Mississippi hospitals could lose up to $1 billion over the next decade under the sweeping, multitrillion-dollar tax and policy bill President Donald Trump signed into law last week, according to leaders at the Mississippi Hospital Association.
The leaders say the cuts could force some already-struggling rural hospitals to reduce services or close their doors.
The law includes the largest reduction in federal health and social safety net programs in history. It passed 218-214, with all Democrats voting against the measure and all but five Republicans voting for it.
In the short term, these cuts will make health care less accessible to poor Mississippians by making the eligibility requirements for Medicaid insurance stiffer, likely increasing people’s medical debt.
In the long run, the cuts could lead to worsening chronic health conditions such as diabetes and obesity for which Mississippi already leads the nation, and making private insurance more expensive for many people, experts say.
“We’ve got about a billion dollars that are potentially hanging in the balance over the next 10 years,” Mississippi Hospital Association President Richard Roberson said Wednesday during a panel discussion at his organization’s headquarters.
Richard Roberson, Mississippi Hospital Association president and CEO, discusses the impact of what the White House calls “One Big Beautiful Bill,” Wednesday, July 9, 2025, at the Mississippi Hospital Association Conference Center in Madison. Credit: Vickie D. King/Mississippi Today“If folks were being honest, the entire system depends on those rural hospitals,” he said.
Mississippi’s uninsured population could increase by 160,000 people as a combined result of the new law and the expiration of Biden-era enhanced subsidies that made marketplace insurance affordable – and which Trump is not expected to renew – according to KFF, a health policy research group.
That could make things even worse for those who are left on the marketplace plans.
“Younger, healthier people are going to leave the risk pool, and that’s going to mean it’s more expensive to insure the patients that remain,” said Lucy Dagneau, senior director of state and local campaigns at the American Cancer Society.
Among the biggest changes facing Medicaid-eligible patients are stiffer eligibility requirements, including proof of work. The new law requires adults ages 19 to 64 to work, do community service or attend an educational program at least 80 hours a month to qualify for, or keep, Medicaid coverage and federal food aid.
Opponents say qualified recipients could be stripped of benefits if they lose a job or fail to complete paperwork attesting to their time commitment.
Georgia became the case study for work requirements with a program called Pathways to Coverage, which was touted as a conservative alternative to Medicaid expansion.
Ironically, the 54-year-old mechanic chosen by Georgia Gov. Brian Kemp to be the face of the program got so fed up with the work requirements he went from praising the program on television to saying “I’m done with it” after his benefits were allegedly cancelled twice due to red tape.
Roberson sent several letters to Mississippi’s congressional members in weeks leading up to the final vote on the sweeping federal legislation, sounding the alarm on what it would mean for hospitals and patients.
Among Roberson’s chief concerns is a change in the mechanism called state directed payments, which allows states to beef up Medicaid reimbursement rates – typically the lowest among insurance payors. The new law will reduce those enhanced rates to nearly as low as the Medicare rate, costing the state at least $500 million and putting rural hospitals in a bind, Roberson told Mississippi Today.
That change will happen over 10 years starting in 2028. That, in conjunction with the new law’s one-time payment program called the Rural Health Care Fund, means if the next few years look normal, it doesn’t mean Mississippi is safe, stakeholders warn.
“We’re going to have a sort of deceiving situation in Mississippi where we look a little flush with cash with the rural fund and the state directed payments in 2027 and 2028, and then all of a sudden our state directed payments start going down and that fund ends and then we’re going to start dipping,” said Leah Rupp Smith, vice president for policy and advocacy at the Mississippi Hospital Association.
Leah Rupp Smith, Mississippi Hospital Association general counsel and vice president for policy and advocacy, breaks down a timeline for what the White House calls “One Big Beautiful Bill,” during an event to discuss the impact of the law on health care in the state, Wednesday, July 9, 2025, at the Mississippi Hospital Association Conference Center in Madison. Credit: Vickie D. King/Mississippi TodayEven with that buffer time, immediate changes are on the horizon for health care in Mississippi because of fear and uncertainty around ever-changing rules.
“Hospitals can’t budget when we have these one-off programs that start and stop and the rules change – and there’s a cost to administering a program like this,” Smith said.
Since hospitals are major employers – and they also provide a sense of safety for incoming businesses – their closure, especially in rural areas, affects not just patients but local economies and communities.
U.S. Rep. Bennie Thompson is the only Democrat in Mississippi’s congressional delegation. He voted against the bill, while the state’s two Republican senators and three Republican House members voted for it. Thompson said in a statement that the new law does not bode well for the Delta, one of the poorest regions in the U.S.
“For my district, this means closed hospitals, nursing homes, families struggling to afford groceries, and educational opportunities deferred,” Thompson said. “Republicans’ priorities are very simple: tax cuts for (the) wealthy and nothing for the people who make this country work.”
While still colloquially referred to as the One Big Beautiful Bill Act, the name was changed by Democrats invoking a maneuver that has been used by lawmakers in both chambers to oppose a bill on principle.
“Democrats are forcing Republicans to delete their farcical bill name,” Senate Democratic Leader Charles Schumer of New York said in a statement. “Nothing about this bill is beautiful — it’s a betrayal to American families and it’s undeserving of such a stupid name.”
The law is expected to add at least $3.3 trillion to the nation’s debt over the next 10 years, according to the most recent estimate from the Congressional Budget Office.
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