Potential $880B cut to Medicaid could have big impacts on Wyoming hospitals, nursing homes
Congress is having ongoing discussions about how to cut $880 billion in program spending. There is a current deadline of May 9 for congressional committees to make their budget recommendations, but this deadline is not set in stone, according to reporting by Politico.
'To get to that number, Medicaid would have to take a pretty big hit,' said Wyoming Hospital Association Vice President Josh Hannes.
States with expanded Medicaid programs under the Affordable Care Act are going to feel the brunt of these cuts. Although Wyoming is one of a handful of states that didn't opt in to Medicaid expansion, the Cowboy State is far from being in the clear, according to sources.
'Wyoming didn't expand Medicaid, so that wouldn't touch us. But that also doesn't get them to $880 billion,' Hannes said. 'So, what else are they gonna do?'
One potential area that has health care officials concerned is the looming expiration date of premium tax credits. These are a federal subsidy that makes insurance policies more affordable on the health insurance marketplace. Around 42,000 Wyomingites depend on these tax credits, Hannes said.
'If those go away … rates on the marketplace are going to jump dramatically,' he said.
This is a 'significant concern' for Cheyenne Regional Medical Center, said Cheyenne Regional Health System Chief Financial Officer Yvonne Wigington. First and foremost, hospital associates are worried about the impact the loss of these credits will have on patients, she said.
People will either have to forgo their health insurance or choose a plan that doesn't fully meet their health care needs. More people will be at risk of losing their health coverage and delaying treatment, Wigington said.
'We really don't ever want patients to feel like they have to delay their care,' she said.
On the financial side, CRMC would lose between $9 million and $18 million in annual revenue if the tax credits were to expire.
'We care for any patient, regardless of their ability to pay for their services,' Wigington said. 'If those individuals did not have health care insurance and did not have a way to pay for their health care, that would be $9-18 million that we don't get paid for.'
Hospital officials are currently evaluating 'many different scenarios for potential cuts' at CRMC, Wigington said. However, it's difficult to pinpoint what the actual impact would be, with so many cuts being proposed at the federal level.
'We're not sure exactly which cuts may actually be implemented,' Wigington said.
In addition, the hospital is facing stress from another major federal action — increased tariffs. Wigington said President Donald Trump's tariffs affect the hospital's vendor contracts, medical supplies, pharmaceuticals and the information technology area. However, with the percentage of these tariffs constantly changing, preparing for financial impacts has been a moving target.
'We're in the preliminary stages, but we definitely have seen price escalations,' Wigington said. 'Some of our vendors have notified us that they're not able to honor quotes that they've given us previously until they are better able to evaluate the impact of tariffs.'
Wigington said tariffs have not impacted services or employment at CRMC so far.
'The (tariffs') percentages have changed a few different times,' Wigington said. 'We, like probably every other hospital, are really just trying to plan with what we know now and anticipate those things that are being proposed.'
Uninsured rates in Wyoming
The Kaiser Family Foundation (KFF) reported that 59,400 Wyomingites, or 10.5% of the state's population, were uninsured in 2023. By comparison, 8% of the entire U.S. population was uninsured that same year.
'We already have struggling hospitals and nursing homes, and Medicaid is a lifeline for a lot of those facilities,' Hannes said. 'Medicare and Medicaid together represent way over half of total revenue for our hospitals in the state.'
A 2022 contribution analysis conducted by the Center for Business and Economic Analysis at the University of Wyoming found that Wyoming's hospitals and nursing homes directly contribute a combined $47.5 billion to the gross state product.
The hospital and nursing home industry made up 3.5% of Wyoming's total economic contribution, as well as provided 19,370 jobs, according to the analysis.
'If you're not investing in our health care infrastructure, you're doing harm, and if you're going to pull away investment, that's even worse,' Hannes said. 'So it's certainly concerning, the discussions that are going on at the federal level.'
