Analysis from the center found that rural hospitals across the country would be majorly hurt by the Medicaid cuts the Republican budget bill calls for, because rural hospitals often have a significant portion of their patient pool, sometimes a majority of it, in the Medicaid or Medicare programs that serve poor and elderly people, respectively.
The Sheps Center looked for hospitals that are both in the top 10% of Medicaid payer mix, meaning they have the largest proportions of Medicaid patients to non-Medicaid patients, and that have reported three straight years of negative total operating margins, meaning they’ve been paying out more money than they’ve been taking in.
In New York, 11 hospitals fit that criteria, including 5 in the north country; Claxton-Hepburn Medical Center in Ogdensburg, Massena Hospital, Clifton-Fine Hospital in Star Lake, Gouverneur Hospital and Lewis County General Hospital in Lowville.
Ogdensburg and Lowville are not considered top Medicaid providers, but they do each serve a significant number of Medicaid recipients each year and both demonstrate negative annual margins.
The Sheps Center analysis posits that the cuts to Medicaid, which come from a combination of changes to federal support for Medicaid spending, expanded work requirements and adjustments to the fees and taxes states can charge providers, would result in significant numbers of everyday Americans being kicked off of the program. Those people would still need emergency medical care as they receive at hospitals, which have a duty to provide it, but those hospitals would no longer be paid for the care they provide at all.
In a letter to President Donald J. Trump and the Republican leaders in the House and Senate, Sen. Charles E. Schumer, D-N.Y., and three other Democratic Senate leaders implored them to reverse course on the Medicaid cuts outlined in the reconciliation bill, which Trump has named the “One Big Beautiful Bill.”
“Many of these rural hospitals are facing financial instability today, even before any of the Republican health care cuts take effect,” their letter reads. “Rural hospitals will be disproportionately impacted by health care cuts. Addressing the crisis in rural health care access is a national, bipartisan priority, and it should be bipartisan to not worsen it. However, if your party passes these health care cuts into law, Americans in rural communities across the country risk losing health care services and jobs supported by their local hospitals.”
State Democrats are criticizing north country Rep. Elise M. Stefanik, R-Schuylerville, for backing the bill and continuing to support it as Republicans push it to final approval.
“Five hospitals in Elise Stefanik’s district are on the chopping block because of her vote for the largest cut to Medicaid in history,” said Addison Dick, spokesperson for the state Democratic Party. “Instead of fighting for her constituents, Stefanik is caving to Trump and supporting his budget that will rip away coverage, increase health care costs, and devastate rural health care.”
A spokesperson for Stefanik pushed back on the claims that the Medicaid provisions in the reconciliation package will result in loss of coverage for her constituents, which he called an “indespensible lifeline for our nation’s most vulnerable.”
“However, far left Democrats continue to fearmonger because they know that President Trump is delivering results for the American people,” the spokesperson said. “He ran on the promise that he would root out the wasteful and fraudulent government spending. In New York alone, an estimated $20 billion is spent on fraudulent Medicaid claims annually. On top of this insurmountable burden resting on the shoulders of hardworking taxpayers, illegals are also eligible for Emergency Medicaid which has ballooned more than 1,200 percent since 2014. This spending is unsustainable and in order to continue protecting and preserving benefits for America’s most vulnerable, waste, fraud, and abuse must be rooted out.”
The Empire Center for Public Policy, a conservative New York think tank, found in late 2024 that as many as 3 million New Yorkers may be fraudulently collecting Medicaid and other health insurance benefits from the state, basing their analysis off of census data and information obtained from the state Medicaid program.
Overall, 44% of New Yorkers receive Medicaid or a similar program, including children on the state-level Child Health Plus program and the New York Essential Plan, provided through the American Care Act health insurance marketplace and providing Medicaid-like coverage to people making up to 250% of the federal poverty level.
The Empire Center also found earlier this year that the state program to offer emergency medicaid to undocumented immigrants, which has 480,000 people enrolled as of March, represents 7% of total Medicaid enrollment in the state.
If the reconciliation package passes into law with the provisions for Medicaid included in the House-passed version, the federal government could cut the money it pays to the state for its portion of Medicaid funding, which would reduce available benefits for all recipients.
Stefanik, who has floated a run for governor next year and has made criticisms of state programs aiding undocumented immigrants a core part of her early, pre-campaign message, said in a visit to Albany last month that she would seek to use executive actions and push the state legislature to end the emergency Medicaid program and cut down on fraud if elected.
Gov. Kathleen C. Hochul, who is running for reelection, has not expressed any interest in changing that aspect of the state’s Medicaid operations.
It’s not clear if the final package will include the major Medicaid provisions as passed by the House. On Thursday, the U.S. Senate Parliamentarian, which is charged with ensuring all actions taken by that chamber follow the proper laws and procedures, struck many of the most impactful Medicaid provisions from the bill for procedural reasons. Whatever resulting legislation passes in the U.S. Senate will have to go back to the House for a final vote before it can go to the president for approval. The two chambers have not seen eye to eye on many aspects of the reconciliation bill.
Trump has demanded that lawmakers deliver a finished bill to his desk by July 4