The Big Beautiful Bill and Rural Health

What it means for Public Health, Digital Technology, and Reproductive Health

On July 4th, the reconciliation bill dubbed the “Big Beautiful Bill” was signed into law—an ironic name, given the wreckage it leaves in its wake for rural communities. While much of the media has focused on tax cuts and partisan victories, this sweeping legislation quietly delivered the most significant restructuring of Medicaid, public health infrastructure, and reproductive care access in over a decade. The ripple effects will be especially massive in the rural South, where healthcare deserts, poverty, and political neglect already intersect.

This newsletter breaks down what the bill means for rural health, women’s health, health technology, and the future of healthcare in America’s most overlooked regions.

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Medicaid Takes a Hit: Death by Paperwork

Just weeks before Medicaid’s 60th anniversary, the program has been completed reshaped.

• Federal Work Requirements Introduced: For the first time in history, a federal work requirement will be tied to Medicaid. While not immediately enforceable, enhanced subsidies will end as soon as January. The Congressional Budget Office (CBO) projects millions will lose coverage due to bureaucratic hurdles alone—not policy violations, but simply because the paperwork is too burdensome.

• Work Requirements Don’t Work: A study in Arkansas, the only state to pilot a Medicaid work requirement, found no increase in employment—only a significant loss of healthcare coverage.

• Frozen Provider Taxes: These are a key funding mechanism many states (especially in the Southeast) use to sustain their Medicaid programs.

• Widespread Coverage Loss: Medicaid covers over 20 million people across Southeastern states. Cutting reimbursement and shifting funds directly to patients will devastate rural hospitals, many of which rely on predictable Medicaid payments to stay afloat.

• Impact Beyond Medicaid: If these hospitals shutter, even people with private insurance will suffer from lack of access. Already-overcrowded ERs will get worse.

  • Louisiana hospital systems have warned of closure risks in a joint statement prior to the bill’s passage: Officials from major hospital systems in Louisiana have expressed grave concerns that the Medicaid funding changes in the Big Beautiful Bill could "jeopardize health care for millions" of residents. Louisiana is highly dependent on federal Medicaid dollars—over 1.6 million residents (approximately 35% of the state's population) receive Medicaid coverage .

Long-Term Care & Nursing Homes

• Rural long-term care facilities will be hit particularly hard. With Medicaid cuts and declining reimbursement, many nursing homes and assisted living facilities face closure—leaving seniors and people with disabilities stranded without support in counties with no alternatives.

• Reductions in LTC availability increase pressure on informal caregivers and hospital systems. Older adults with limited mobility or cognitive decline may face care disruptions, increased hospital readmissions, or premature institutionalization. Gaps in long-term care are associated with negative health outcomes for both patients and families, especially in areas with limited home-based care infrastructure.

The bill cuts an estimated $930 billion from Medicaid—with only $50 billion offered in vague “rural health investment funds” unlikely to fill the gap.

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Reproductive Health in Crisis: The Planned Parenthood Provision

This bill also takes a targeted swipe at Planned Parenthood, with potentially devastating effects:

• A 1-year defunding provision was approved by the Senate Parliamentarian, who ruled that while a 10-year defunding plan couldn’t be included in reconciliation (created in 2017), a one-year version could pass.

• Anti-abortion groups are uneasy—this move will bring the issue back to a vote just before the 2026 midterms.

• Already, Planned Parenthood clinics across the South are closing due to budget instability, lack of state support, and now, federal exclusion from Medicaid.

But the impact goes far beyond abortion:

• In rural areas, Planned Parenthood is often the only source for cancer screenings, STI testing, and contraception.

• This funding cut is being seen as a backdoor national abortion ban—especially cruel in states where abortion is still legal but infrastructure is being gutted.

Update (July 7th): Planned Parenthood Federation of America and two affiliates have sued the Trump administration over this provision, arguing it violates First Amendment and equal protection rights. A federal judge has temporarily blocked the funding cuts, pending a longer injunction hearing on July 21st.

Filling the Gap? Crisis Pregnancy Centers Step In

With Planned Parenthood clinics closing, deceptive "reproductive health" centers—often run by unlicensed staff—are filling the void. These facilities:

• Aren’t required to follow HIPAA, exposing patients to privacy risks, especially in states with strict abortion bans.

• Have reportedly misled patients on fetal gestational age, delaying or denying abortion care.

CPCs do not provide comprehensive reproductive care and may delay patients from receiving clinically appropriate services. Misinformation about pregnancy, abortion options, or fetal development may lead to preventable health complications. In high-barrier states, this contributes to a fragmented and opaque care landscape with limited accountability and oversight.

Source used for section research can be found here

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ACA Undermined: More Barriers, Less Access

While the bill stopped short of introducing all proposed barriers, it still undermines the ACA in key ways:

• No extension of ACA subsidies, which previously doubled marketplace enrollment.

• Shortens enrollment windows, cancels auto-renewals, and increases paperwork—designed to suppress participation.

These changes will take effect in 2026 and are expected to disproportionately affect rural enrollees but subsidies will be impacted starting at the fiscal year of 2026.

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Medicare Sequester on the Horizon

Tax cuts balloon the deficit—so much so that under budget rules, automatic Medicare cuts (aka a sequester) are likely to be triggered. Analysts project this could happen as early as next year, threatening access for seniors in underserved areas.

Medicare payment cuts may lead some providers—particularly rural hospitals and specialty practices—to limit the number of Medicare patients they accept. This would affect access for older adults, potentially delaying treatment for age-related illnesses, increasing out-of-pocket costs, and reducing the availability of specialized geriatric care in rural counties.