Adding to the number of uninsured patients increases cost of care, Hannes said. When a patient is unable to pay for services, 'hospitals eat that.'
'Our industry is different from so many others, because we don't get to decide what we get paid, and we have to serve everyone who comes in through the door,' he said.
About 7% of CRMC's total patient population is on Medicaid, Wigington said. The potential $880 billion cut in funding to Medicaid, equivalent to about an 11% spending reduction for the program, would expand the local hospital's funding gap by $1.8 million.
'The payments already that we receive for caring for our Medicaid patients don't cover our cost to care for those patients,' Wigington said. In the 2024 fiscal year, there was a $10 million shortfall in Medicaid payments, which the hospital tries to alleviate through other funding sources, she said.
'That is a lot of money,' Wiggington said.
In January, U.S. Sen. John Barrasso, R-Wyo., brought up Wyoming's challenges with rural health care to Robert F. Kennedy Jr., who is now U.S. secretary of Health and Human Services. Barrasso said six Wyoming hospitals are at risk of closing, two are in immediate risk of closing in the next two years, and 10 have had to cut available services, according to a news release from his office.
'We have 33 hospitals in Wyoming. Twenty-six are located in various locations often hard to get to, or weather impacts them,' Barrasso said. 'This is a concern of rural hospitals in both Republican and Democrat states. It's bipartisan. It is critical that the financial, workforce challenges that we are facing are addressed.'
Nursing homes at risk
Most states finance at least a portion of their Medicaid spending through taxes collected from health care providers, which generates additional federal matching payments to the states, according to a Congressional Budget Office (CBO) analysis. States return the collected taxes to those providers in the form of higher Medicaid payments.
Wyoming's had a hospital provider tax since 2017 and a nursing home provider tax since 2011, according to the Center on Budget and Policy Priorities, a progressive think tank based in Washington, D.C. These mechanisms help draw down federal dollars to the state, Hannes said, and nursing homes are a huge benefactor of these programs.
There is currently a 6% provider tax cap. The CBO estimated a 5% cap on the provider tax 'would reduce the deficit by $41 billion from 2024 to 2032.' A 2.5% cap 'would reduce the deficit by $209 billion over that period.'
Critics of restricting provider taxes argue this 'will create financing gaps for states that could result in higher state taxes, reductions in Medicaid eligibility, lower provider payment rates, and fewer covered benefits,' according to KFF.
'If they dial back these provider loopholes, that's a direct reimbursement reduction to the nursing homes,' said Wyoming HealthWorks CEO Tracy Brosius. 'They're almost entirely dependent on that.'
Around 70-80% of patients in nursing homes are reliant on Medicaid, Brosius said. People are there because they have a high clinical need and no one to take care of them. She questioned where these people are supposed to go once nursing homes start shutting down.
'What happens if they cut the provider taxes and now the nursing homes start to fold?' Brosius said. 'What happens to the 80 people that are there?'
