In the heart of northwest Louisiana, the effects of a sweeping new federal spending bill are being felt long before the ink has dried. House Speaker Mike Johnson, whose own rural district relies heavily on Medicaid, recently championed a megabill through Congress that could dramatically reshape health care access for some of the state’s most vulnerable residents. According to data from the health information nonprofit KFF, more than a third of people in Johnson’s district are enrolled in Medicaid—a lifeline for low-income Americans that now finds itself on the chopping block.
The stakes are high. Statewide, over 200,000 Louisianans could lose Medicaid coverage under the new law. For thousands who depend on Medicaid for prescriptions, routine doctor visits, and even dental care, the prospect of losing these benefits is daunting. The ripple effects don’t stop there: Federally Qualified Health Centers (FQHCs), which serve as the backbone of primary care in many rural communities, risk closure as Medicaid reimbursement revenue dries up. As reported by NPR, these centers are already stretched thin, and any reduction in funding could push them over the edge.
For constituents like Jamie Collins, the uncertainty is personal. Collins, who painted Johnson’s house back in 2021, has been out of work since November 2024 and now finds himself homeless, sleeping on the streets of Shreveport-Bossier City. Medicaid is his only safety net. “I mean, he liked the job,” Collins recalled of his brief encounter with Johnson. “But, I mean, how can you like a job with a person that’s performing work on your house, cutting Medicaid, that’s putting him in a bind?”
Collins isn’t alone in his anxiety. David Jackson, another Medicaid recipient in Johnson’s district, sits on his porch—one of the few places cooler than his un-airconditioned house—worrying about the future. Jackson, who recently left a landscaping job that paid cash under the table, is between jobs and unsure if he’ll be able to meet the new requirements to keep his coverage. Under the law, adults aged 19 to 55 will need to prove they are volunteering, receiving job training, or working at least 80 hours each month starting in 2027. “What would I be able to do for myself? How can I get help?” Jackson wondered aloud. “I can’t afford no doctor. I don’t have the money to afford no doctor.”
The new work requirements are designed to ensure that Medicaid recipients are actively engaged in the workforce or their communities, but for people with irregular or informal employment, the reporting burden is significant. As Jackson points out, the unpredictability of his work makes compliance a real challenge. The Congressional Budget Office estimates that the changes will result in nearly a trillion dollars in cuts nationwide, with 12 million people expected to lose health coverage.
Speaker Johnson, facing a summer of tough questions from constituents, has defended the legislation. At a July press conference in Bossier City, he dismissed concerns about coverage loss, insisting the bill is about cracking down on “waste, fraud, and abuse.” “There’s a lot of misconceptions,” Johnson said. “This idea about how we’re cutting Medicaid and people are going to lose their health coverage is just simply not true.” His office, however, declined requests for a more in-depth interview, leaving many in his district feeling unheard.
The implications go beyond individual coverage. Louisiana’s 2016 Medicaid expansion halved the state’s uninsured rate and stabilized rural hospitals that had been teetering on the brink of closure. Now, 33 of those hospitals are at risk again, and the community health centers that provide care regardless of a patient’s ability to pay are bracing for a financial hit. Louisiana’s network of FQHCs served more than half a million patients last year, according to the Louisiana Primary Care Association. Nationally, Medicaid reimbursements account for 42 percent of FQHC revenue—compared to just one-tenth from direct congressional funding. Any reduction in Medicaid thus threatens the very existence of these clinics.
Joe Dunn, chief policy officer of the National Association of Community Health Centers, told NPR, “Right now a lot of health centers are having financial troubles and about 40 percent have less than 90 days cash on hand.” Without additional funding from Congress, Dunn warns, “It certainly could lead to closures and, you know, loss of staff and things like that.”
The situation is particularly acute for families like David Jackson’s. His seven-year-old son receives care at a school-based clinic that is part of the David Raines Community Health Center in Bossier City. The clinic has helped his son overcome a speech impediment, providing services that would otherwise be out of reach. “They have helped me to get him to talking and sending him to extra centers and things like that,” Jackson said. “They are very helpful.” If the clinic were to close, Jackson fears his son’s progress—and their ability to communicate—would be lost.
Advocates are now looking to Congress for relief. Lawmakers face a September 30 deadline to reauthorize funding for FQHCs, and the stakes could not be higher. Historically, these centers have enjoyed bipartisan support, but this year advocates are seeking an additional $1.2 billion to offset the $7 billion clinics are projected to lose because of Medicaid cuts. The chair of the committee overseeing FQHC funding is Senator Bill Cassidy, a Republican from Louisiana. In a statement to NPR, Cassidy’s office said he is “committed to reauthorizing funding for community health centers on time, in a fiscally responsible manner,” but stopped short of pledging support for the additional funds advocates say are needed.
For the people of Johnson’s district, the debate in Washington is more than an abstract policy fight—it’s a question of survival. Jamie Collins, reflecting on his brief encounter with the Speaker, says he would have more to say if they met again today. “I would actually ask him: ‘What’s the reason you’re cutting Medicaid,’” Collins said, “and hurting a lot of people in this city?”
As the September 30 deadline looms, Louisiana’s rural communities wait anxiously, hoping that the safety nets they’ve come to rely on will not be pulled out from under them. The decisions made in Congress in the coming weeks will determine whether clinics stay open, hospitals remain solvent, and thousands of families continue to have access to basic health care. For many, the outcome will shape the future of health in Louisiana for years to come.
