Senator Tom Cotton voted for the 2025 budget reconciliation law — the so-called “One Big Beautiful Bill.”
There are a lot of things buried in that enormous piece of legislation, but two deserve particular attention in Arkansas: Medicaid and SNAP.
And these aren’t abstract Washington programs.
They pay doctors. They keep rural hospitals operating. Medicaid pays a huge share of nursing-home bills. SNAP buys groceries for families who don’t have enough money to buy them otherwise.
So what did Congress do?
It made major cuts and added new restrictions.
The Congressional Budget Office estimates the law will reduce federal Medicaid spending by roughly $1 trillion over ten years and leave about 10 million more Americans without health insurance by 2034.
That matters everywhere. It matters even more in rural America, where Medicaid covers about one in four adults and nearly half of all births.
In Arkansas, we’ve already had a preview of Medicaid work requirements. We tried them in 2018. Thousands of people lost coverage before a federal judge stopped the program.
Now we’re going back for another helping.
Then there’s SNAP.
The new law expands work requirements and changes how the federal government and states pay for the program. The Congressional Research Service says the changes are expected to reduce some households’ monthly benefits and make it harder for some people to qualify.
Again, these aren’t just numbers on a federal spreadsheet.
They’re groceries.
And Medicaid cuts aren’t simply cuts to people receiving Medicaid.
A Medicaid dollar eventually lands somewhere.
At a doctor’s office.
At a pharmacy.
At a nursing home.
At a hospital.
That is especially important in rural Arkansas, where hospitals already operate on thin margins. Nationally, 44 percent of rural hospitals were already losing money before these cuts.
Nursing homes have the same problem. Medicaid is the country’s primary payer for nursing-home care. When Medicaid money gets squeezed, nursing homes don’t magically become cheaper to operate.
Something else gets squeezed.
Staffing. Services. Access.
Maybe eventually the facility itself.
Supporters of the law will point out that Congress included a temporary $50 billion Rural Health Transformation Program.
That’s true.
But Congress simultaneously enacted Medicaid reductions vastly larger than that. KFF estimates the Medicaid reductions affecting rural areas nationally at about $137 billion over ten years.
So, yes, there’s money in the bill for rural health care.
There’s just considerably more money coming out.
And Tom Cotton voted for it.
That’s why I think the cartoon gets to the point better than several thousand pages of legislation ever could.
Cotton didn’t eliminate the need.
He didn’t eliminate sickness.
He didn’t eliminate old age.
He didn’t eliminate hunger.
He just helped cut the safety net underneath them.
Don’t worry. The cuts are only to the safety net.
Odds & Ends 007
