In the heart of Michigan’s rural communities, anxiety is mounting over the U.S. Senate’s recently passed budget bill, which experts warn could deliver a devastating blow to Medicaid users and the hospitals that serve them. With the legislation awaiting action in the House of Representatives, health care leaders, patients, and politicians are sounding alarms about the far-reaching consequences of what’s officially known as the One Big Beautiful Bill Act.
At the center of the storm is a proposed $930 billion cut to Medicaid over the next decade—a move the Congressional Budget Office says could strip health coverage from more than 11 million Americans. In Michigan alone, the numbers are staggering. According to Brian Peters, CEO of the Michigan Health and Hospital Association, nearly 2.7 million state residents—over a quarter of Michigan’s population—currently rely on Medicaid. The Michigan Department of Health and Human Services estimates that as many as 700,000 Michiganders could lose their coverage if the bill becomes law.
“That’s where the majority of our Medicaid patients are centered because of the economies in those rural communities,” said Jeremiah Hodshire, president of Hillsdale Hospital, in an interview with WLNS. He painted a grim picture of what’s to come: fewer doctors, shuttered clinics, and families left scrambling for care. “You may have your Medicaid card in your wallet or your purse, but there’s nowhere to use that because those hospitals or those programs have closed, and when they close for a Medicaid patient, they close for a commercial patient.”
The ripple effects, Hodshire warned, extend far beyond health care. “The economies in those communities suffer. We’ve watched that happen as hospitals close across the country, so goes the hospital, so goes their community. There’s so much more at stake.” Hospitals in rural areas often serve as major employers, and their closure can mean economic decline for entire towns.
Laura Appel, also with the Michigan Health and Hospital Association, echoed these concerns, noting that Michigan hospitals stand to lose more than $6 billion over the next ten years, with rural hospitals especially hard-hit. “Over that same 10-year period, Michigan hospitals will lose $6 billion, more than $6 billion dollars and rurals are right in the mix of that,” Appel said.
For many Michigan families, the debate isn’t just about numbers—it’s about basic access to care. Sharon Watson, a Howell mother of three, knows firsthand how vital Medicaid can be. Her son Eli, diagnosed with epilepsy before his fourth birthday, requires constant medical attention. “I feel like one of the hardest things about this is how many uncertainties there are,” Watson told NPR. “The hospitals are honestly already overloaded. We have a shortage of specialists. And, you know, oftentimes the wait is already several months long just to see a specialist that we’re already well established with.” Watson worries that if the bill’s changes to coverage hurt hospitals’ bottom lines, wait times will only worsen.
Jennifer Middlin, 45, never imagined she’d need Medicaid. But after a car accident left her unemployed, she found herself dependent on the program. “I was earning more than six figures. I have kids, I’m in a professional setting,” she said. “And within four months I go from that to being unemployed and desperately in need of medical care with nowhere to go.” Middlin’s story is a stark reminder that, as she put it, “You’re a lot closer to needing this than you might think—a heck of a lot closer.”
At a recent Democratic town hall in Macomb County, the Medicaid cuts took center stage. The mere mention of the law drew boos from the crowd. Former Rep. Gabby Giffords and her husband, Sen. Mark Kelly (D-Ariz.), headlined the event, rallying opposition in a swing district with an open House seat next year. “A lot of my Republican colleagues had an opportunity to suck it up and do the right thing,” Kelly said of the vote on the package. “There are members who were like, ‘Well, we can’t cut funding to Medicaid. This is a bad decision.’ This came from Republicans. But ultimately, you saw what happened. You know, they tend to fall in line.”
All seven Republicans in Michigan’s House delegation supported the law, which narrowly passed the Senate in July 2025 after Vice President JD Vance cast a tie-breaking vote. Three Senate Republicans joined all Democrats in opposition, while several others voiced concerns but ultimately backed the bill. The legislation’s new work requirements mean that hundreds of thousands of enrollees will have to document their eligibility every six months, raising fears that many may lose coverage due to paperwork burdens rather than actual ineligibility.
Republicans, for their part, insist the bill is aimed at rooting out “waste, fraud, and abuse.” But Peters from the Michigan Health and Hospital Association disputes this rationale. “When you look at the Medicaid population here in the state of Michigan, we know that almost all of those folks are working and working full time,” he said. Peters added that there’s no evidence of widespread waste and abuse in Michigan’s Medicaid program.
Political strategists are watching closely. Michigan State University political science professor Corwin Smidt described the issue as a potential “vulnerable issue” for Republicans, given the sheer number of people who depend on Medicaid. He cited a recent statewide survey showing that 82% of Michigan residents oppose cutting Medicaid to pay for tax cuts. Smidt also noted that the argument over waste and fraud can backfire. “It resonates with voters to say, ‘there’s waste and fraud,’” he said. “When you find out that your hospital might be considered waste and fraud, and you’re like, ‘that provides essential services.’ That’s a much different story suddenly.”
Yet, the political impact remains uncertain. Many of the bill’s Medicaid provisions won’t take effect until after the 2026 midterm elections, so it’s unclear how much the issue will motivate voters next year. Meanwhile, Republicans are touting other elements of the law, such as an expanded child tax credit and reductions in taxes on tips, urging lawmakers to “sell our wins” rather than focus on Medicaid cuts.
As the legislation heads to the House and awaits the president’s signature, advocates like Laura Appel urge concerned citizens to make their voices heard. “There’s still time to voice any concerns to local legislators,” she said.
For now, families like the Watsons and Middlins—and the hospitals that serve them—are left in limbo, waiting to see whether Congress will listen to their pleas or press ahead with cuts that could reshape Michigan’s health care landscape for years to come.
