{"id":155736,"date":"2025-09-14T07:56:08","date_gmt":"2025-09-14T07:56:08","guid":{"rendered":"https:\/\/www.newsbeep.com\/us\/155736\/"},"modified":"2025-09-14T07:56:08","modified_gmt":"2025-09-14T07:56:08","slug":"trumps-health-care-funding-cuts-leave-states-with-impossible-budget-choices","status":"publish","type":"post","link":"https:\/\/www.newsbeep.com\/us\/155736\/","title":{"rendered":"Trump\u2019s Health Care Funding Cuts Leave States With Impossible Budget Choices"},"content":{"rendered":"

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Patients begin lining up before dawn at Operation Border Health<\/a>, an annual five-day health clinic in Texas\u2019 Rio Grande Valley. Many residents in this predominantly Latino and Hispanic region<\/a> spanning the Mexican border lack insurance, making the health fair a major source of free medical care in South Texas for more than 25 years.<\/p>\n

Until this year. The Trump administration\u2019s plan to strip more than $550 million<\/a> in federal public health and pandemic funds from Texas helped prompt cancellation of the event<\/a> just before its scheduled July 21 start.<\/p>\n

\u201cSome people come every year and rely on it,\u201d said Hidalgo County Health and Human Services Director Dairen Sarmiento Rangel. \u201cSome people even camp out outside of Border Health so they can be the first in line to receive services. This event is very important to our community.\u201d<\/p>\n

States and local governments have made painful program cuts in the wake of major reductions<\/a> in federal health funding that have already taken effect. Now, they\u2019re sizing up the financial hits<\/a> to come \u2014 some not until late next year or beyond \u2014 from the \u201cOne Big Beautiful Bill Act<\/a>,\u201d the tax and spending law congressional Republicans passed in July that enacts much of President Donald Trump\u2019s domestic agenda.<\/p>\n

Texas, for instance, expects to see its federal Medicaid funds reduced by as much as $39 billion <\/a>over 10 years due to new barriers for enrollment, such as more frequent eligibility checks, according to a July analysis by KFF.<\/p>\n

Taken together, the reductions amount to a seismic shift in how state health programs are provided and paid for. The administration is, in effect, pushing a significant amount of health costs to states. That will force their leaders to make difficult choices, as many state budgets are already strained by declining tax revenues, a slowdown in federal pandemic spending, and economic uncertainty.<\/p>\n

Revenue forecasters in more than a dozen states<\/a> have lowered expectations for the coming year, according to a June report by Pew<\/a>.<\/p>\n

\u201cIt\u2019s almost inevitable that states will enact a number of cuts to health services because of the fiscal pressure,\u201d said Wesley Tharpe, senior adviser for state tax policy at the left-leaning Center on Budget and Policy Priorities<\/a>.<\/p>\n

Some are proactively trying to stanch the impact.<\/p>\n

Hawaii lawmakers are looking to aid nonprofits that are already contending with federal funding cuts. They\u2019re doling out $50 million<\/a> in grants to health, social service, and other nonprofits hit by federal funding cuts. To get the money, nonprofits must show a termination or drop in funding, or that they have otherwise been harmed by the cuts.<\/p>\n

\u201cIt is not fair that organizations dedicated to supporting the people of Hawaii are being forced to scale back due to federal funding cuts,\u201d Democratic Gov. Josh Green said in a statement<\/a>.<\/p>\n

Other states are scaling back projects to contend with cuts. Delaware Gov. Matt Meyer, a Democrat, received notice in March that the Trump administration was cutting $38 million<\/a> in public health funding from the state. The next month, state legislative leaders halted a planned project to upgrade and expand the Capitol complex as a result.<\/p>\n

\u201cWe recognized that the reckless federal cuts to the social safety nets of thousands of Delawareans called for us to hold back resources to protect our most vulnerable,\u201d said David Sokola<\/a>, president pro tempore of the Delaware Senate.<\/p>\n

In New Mexico, the state with the highest percentage of residents enrolled in Medicaid<\/a>, a bipartisan group of lawmakers voted to create a trust fund to boost funding for the program. About 10% of the more than 800,000 state residents<\/a> covered by Medicaid and the related Children\u2019s Health Insurance Program could lose their health coverage under the federal spending law, based on some estimates<\/a>.<\/p>\n

Some state leaders are warning constituents that the worst may be yet to come.<\/p>\n

At an Aug. 18 event at a hospital in the South Bronx section of New York City, New York Gov. Kathy Hochul, a Democrat, stood on stage among health care workers in white coats to skewer Trump\u2019s new law.<\/p>\n

\u201cWhat Republicans in Washington have done through the \u2018Big Ugliest Bill\u2019 I\u2019ve ever seen is literally screwing New Yorkers,\u201d she said. The state\u2019s health system is bracing for nearly $13 billion<\/a> in annual cuts.<\/p>\n

