re: Why are people at my work saying that trump took away medicaid and food stamps 4 americans

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According to the nonpartisan Congressional Budget Office, millions of legally eligible people will lose Medicaid and SNAP if this bill passes

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conservatives claimed to oppose bureaucracy. Now you’re weaponizing it.

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False. Most of their money comes from Medicare and Medicaid.

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Jul 1, 2025 11:19 AM ET
The Surprising Reason Rural Hospitals Are Closing

Alana Semuels / Thomasville, Ala.

Senior Correspondent Time

The Brief July 2, 2025

THOMASVILLE, ALA.—Thomasville Regional Medical Center was supposed to be a gamechanger. Situated in the U.S. Congressional district with the worst health outcomes in the country, the hospital opened in 2020 with state-of-the art equipment, including a 3D mammogram and an MRI scanner. But it closed less than five years later in

The hospital now stands empty: its pristine hallways dark, its expensive machines gathering dust. “It’s almost like the apocalypse happened,” says Sheldon Day, the mayor of Thomasville, who had worked for almost a decade to get a hospital to open there.

This apocalypse is happening throughout rural communities across the country. More than 100 rural hospitals have closed in the past decade, according to the Center for Healthcare Quality and Payment Reform (CHQPR), a national policy center that works to improve health care payment systems and whose data have been cited by the Bipartisan Policy Center. About one-third of all rural hospitals in the country are at risk of closing because of financial problems. In Alabama, 23 rural hospitals—about half of all of them in the state—are at immediate risk of closing.

Why rural hospitals are closing

People often blame rural hospital closures on poor reimbursement rates from Medicare and Medicaid. There’s a reason for that assumption: Just about every hospital loses money on Medicaid and Medicare, since reimbursement rates are low nationwide. But hospitals like the one in Thomasville are struggling not because they serve a large share of poor patients or elderly people on these plans. 

“When you look at the data, what you see is that Medicare and Medicaid are not the problem,” says Harold Miller, president and CEO of CHQPR. “The problem is private insurers.”

Rural hospitals depend on private insurers for the majority of their patient costs, Miller says. In Alabama, for instance, CHQPR’s data shows that most rural hospitals depend on private insurers for anywhere between 65-80% of patient costs; in Thomasville, 18.4% of patients were using Medicare to pay for their coverage, 16.2% were using Medicaid, and 65.4% were using private insurance.
This is a very different situation than what is happening between private insurers and urban hospitals, he says. Urban hospitals and large rural hospitals are able to make up for the losses from Medicare and Medicaid patients with what they can charge private insurers. Small rural hospitals can’t do that.

Rural hospitals actually need higher compensation than urban hospitals, Miller says, because they have the same fixed costs like 24-hour staffing, but have a lower volume of patients to cover those costs.

Why small rural hospitals get less from private insurers
One reason why small hospitals get less money: Insurers demand discounts. Larger hospitals have more leverage to negotiate with private insurers over those discounts because they have higher patient volumes. Smaller hospitals have less wiggle room to negotiate.

Another problem in Alabama in particular is that just one health insurer, Blue Cross and Blue Shield of Alabama, has an estimated 94% of the large-group private insurance market, which most people with private health insurance fall under. Hospitals can’t negotiate as well because they have to accept Blue Cross and Blue Shield of Alabama patients, and losing those patients would be financially ruinous. That’s how one small rural hospital in Alabama, Medical Center Barbour in Eufaula, gets paid just $65 for an X-ray by Blue Cross and Blue Shield of Alabama, compared to $97.03 by Aetna, according to Miller’s data.

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Through my work, I met a young man who works the overnight shift at a fast food restaurant as a manager. He drives straight to GED classes when he gets off in the morning. What about that is easy to you?

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