From Jackson, Mississippi, to Anchorage, Alaska, healthcare advocates are concerned Medicaid changes in President Trump's big bill will hurt rural hospitals and the patients who rely on them. The tax and spending cut bill passed the Senate Tuesday and is now back in the hands of House members. "We thought the House version was bad, but the Senate version in terms of Medicaid is much worse," said Roy Mitchell, executive director of the Mississippi Health Advocacy Program. According to a 2025 study by the Center for Healthcare Quality and Payment Reform, 54% of Mississippi's 67 rural hospitals are already at risk of closing. "We've got hospitals that are in danger of closing—rural hospitals that are going to be directly impacted by this bill," Mitchell said. Executives at the Franciscan Missionaries of Our Lady Health System, which operates in Mississippi and Louisiana, echo Mitchell's concerns. Ryan Cross, the chief government relations officer for FMOL, said their system was financially strained by the covid-19 pandemic and doesn't have much room in its budgets left to accommodate more cuts. "Our facilities rely on the Medicaid program to support vital access to care for some of the most vulnerable in our community. These are pregnant women, children, working families that cannot afford commercial insurance," Cross said. "Our hope is that we won't see hospitals close as a result of passing this legislation in the near term, but as we know, in the state of Mississippi, there are many rural hospitals that are already on the brink of closure." The bill includes a fund to offset the impact of Medicaid cuts on rural providers. However, the President and CEO of the Alaska Hospital and Healthcare Association Jared Kosin said the bill will still hurt rural providers overall. "There is no spinning this as if there's a positive thing. Even the rural health fund can't be championed as a great thing because it's an attempt to offset impact that was self imposed," Kosin said. He also expressed doubt that the federal government will make good on its promise to give those funds. "What we've witnessed over the last year is a lot of unpredictability, a lot of attempted claw backs and zero uncertainty on funding," Kosin said.