Last summer, Republicans passed Trump's budget bill. KFF projects it cuts an estimated $911 billion from federal Medicaid spending over ten years. About $137 billion of that comes out of rural areas, according to the health research group KFF.
The same law also set up a $50 billion "Rural Health Transformation Program." The first checks went out to the states this year.
Now, with less than two weeks until Election Day, Republicans in close races are telling voters about the checks and not the cuts. On Wednesday, the health advocacy group Protect Our Care named nine of them and said they were "touting bald-faced lies." Eight of the nine are on this site. (The ninth, Ted Cruz, doesn't have a page here.)
Protect Our Care is an advocacy group. So we didn't take its word for it. We went to each Republican's own words, and to the roll call for the vote.
What the fund is, and what it isn't
Here is the math, from KFF:
- The fund is $50 billion, paid out from 2026 to 2030.
- The same law cuts an estimated $137 billion from Medicaid in rural areas over ten years.
- So the fund covers a little over a third (37%) of the rural cuts, and about 5% of the total Medicaid cuts.
- The fund runs out. All of it has to be spent by September 30, 2032, the end of fiscal year 2032. Most of the Medicaid cuts don't end.
KFF also says the money "could mitigate but will not fully offset" the rural cuts. And there are limits on how hospitals can use it.
People who run rural health care have been saying the same thing all year. Jed Hansen leads the Nebraska Rural Health Association. In March, he told KFF Health News: "Rural Health Transformation will not save a single hospital in our state."
What each of them is saying
Roger Marshall (Kansas). On a stop in Hutchinson, Marshall pointed to the $222 million Kansas got from the fund. He also talked about new money for dental and mental health care. He voted for the budget bill when it passed the Senate on July 1, 2025.
Jon Husted (Ohio). In a Washington Times op-ed, Husted wrote that he "fought to include the $50 billion Rural Health Transformation Fund." He said it "protects rural hospitals" and gives them "the stability they need." He voted for the bill on the same Senate roll call. Axios reports that Republicans in Ohio are attacking Sherrod Brown for not backing "the GOP law's rural health fund." At the same time, Brown's ad features a mother who says Husted broke his promise to protect her daughter's Medicaid.
Susan Collins (Maine). Collins says she proposed the $50 billion. Maine has gotten $190 million from it. Maine faces about $3 billion in Medicaid cuts over the next ten years. Collins voted no on final passage. But she voted for the procedural motion that brought the bill to the floor. Her opponent, Troy Jackson, put it this way in a debate this month: "Senator Collins is like an arsonist who helped set the fire, and then she wants credit for bringing a cup of water to put it out."
Juan Ciscomani (Arizona). Ciscomani has the clearest record of the eight, because he warned about the damage himself before he voted for it. The Tucson Sentinel laid out the record:
- In April 2025, he signed a letter warning that Medicaid cuts "threaten the viability of hospitals." It said rural hospitals in particular are "especially at risk of closure."
- In June 2025, he signed another letter. It said he and 15 other Republicans "cannot support a final bill that threatens access to coverage or jeopardizes the stability of our hospitals."
- Days later, on July 3, 2025, he voted yes.
- In January, he said Arizona's $167 million from the fund "falls short of my expectations." Per person, that was the sixth-lowest amount of any state.
- In a debate this fall, he held up the same money as a selling point: "This bill that my opponent criticizes also brought in $167 million specifically for rural healthcare."
Jeff Crank (Colorado). On September 28, Crank posted that the Trump administration had announced $169 million "to expand healthcare for rural Coloradans." He called the fund "the single largest investment in rural healthcare in U.S. history." He voted yes on July 3, 2025.
Mariannette Miller-Meeks (Iowa). Her office says she "has helped deliver" $209 million for rural hospitals in southeast Iowa through the fund. Her release credits "the Working Families Tax Cuts," which is the Republican name for Trump's budget bill. In her race, Axios reports, "Republicans are highlighting her role in securing more funding for rural hospitals," while Democrats hit her Medicaid vote. She voted yes on July 3, 2025.
Jason Smith (Missouri). Smith chairs the House Ways and Means Committee, which wrote the bill's tax cuts. On October 20, he published an op-ed in the Ste. Genevieve Herald called "Fighting for rural health care in Missouri." It praises rural health money going to hospital upgrades, health workers and maternal care. He voted yes on July 3, 2025.
Derrick Van Orden (Wisconsin). In September, Van Orden went to the Republican convention in Dallas. There, he said the money for rural hospitals "would not have been possible without President Trump's Working Families Tax Cut Act." The Wisconsin Examiner points out that the law will cost Wisconsin $7 billion in federal health money over ten years, according to KFF. It also cites a Third Way analysis: hospitals in Van Orden's own district are projected to lose more than $42 million a year. He voted yes on July 3, 2025.
The cuts and the tax cuts came in one bill
The Medicaid cuts and the tax cuts were passed together, in one bill. Republicans now name the whole law after the tax cuts: Crank, Miller-Meeks and Smith call it the "Working Families Tax Cuts," and Van Orden called it the "Working Families Tax Cut Act."
That leaves rural voters with a lopsided trade. Most of the Medicaid cuts don't expire. The rural fund is a five-year grant program that pays for technology, workforce training and new models of care. KFF notes that it can't be used to prop up a struggling hospital with temporary relief.
The pattern isn't new. We've written about the same move by Jake Ellzey, who called the fund a "historic investment" after voting for the law that made it necessary. We wrote about Michael Guest, who spent his August recess promoting $206 million for Mississippi hospitals. And we wrote about Andy Barr, who says the fund will save Kentucky's hospitals while Kentucky's governor says the rules forbid spending it on the hospitals most at risk.
What the record shows
Seven of these eight Republicans voted for Trump's budget bill. It takes an estimated $137 billion out of rural Medicaid over ten years. Susan Collins voted no on the bill, but she voted to bring it to the floor and now says she proposed its rural fund. All eight are now touting that $50 billion fund, which KFF says covers about 37% of the rural cuts and runs out by 2032. Juan Ciscomani warned in writing that the cuts threatened rural hospitals and then voted for them anyway.
