“This bill falls short of supporting individuals and families who are poor, vulnerable, or too often left out of important decisions in Washington, causing nearly 12 million to lose their health coverage,” Ascension president Eduardo Conrado stated after the House passed the sweeping tax and spending bill on July 3. The weight of those words hits especially hard when considering that this legislation marks what KFF calls the “biggest rollback in federal support for health coverage ever” with about 17 million more people projected to be uninsured if all policy changes take effect.
The federal budgeting process, often a battleground of priorities, has real-world consequences. The newly approved reconciliation bill includes $1.2 trillion in cuts to Medicaid and the Affordable Care Act (ACA), with the Congressional Budget Office estimating that 11.8 million people could lose coverage by 2034. The brunt of these losses will be felt in Medicaid, which is a lifeline for millions in rural and underserved communities. In rural America, Medicaid covers one in four adults and nearly half of all births making it a pillar of local healthcare systems.
But the ripple effects go beyond individual coverage. The cuts are projected to reduce federal Medicaid spending in rural areas by $155 billion over ten years—far more than the $50 billion set aside for rural health transformation grants raising concerns about hospital closures, layoffs, and reduced services. As hospitals shift from insured patients to more uncompensated care, research shows that uninsured people use fewer healthcare services, and hospital costs drop by about 44 percent when shifting from insured payers to uncompensated care which can threaten the financial stability of already struggling rural hospitals.
The mechanics of these cuts are complex. Funding reductions are allocated across states based on current Medicaid spending, expansion status, and use of provider taxes meaning states with higher Medicaid enrollment or provider taxes face steeper losses. For states that expanded Medicaid under the ACA, the federal government’s share will gradually drop from 90 percent to regular match rates, which can force states to either pick up the tab or roll back coverage potentially eliminating coverage for millions.
Amid this upheaval, Catholic health systems like Ascension play a unique and influential role. With 142 hospitals and 40 senior living facilities in 19 states, Ascension is part of a tradition that dates back to the 1800s, when Catholic nuns established hospitals to serve the poor and marginalized Their mission remains rooted in providing compassionate care to all, regardless of ability to pay. Today, four of the ten largest U.S. healthcare systems are Catholic, and in some states, more than 40 percent of hospital beds are in Catholic hospitals demonstrating the sector’s reach and responsibility.
Conrado reaffirmed Ascension’s commitment: “We will continue to provide compassionate, high-quality care to everyone we serve, with special attention to those most in need, regardless of their health coverage status.” This advocacy is especially crucial as Catholic systems, governed by the Ethical and Religious Directives, have a longstanding focus on serving vulnerable populations and advocating for social responsibility in healthcare placing them at the heart of the national debate on access and equity.
As the dust settles on this latest federal budget battle, the nation’s most at-risk communities—and the hospitals that serve them—face an uncertain road ahead. The interplay between policy decisions, healthcare financing, and the missions of faith-based providers will shape the future of care for millions across the country.
