a nurse practitioner. Each voter must know why their neighbor postpone their healthcare till it was too late.
Throughout the nation, voters have to know the why: This wasn’t about being cautious stewards of your hard-earned tax {dollars}—if that was the case, they wouldn’t have added one other $3 trillion to the federal debt. Republicans voted towards our healthcare, and so they did it so they might give a little bit extra money to the wealthiest amongst us.
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I hope the following time I go to Choteau the hospital remains to be there. I bear in mind how its folks reacted to the chair of the County Fee’s warning—if we lose the hospital, we lose the city.
Montana doesn’t want any extra rural ghost cities, however that’s what Republicans voted for. Throughout the nation, rural hospitals will shut, and the empty cities will mirror the quiet halls the place docs and nurses as soon as rushed to heal.
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