The Republicans’ Medicaid Cuts Could Cause a Rural Unemployment Crisis

Those problems led 136 rural hospitals, or about 3 percent, to close between 2010 and 2021. Almost three-fourths of those were in states that hadn’t expanded Medicaid through the Affordable Care Act, or had expanded it only within the previous year, hinting at how big a role the program plays in keeping those hospitals open. Not all rural hospitals are in crisis, though: Those in states that did expand Medicaid under the ACA are doing better. (However, the Center for Healthcare Quality and Payment Reform study found that 190 of the rural hospitals facing risk of immediate closure are in states that expanded Medicaid.)

If the past is any indication, the magnitude of the proposed new cuts could severely impact states and the hospitals that rely on those programs. “It’s kind of hard to specifically say that there’s a specific policy with a discrete and direct impact on hospital employment,” Zachary Levison, project director of the KFF Project on Hospital Costs, said. “But I think given the magnitude of the cuts to Medicaid that are being considered, these are likely to have an impact on hospital finances, and could especially hit rural hospitals, given the financial challenges that those facilities tend to have.”

Jobs in health care have been growing and are pathways into well-paying careers, and educators often promote the field to rural students to help address staffing shortages in rural areas. As employers, hospitals and medical offices are home to the pink-collar jobs of the new working class. In rural areas, they provide coveted desk jobs that don’t require standing all day or lifting heavy equipment—unlike many other jobs available to non-college graduates in these areas, in industries such as retail, manufacturing, construction, and farming.