A coalition of Senate Democrats is warning that Louisiana could be one of the hardest-hit states under a Republican-backed health care proposal passed by the U.S. House. The legislation—part of a broader reconciliation package—includes more than $1 trillion in cuts to Medicaid and the Affordable Care Act, along with $500 billion in Medicare reductions. According to Senators Ed Markey, Ron Wyden, Jeff Merkley, and Chuck Schumer, those cuts would cause 16 million Americans to lose their health insurance, with rural communities bearing the brunt of the fallout.
In a letter addressed to President Donald Trump, Senate Majority Leader John Thune, and House Speaker Mike Johnson, the senators lay out in detail how these cuts would destabilize rural hospitals already operating under financial duress. Drawing on research from the University of North Carolina’s Cecil G. Sheps Center for Health Services Research, the senators cite 338 rural hospitals nationwide that are currently at risk of cutting services, converting into standalone clinics, or closing entirely. These hospitals either experienced three consecutive years of financial losses, served a high proportion of Medicaid patients, or both. Of those, 83 are considered at the highest relative risk of financial distress.
Louisiana stands out in the data. With 33 hospitals meeting these risk criteria, the state ranks among the most vulnerable in the nation. That’s more than half of all rural hospitals in Louisiana. For many of the state’s smaller parishes, the local hospital is not only a primary health care provider but often one of the area’s largest employers. If those hospitals shut their doors or scale back operations, the impact could be devastating—not just in terms of medical access but also economic stability.
The letter describes a health care ecosystem already stretched thin. From 2017 to 2023, the United States lost 50 rural hospitals. Others remain open but have eliminated critical services. According to the Chartis Center for Rural Health, more than 290 rural hospitals across the country stopped offering obstetrics between 2011 and 2023. In Louisiana, that trend deepens existing maternal care shortages in regions already classified as maternity care deserts.
The senators warn that cutting Medicaid reimbursements will only accelerate this crisis. Medicaid plays an outsized role in rural health care, accounting for nearly 41 percent of rural births nationally. Yet the reimbursement rate often falls well below the cost of care, with some hospitals recouping only around 63 cents for every dollar spent on inpatient obstetric services. If Medicaid is scaled back further, hospitals already operating on razor-thin margins may not survive.
Recent polling cited in the letter suggests rural Americans understand what’s at stake. A majority of adults living in rural areas say they are concerned that cuts to Medicaid and the ACA would negatively impact hospitals, nursing homes, and other providers in their community. The senators say those concerns are justified. In some cases, communities may lose access not just to emergency rooms, but to basic primary care, mental health treatment, and maternity wards. In others, entire hospitals may disappear.
While the letter focuses on national trends, the potential consequences for Louisiana are particularly severe. Many of the state’s at-risk hospitals serve low-income populations in areas where transportation and provider shortages already limit access to care. Closures in places like Ruston, Mamou, Bogalusa, and Bastrop could leave entire parishes without a functioning hospital within a reasonable distance. For residents facing chronic conditions, pregnancy, or emergencies, the consequences could be life-threatening.
The financial ripple effects are just as troubling. When a hospital closes, job losses follow. Local economies often depend on these facilities not only for direct employment but also for indirect support to pharmacies, clinics, ambulance services, and other related sectors. In rural areas with already limited job markets, the closure of a hospital can tip an entire community into economic decline.
The senators argue that the proposed cuts are not just ill-advised—they are dangerous. In their letter, they state plainly, “It is not too late to stop these cuts. Billionaire tax breaks are not worth the cost to American lives and livelihoods.”
That framing underscores their broader claim: this isn’t simply a fiscal policy dispute. It’s a moral decision about which communities are worth protecting and who pays the price for political choices made in Washington. For Louisiana, where rural health care infrastructure is already fragile, the stakes couldn’t be higher.
