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President Trump's One Big Beautiful Bill Act is expected to dramatically cut money for Medicaid, which pays for medical care for low-income and disabled Americans. Cuts to the program could reach nearly $1 trillion over a decade. That has alarmed rural hospitals and doctors because many of their patients depend on the program. In response to those concerns, Congress added $50 billion to the bill to shore up rural health infrastructure. Iowa Public Radio's Natalie Krebs reports on how health officials are trying to figure out how to make the best use of that money.
NATALIE KREBS, BYLINE: The money that Congress added to Trump's massive tax and spending bill is called the Rural Health Transformation Program. And Mahaska Health in Oskaloosa, Iowa, has already received more than $3 million that will be used for a new PET scanner to detect cancer. CEO Kevin DeRonde steps into a suite of empty offices filled with various cardboard boxes, storage bins and office furniture.
KEVIN DERONDE: So this'll all be gutted, and the PET/CT'll be housed over here.
KREBS: DeRonde says the grant funding will allow the hospital to replace a scanner on a mobile truck years ahead of schedule. And Mahaska Health will be able to do more than twice as many scans as it now conducts.
DERONDE: To have an in-house PET/CT where we can scan patients five days a week is significant to reduce the diagnosis-to-treatment times.
KREBS: Iowa health officials say in addition to investing money in rural cancer care, they also plan to use the federal dollars for telehealth infrastructure and mobile care units, among other things. The state hopes to draw down a total of $1 billion from the Rural Health Transformation Program over five years. It's received $209 million in this first year. Larry Johnson is the principal deputy director at the Iowa Department of Health and Human Services. He says the state wants to spend the money quickly.
LARRY JOHNSON: Because if you don't spend the money on the projects that you tell the federal government you're going to, they're going to claw the money back. So we actually are hoping we're organized enough to get it done that we hope to take money from states that aren't able to do what we are.
KREBS: Iowa officials say they see the rural health fund as a separate investment regardless of what happens with Medicaid. But most healthcare workers in rural communities are looking at the new fund in the context of the looming cuts to Medicaid, says Timothy McBride, a public health professor at Washington University in St. Louis.
TIMOTHY MCBRIDE: It's like - yes. I mean, it's certainly an unequivocally good thing for rural to get this $50 billion relative to not having it. But the net effect of all this is going to be negative.
KREBS: According to the nonpartisan health policy think tank KFF, even if Iowa gets $1 billion from the rural health fund, the Medicaid loss for rural healthcare facilities in the state will total nearly $4 billion over a 10-year span. Iowa Hospital Association President Chris Mitchell says that's a huge concern for rural hospitals.
CHRIS MITCHELL: As soon as the rural health transformation dollars go away, then the Medicaid cuts start to come into place. And that's not a temporary proposition. That is ongoing.
KREBS: In Western Iowa, Brett Altman, the CEO of Cass Health, agrees. He says while his hospital will also get nearly $3 million for a PET scanner, that money from the rural health fund won't come close to making up for the reduction in Medicaid funding he's anticipating.
BRETT ALTMAN: When you break it down to the ridiculous, we know that more than half that money isn't going to hospitals.
KREBS: Still, Altman and others say they have to try to get what they can, since rural hospitals face such an uncertain financial situation.
For NPR News, I'm Natalie Krebs in Des Moines.
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