And in California, lawmakers weighed the impact of the coming cuts from the federal law at a general assembly committee hearing on Aug. 20<\/a>, where some Democratic legislators said state efforts to protect reproductive health services and other programs were in jeopardy.<\/p>\n

\u201cWe\u2019ve been bracing for this reality: President Trump\u2019s so-called \u2018Big, Beautiful Bill\u2019 is now law,\u201d Democratic lawmaker Gregg Hart said at the hearing, calling it a \u201cdirect assault on California\u2019s core programs and our values.\u201d<\/p>\n

\u201cSadly, the reality is, the state does not have the capacity to backfill all of these draconian federal funding cuts in the current budget,\u201d Hart said. \u201cWe cannot simply write a check and make this go away.\u201d<\/p>\n

The sweeping budget law<\/a>, which passed without any Democratic support, will reduce federal spending on Medicaid by about $1 trillion<\/a> over the next decade, based on estimates from the Congressional Budget Office<\/a>. The spending reductions largely come from the imposition of a work requirement<\/a> on people who\u2019ve obtained Medicaid under the Affordable Care Act\u2019s expansion, as well as other new barriers to coverage.<\/p>\n

The law will mean more than 7.5 million people will lose Medicaid coverage and become uninsured, according to the Congressional Budget Office, while extending tax cuts for wealthy people who, Democrats say, don\u2019t need them. Republicans and Trump have said the spending package and its accompanying program cuts were necessary to prevent fraud and waste, and to sustain Medicaid, a state-federal program for people with disabilities and lower incomes.<\/p>\n

\u201cThe One Big Beautiful Bill removes illegal aliens, enforces work requirements, and protects Medicaid for the truly vulnerable,\u201d the White House said in a June 29 statement<\/a>.<\/p>\n

The Medicaid cuts won\u2019t begin until after the midterm elections in November 2026, but other cuts have already hit.<\/p>\n

The Trump administration has sought to claw back $11 billion in federal public health funds<\/a> earmarked to states because of the pandemic, spurring a legal fight <\/a>with a coalition of Democratic-led states. It also cut about $1 billion<\/a> in federal grants<\/a> for mental health services in schools, and halted grants from the National Institutes of Health that provided money to more than 90 public universities<\/a>.<\/p>\n

HHS press secretary Emily Hilliard said the agency is prioritizing investments that advance Trump\u2019s mandate to confront chronic disease. She defended some of the cuts and said, erroneously, that the spending law doesn\u2019t cut Medicaid.<\/p>\n

\u201cThe COVID-19 pandemic is over, and HHS will no longer waste billions of taxpayer dollars responding to a crisis that Americans moved on from years ago,\u201d she said.<\/p>\n

State leaders say the pandemic funding the administration wants returned was earmarked for other public health measures, such as tracking emerging diseases, outbreak responses, and staffing. State attorneys general in May won a temporary restraining order<\/a> against the administration.<\/p>\n

\u201cWhat we\u2019re seeing now is states anticipating big cuts in Medicaid coming, but they\u2019re also dealing with a whole variety of federal cutbacks in public health programs that are smaller but still quite meaningful,\u201d said Larry Levitt<\/a>, executive vice president for health policy at KFF, a health information nonprofit that includes KFF Health News.<\/p>\n

Part of the challenge for states is simply understanding the changes.<\/p>\n

\u201cI think it\u2019s fair to say there is concern, confusion, and uncertainty,\u201d said Kathryn Costanza, a Medicaid expert at the National Conference of State Legislatures.<\/p>\n

States are struggling to sort it all out, forming advisory groups<\/a> that are tracking federal changes<\/a>, suing to try to block the cuts, and reallocating funding.<\/p>\n

In Colorado, lawmakers passed a bill<\/a> to let state Medicaid dollars pay for non-abortion care at Planned Parenthood of America clinics after Trump\u2019s law banned federal funding for such care. Whether the ban holds up in court remains to be seen<\/a>.<\/p>\n

The Louisiana Legislature sent $7.5 million<\/a> to state universities to make up for cuts to federal research funding, much of which goes to health-related research.<\/p>\n

And in South Dakota, the state\u2019s largest food bank has asked lawmakers to spend $3 million<\/a> to make up for funding cuts to the U.S. Department of Agriculture.<\/p>\n

States must balance their budgets every year, so cuts put many services at risk if state lawmakers are unwilling to raise taxes. The work will begin in earnest in January, when many states begin new legislative sessions.<\/p>\n

And the tough choices are likely to continue. Congressional House Republicans are considering legislation that could bring more cuts<\/a>, including by slashing the generous cost sharing the federal government provides for 20 million adults who enrolled in Medicaid under the ACA\u2019s Medicaid expansion.<\/p>\n

Some states will roll back their Medicaid expansions and cut more health programs as a result.<\/p>\n

KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF \u2014 an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\n

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