Ohio Senator Bernie Moreno faced a tough crowd at The City Club of Cleveland on August 21, 2025, defending both the Trump administration and a sweeping new budget law that has sent shockwaves through the healthcare system, especially in rural America. While Moreno painted the One Big Beautiful Bill Act as a boon for the economy and American manufacturing, critics and healthcare experts are sounding the alarm about deep Medicaid cuts that threaten to shutter hundreds of rural hospitals and clinics across the country.
During the event, which was moderated by NBC News’ Henry Gomez, Moreno stood by the Trump administration’s record and its latest legislative achievement. “He should, and probably will, end up getting the Nobel Peace Prize,” Moreno said of former President Donald Trump. “Those are just facts.” Moreno praised the One Big Beautiful Bill Act, emphasizing its permanent tax breaks and temporary deductions for overtime pay and tips, though those expire in 2028. According to Moreno, “The facts are, over the next 10 years, we will spend 20% more on Medicaid nationally than we’re spending now. Medicaid spending will be increased by 20%, that’s a fact.”
Yet, as the Ohio Capital Journal reports, Moreno’s math has been questioned by nonpartisan researchers. The Kaiser Family Foundation points out that Congressional Budget Office (CBO) forecasts predict a $911 billion cut to Medicaid and an increase of 10 million uninsured Americans. The GOP-controlled House Budget Committee, meanwhile, claimed Medicaid spending would climb more than 30% by comparing projected costs in 2034 with current ones, but this ignores the likely higher spending if Trump’s legislation hadn’t passed. Even the CBO noted, “enacting the Medicaid provisions of H.R. 1 would reduce Medicaid spending by $125.2 billion in 2034.”
While the numbers are debated in Washington, the impact is already being felt on the ground. On August 24, 2025, USA TODAY reported that rural hospitals across America are bracing for closures as the Medicaid cuts take effect. Rural communities, which depend more heavily on Medicaid than their urban counterparts, are particularly vulnerable. Advocacy groups estimate that about 700 rural hospitals—roughly one in three—are at risk of closing within the next few years. The Kaiser Family Foundation predicts that Medicaid spending cuts will exceed $155 billion in rural areas over the next decade.
Penny Blue, a resident of Union Hall, Virginia, knows firsthand how critical local hospitals can be. After suffering a brain aneurysm in 2013, she survived thanks to a nearby hospital. “Time, minutes and seconds, make a difference whether you live or die and your recovery, if you live, the quality of your life,” Blue told USA TODAY. With the threat of her local hospital closing, she worries her chances would be much worse if she had to travel an hour or more for emergency care.
The financial strain is already forcing some facilities to close. In Nebraska, McCook-based Community Hospital announced it would shut down its clinic in Curtis, citing the incoming Medicaid cuts as a key reason. The law also ends the Affordable Care Act’s enhanced premium tax credits, which will likely cause insurance costs to spike for the 24 million people who get coverage through the ACA marketplace.
Senator Moreno, for his part, insists that the Trump administration’s approach to tariffs and manufacturing will boost American jobs. “We need to make more things here in America so that we have good, high paying middle class jobs—that’s just a fact,” he said. He also advocated for taxpayers taking equity stakes in companies like Intel when providing financial assistance: “If a company is going to ask for help, if a company is going to ask for money, the taxpayer should get equity so we have the upside.”
When pressed about the threat of rural hospital closures, Republican leaders have pointed to a $50 billion rural health transformation program added by the Senate. The fund will distribute $10 billion a year for five years to help struggling hospitals, with half of the money divided among states that apply. However, medical groups and state officials argue that this won’t be enough to make up for the Medicaid cuts and rising uninsured rates. “There are lots of hospitals in rural and low-income areas that have been operating at very slim margins for a long time, and they are looking at a coming health care cataclysm that begins this year,” Connecticut Sen. Chris Murphy, a Democrat, told USA TODAY.
States are scrambling to respond. Colorado expects to lose up to $800 million in Medicaid funding every year, while Michigan projects a $5.6 billion hole in rural healthcare budgets over the next decade. Colorado has set up a $25 million provider stabilization fund for each of the next two fiscal years, but state senator Dylan Roberts says, “It will be helpful, but it will in no way make up” for the expected losses. Michigan Senate Appropriations Committee Chairwoman Sarah Anthony called the situation “jarring” and “tense,” warning that there is “no world in which we have enough” to fill the gap.
Meanwhile, rural hospitals are already making painful cuts. In Craig, Colorado, the local hospital closed its OB/GYN and maternity practices, forcing women to drive an hour to give birth. Roberts said more closures may be coming. The ripple effects extend beyond hospitals. Medicaid is the largest payer for long-term care facilities, covering more than 60% of nursing home residents nationally. When rural nursing homes close, patients are often left to be cared for by family members who may not have the necessary skills or resources, retired nurse Denise Parashac told USA TODAY. “There’s really a snowball effect,” she said, as other hospitals become more crowded and staff recruitment becomes harder.
At the Cleveland event, Moreno fielded questions about NASA funding, the 529 education savings plan, support for Israel in Gaza, and the ongoing conflict in Ukraine. He assured the audience that NASA is “important for national security and the city of Cleveland,” predicting a “big increase in funding.” On Ukraine, Moreno said, “We cannot allow 6,000, 7,000 innocent people to die every single week. It is a terrible, terrible situation what’s happening there, and I, for one, I’m on the side of peace.”
Moreno also defended Trump’s stance on mail-in voting, emphasizing states’ rights but acknowledging a federal role in ensuring fair elections. On the 2020 election, Moreno referred to Hunter Biden’s laptop as having “altered the election” and criticized Joe Biden’s presidency, though he sidestepped questions about the January 6 events.
Moreno’s critics, frustrated by what they see as a lack of public engagement, protested outside The City Club and his Ohio offices. Organizer Ellen Brown accused the senator of failing to represent all Ohioans and supporting policies that hurt working families. “He refuses to do a town hall with constituents of different points of view, he’s allowing the executive branch to take power from the Senate as he votes with the president 100%, and the budget bill hurts Ohioans in favor of billionaires,” Brown said in a statement.
As rural hospitals brace for a wave of closures and state budgets buckle under the strain, the debate over the One Big Beautiful Bill Act and its impact on America’s healthcare system is far from over. For many in rural communities, the stakes could not be higher.