By Phil Galewitz, KFF Well being Information, KFF Well being Information
MANSFIELD, La. — When Desoto Regional Well being System took out $36 million in loans final yr to renovate a rural hospital that opened in 1952, officers had been banking on its major funding supply remaining steady: Medicaid, the joint federal-state well being program for low-income folks and the disabled.
However these {dollars} at the moment are in jeopardy, as President Donald Trump and the GOP-controlled Congress transfer to shrink the almost $900 billion well being program that covers greater than 1 in 5 People.
Desoto CEO Todd Eppler mentioned Medicaid cuts may make it more durable for his hospital to repay the loans and for sufferers to entry care.
“I just hope that the people who are making these decisions have thought deeply about it and have some context of the real-world implications,” he mentioned, “because it’s going to affect us as a hospital and going to affect our patients.”
One of many decision-makers is Eppler’s consultant in Congress: Home Speaker Mike Johnson, who lives about 35 miles north of right here. He mentioned he is aware of the Republican chief and his workers perceive hospitals’ plight: The mom of Johnson’s chief of workers is CEO of a rural hospital within the district.
“I’ve never met a congressman yet that wanted a rural hospital in their district to close, and certainly Mike is no exception to that rule,” Eppler mentioned.
Final yr almost 290,000 folks in Johnson’s district had been enrolled in Medicaid, about 38% of the entire inhabitants, in response to knowledge compiled by KFF, the well being info nonprofit that features KFF Well being Information.
About 118,000 of them are in this system because of the Inexpensive Care Act, which allowed states together with Louisiana to broaden Medicaid to cowl low-income adults, lots of whom had been working in low-paying jobs that don’t present medical health insurance.
Louisiana ranks second in Medicaid enrollment, at almost 32% — a mirrored image of the state’s excessive poverty fee. As Republicans weigh cuts, their actions may have dramatic penalties for his or her constituents right here. Of the eight GOP-held Home districts with essentially the most Medicaid enrollees as a result of growth, 4 are in Louisiana. Johnson’s largely rural district ranks sixth in growth enrollees.
Amongst them is Chloe Stovall, 23, who works within the produce aisle on the SuperValu grocery retailer in Vivian, Louisiana. She mentioned her take-home wage working full time is $200 per week. She doesn’t personal a automotive and walks a mile to work.
The shop offers well being protection, however she mentioned she gained’t qualify till she’s labored there for a full yr — and even then, it would value greater than Medicaid, which is free.
“I’m just barely surviving,” she mentioned.
In February, Johnson pushed a funds decision via the Home that requires chopping no less than $880 billion over a decade from a pool of funding that features Medicaid, to assist fund an extension of Trump’s tax cuts and his border priorities. Republicans in Congress at the moment are contemplating the place to make cuts, and Medicaid is prone to take a giant hit.
Defending the plan, Johnson mentioned that Medicaid is “not for 29-year-old males sitting on their couches playing video games.”
Stovall mentioned virtually everybody she is aware of on Medicaid works no less than one job. “I don’t even own a TV,” she mentioned.
Contacted for remark, Johnson’s workplace pointed to his remarks at a convention in Washington final month. “We’re going to be very careful not to cut a benefit for anyone who is eligible to receive it and relies upon it,” Johnson mentioned.
KFF Well being Information spoke with two dozen Medicaid enrollees in Johnson’s district. Most mentioned they had been unaware their congressman is main the Republican cost to upend this system. These knowledgeable of the Republican plan mentioned it scares them.
Some GOP members of Congress wish to eradicate the ACA’s Medicaid growth funding, which led to twenty million working-age adults gaining protection and helped slash the nation’s uninsured fee to its lowest degree in historical past. Forty states and the District of Columbia have agreed to the change, which promised further federal funding in trade for increasing eligibility.
On this closely Republican district, the place Johnson gained with 86% of the vote in November, 22% of residents stay in poverty.
Like Trump, Johnson says he needs cuts to Medicaid however hasn’t elaborated aside from saying this system shouldn’t cowl “able-bodied” adults with out imposing a piece requirement.
“Everybody is committed” to preserving Medicaid advantages “for those who desperately need it and deserve it and qualify for it,” Johnson mentioned at a information convention in February. “What we’re talking about is rooting out the fraud, waste, and abuse.”
Medicaid recipients in Johnson’s district, informed about GOP plans to chop this system, mentioned their lives are arduous sufficient in a state the place the minimal wage is $7.25 an hour. With out Medicaid, they mentioned, they couldn’t afford well being protection.