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Transcript: Dr. Mehmet Oz on "Face the Nation with Margaret Brennan," Aug. 3, 2025
The following is the transcript of an interview with Dr. Mehmet Oz, Centers for Medicare & Medicaid Services administrator, that aired on "Face the Nation with Margaret Brennan" on Aug. 3, 2025. MARGARET BRENNAN: Change is coming for the country's Medicaid system as part of the enactment of the Big, Beautiful Bill. To help us understand what's ahead, we turn now to the Administrator of the Centers for Medicare and Medicaid Services, Dr. Mehmet Oz. Good morning. Welcome to Face The Nation. DR. MEHMET OZ: Thank you. MARGARET BRENNAN: You've got a lot of work ahead. I want to start on drug costs. The president put this 25% tariff on India, big drug producer. The President's trade deal with the EU puts a 15 percent tariff on imported medicines from Europe. How do you stop the drug makers from passing along those costs to people on Medicare and Medicaid? DR. MEHMET OZ: Well, the president's letter on Thursday for most favored nation pricing is a good example of that, and he's been working on this tirelessly since the first administration. And just to put this in context for many of the viewers, about two thirds of bankruptcies in America are caused by health care expenses. About a third of people when they go to the pharmacy, they leave empty handed. They can't afford the medication. So the President has said, Enough global freeloading. We've been covering much of the development costs for new drugs to cure cancer, deal with lots of other illnesses that are life threatening. It is in time for the American public to understand that we should not be paying three times more for the exact same medication in the same box, made in the same factories. The president's saying, equalize it out. Let's use a model that's worked, for example, for external threats, that's what NATO did. Everyone has to pay a little more. We'll pay extra too, but we won't pay a lot more than everybody else, so they actually have to raise their contributions, in this case, to an internal threat, which is illness. We'll pay a little less than America that way more Americans can afford these medications, and it's a fair system for the entire globe. MARGARET BRENNAN: So this was declared in these letters that were sent out to 17 pharmaceutical companies this past week, and it calls for extending that to Medicaid drug prices. Is that intended to offset what will be, you know, cuts to Medicaid? And do you know, you know, if the companies are actually going to follow through on this, like, how do you actually strong arm them into doing it? DR. OZ: Well just get the numbers correct. We're putting 200 billion more dollars into Medicaid. So we're actually investing— MARGARET BRENNAN: —by the time when costs are going up, so. DR. OZ: Costs are going up, but there's been a 50 percent increase in the cost of Medicaid over the last five years. So I'm trying to save this beautiful program, this noble effort, to help folks giving them a hand up. And as you probably gather, if Medicaid isn't able to take care of the people for whom it was designed, the young children, the dawn of their life, those are the twilight of their life, the seniors and those who are disabled living in the shadows, as Hubert Humphrey said, then we're not satisfying the fundamental obligation of a moral government. And this President has said over and over that he believes that it is the wise thing and the noble thing to help those who are vulnerable and every great society does that, we're going to as well. So we're going to invest in Medicaid as is required, but we want an appropriate return on that investment. One thing that Medicaid patients should not face are drug prices they can't afford. MARGARET BRENNAN: Right, how do you enforce this? Pharmaceutical companies— DR. OZ: Well, the pharmaceutical companies, if you sit them down quietly, Margaret, and we've done that, and say you went into this business at some point, because you cared about people. I know there's many out there shaking their heads, but that is actually the truth. People go into health care, whether they're pharmaceutical companies or insurance companies or the PBMs or anybody in the space. Even at the CMS, the most impressive thing to me in my new task, and the President has appointed me to, is the remarkable quality of people within the organization, just unbelievably talented. They went into this job because they care about health care and about people. Somewhere along the lines, people forget. They put numbers ahead of patients. And when that happens, then you start running into problems. We went to the pharmaceutical companies and we said, you appreciate this is not a fair system. We should not be paying more in America, three times more, for your products than you charge in Europe. They get the joke. They understand the reality of this problem. They are engaging with us. We're in the middle of those negotiations. The President has a unique power to convene. We've done it with dealing with prior authorization, this heinous process where patients feel like they're trying to get care from a doctor. Everything's being done except all of a sudden the arm of insurance comes in and stops the whole process for unknown reasons for weeks, sometimes months. The insurance companies, representing 80 percent of the American public, got together and they said, because we pushed them, we're going to deal with this. We can do the same, I believe, with the pharmaceutical industry, with