When the One Beautiful Bill Act was being debated by Congress in the first half of 2025, critics made clear the Act would cripple our already struggling rural health care system. The law’s drastic cuts to Medicaid would strip further the finances of our health care system, particularly in rural areas.
As a compromise, federal legislation responded by creating the Rural Health Transformation Program which will distribute $10 billion to the 50 states annually through the end of this decade — a total of $50 billion. Few people understand that this federal compromise falls far short of the total financial losses we will see with the Medicaid cuts.
The Kaiser Family Foundation — a credible, non-partisan, nonprofit newsroom focusing on national health policy — estimates that the One Beautiful Bill Act will cut spending on Medicaid by $990 billion by the end of 2030. Clearly, the $50 billion for the federal Rural Health Transformation Plan over the next five years pales in comparison to the health care funds lost with the Medicaid cuts.
New Hampshire expects to receive roughly $200 million annually through 2030 from the federal Rural Health Transformation Plan. Much fanfare was made when Gov. Kelly Ayotte established the GO-NORTH office and tasked it with managing the money. Foundations for Healthy Communities, the New Hampshire Community Development Finance Authority, Community Behavioral Healthcare, the University System of New Hampshire and the Community College System of New Hampshire have been named as hubs to distribute the money to different programs.
The annual $200 million of federal support appears to give great hope to rural health in New Hampshire. Unfortunately, this amount of money is a small portion of what will be lost with Medicaid cuts. Additionally, Congress let a set of credits Americans use to pay for health care on the Affordable Care Act expire last year. Already this has resulted in many more uninsured lives.
Rural health care clinics are closing and rural hospitals will not survive as the uninsured population grows. Our emergency rooms are clogged with sicker patients lacking any kind primary care. With the growth of the uninsured, all medical costs increase and insurance premiums rise for all of us. The One Big Beautiful Bill Act has created more of a health care crisis. It is an ugly failure of our leaders.
Oge Young is a retired OB-GYN. He practiced in Concord for more than 30 years, was the president of New Hampshire Medical Society and was a member of the general council representing New Hampshire obstetricians.