In Vivian, close to the borders with Arkansas and Texas, near half of the two,900 residents stay in poverty. The primary-street retailers are largely shuttered, apart from a thrift retailer and a mom-and-pop restaurant that focuses on fried pork chops.
“Most everybody you know is on Medicaid here,” mentioned Doris Luccous, 24.
Luccous mentioned she makes $250 per week after taxes as a housekeeper at a nursing house whereas elevating her 2-year-old daughter in her childhood house. Whereas buying together with her father — who doesn’t work, due to a incapacity — she mentioned she counts on Medicaid for her bipolar medicines and to pay for remedy appointments.
“I don’t know where I would be without it,” she mentioned.
Neither Luccous nor Stovall mentioned they voted within the final election, and neither knew that Johnson is their consultant in Congress.
Vivian has few massive employers, and most employers pay the minimal wage, which hasn’t modified since 2009. “We are just stuck,” Stovall mentioned.
Nonetheless, she mentioned, “it’s a community where everybody knows everybody, and people are always willing to lend a hand because so many are in difficult financial circumstances.”
Willie White is CEO of David Raines Group Well being Facilities, which operates six outpatient clinics in northwestern Louisiana that serve primarily Medicaid enrollees. He mentioned that Louisiana already ranks among the many worst states for folks’s well being and that Medicaid cuts would solely worsen the state of affairs.
“You cannot expect health outcomes to improve if people can’t afford to access care,” White mentioned.
Whereas the clinics present major and dental care on a sliding charge scale for uninsured sufferers, signing them up for Medicaid provides them higher entry to specialists and brings the well being facilities income to cowl the price of delivering care.
Lots of the facilities’ sufferers gained protection via Medicaid growth. Afterward, charges of screenings for colon and cervical most cancers went from 10% to 50%, White mentioned.
But when Congress cuts Medicaid, the well being facilities can be pressured to chop providers, he mentioned.
“Mike Johnson has been here and knows us, and he and his office have been responsive about our issues,” White mentioned. “The message in prior years was, ‘We need additional funding,’ but now it is asking for no cuts.”
Group well being facilities, which in 2023 offered care nationally to greater than 32 million largely low-income folks, have seen funding will increase from Republicans and Democrats for many years.
“Everyone is supportive, but the question remains what that support will look like under the current administration,” White mentioned. “If there are to be reductions, they need to be done with a scalpel.”
Anticipating cuts, the well being facilities have already restricted journey and put a maintain on filling vacant positions, White mentioned.
Sitting in a David Raines clinic in Bossier Metropolis, Benjamin Andrade, 57, mentioned having Medicaid has been a lifesaver since he wanted coronary heart surgical procedure in 2020. Andrade is a chef and mentioned he helps his spouse and two youngsters on $14 an hour.
He had not heard about any potential cuts to this system. With out Medicaid, he mentioned, “it would be very hard for me to pay for all the medicines I take.”
Dominique Youngblood, 31, who was on the clinic for a dental checkup, mentioned she’s had Medicaid most of her life. “Medicaid helps me so I don’t have to pay out-of-pocket going to the doctors,” she mentioned.
Youngblood, who has two youngsters, makes $12 an hour at a day care middle. Requested about GOP efforts to cut back this system, she mentioned, “It’s not fair, because it helps a lot of people who cannot afford medications and emergency room trips, and those are costs you can’t control.”
Again in Mansfield, Eppler’s hospital is greater than only a well being facility — it’s the place many individuals on the town come for lunch. The cafeteria was packed on a latest Friday as employees served boiled shrimp, fried okra, and baked fish.
Eppler mentioned he’s conscious Republicans in Congress are focusing on a system of taxes that some states, together with Louisiana, levy on hospitals and different well being suppliers to attract down extra federal Medicaid funding. That cash helps finance what are generally known as supplemental funds to suppliers. Some conservatives belittle the additional funding as “money laundering.”
However that cash accounts for about 15% of the DeSoto well being system’s funds, mentioned Eppler, a retired Air Drive lieutenant colonel who has been CEO for a dozen years. “We are using that money to invest in the next 50 years of Desoto Parish, to build a hospital that they can have that will be sustainable,” he mentioned.
The supplemental funds, for instance, assist pay to offer psychological well being providers at three outpatient clinics. “If that $4 million went away, we would have to limit services — it’s just that simple,” he mentioned.
©2025 KFF Well being Information. Distributed by Tribune Content material Company, LLC.
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