most favored nation pricing. MARGARET BRENNAN: Let me ask you about the changes that are coming because of this new law to Medicaid, which is jointly administered between the feds and the states. There are major reduction- reductions to federal health care spending here, one of the changes are these work requirements. It's about 20 hours a week, volunteer or work to qualify for health care. What is the guidance you are giving to states on how to implement this? Because in this economy, things are more complicated. Uber driver, independent contractor, how do they show they work their 20 hours a week? DR. OZ: Last weekend, I was at the National Governors Association with Secretary Kennedy, who has been a big advocate of work as well. Every Democratic president and Republican president has said that the foundation of a healthy welfare system of a social system of support is work. MARGARET BRENNAN: Right, but I'm asking how you actually implement that and register it so that people who are working do qualify, and they don't get caught up in paperwork because they didn't file something on time. DR. OZ: As long as we're okay that people should work and would want to work, and it's not just work, it's community engagement. They can go get educated, right? They can take care of family members. They can contribute in other ways, but work is a great way of doing and get you out of poverty if you can find jobs and elevate yourself. There have been efforts to do this in the past, but they haven't been able to achieve what we can achieve, because we have technologies now. And we've invested already, as soon as the bill was signed, began pilots to try to demonstrate that we can actually do this correctly. We have pilots now in Louisiana and in Arizona, in both cases, within seven minutes, you can click on where you're working. You mentioned Uber, you're an Uber driver. You click that button on your phone. It just takes you to your payroll provider. Let's say it's ADP. We then ask your permission, can we connect with this payroll provider to demonstrate what you've actually been able to work and earn over the past month? This also, by the way, confirms your eligibility. But there's a bigger benefit here. Once you do that, you're in, you're done. However, what if we take one step further, Margaret? What if we go beyond just proving that you tried the work to actually say, You know what, you didn't work enough, but we can actually help you by connecting you through an employment office? MARGARET BRENNAN: So you're still figuring out the technology, but isn't there an end-of-December deadline for a lot of these things to be figured out? And how do you make sure that people don't get kicked off? Because in the state of Georgia, which already had work requirements, they have really struggled to make this work. DR. OZ: Well, a couple of things. It's not the end of December, it's end of December a year from now, and Georgia is apples and oranges. Georgia had a program only for people under the poverty level, and for those people, if they wanted, they could elect to come into a system to help them get jobs. There have been 50,000 reduction in head count of uninsured people in the overall program in the last five years. Overall, Georgia, 2 million less uninsured people. So Georgia is using a lot of tactics, and they're going in the right direction. I would argue that if you have confidence in the American people and their desire to take to offer to try to get a job, if we challenge you to that. And remember, if you're an able-bodied person on Medicaid, you're spending 6.1 hours watching television or leisure time, so you don't want that— MARGARET BRENNAN: —Well, KFF Health Policy found 92 percent of adult Medicaid recipients already are working. Or they have the carve out because they have to have caregivers, or they have to do other things. DR. OZ: They're fine. All they have to do is there'll be a simple app. If you've already carved out, that's super simple. If you're supposed to be if you're able-bodied and supposed to be working, we want to help connect you to the job market and get you into work. We have twice as many jobs available in America as people who seem to want them. The foundation of work is not just about fulfilling eligibility. The goal of health care insurance is to catalyze action in the right direction, to get you healthier, to give you agency over your future, so you recognize you matter, and you should have a job, therefore to go out and change the world. MARGARET BRENNAN: So there's a drug addiction problem in this country. How are those changes going to impact people who are on Medicaid in states like Kentucky, in states like West Virginia? DR. OZ: In many instances, there are carve outs for folks who have substance use disorder problems. There are programs-- MARGARET BRENNAN: —How do they prove that? ADMINISTRATOR OZ: Well, they can— MARGARET BRENNAN: Is this in the app? DR. OZ: Yes, it will be in the app. The app, again, this is being developed by the United States Digital Service, led by Amy Gleason, who is a wonderful technologist. She and I were with the President and Secretary Kennedy and the head of the czar for AI in this country on Wednesday, talking about overall how we're going to change the use of health technology in America. We've got to get into 2025 with health technology, as is true in every other sector. If you're watching the show right now, you could also be streaming media. You could take an Uber somewhere, the rideshare. You could do an Airbnb. Technology should make the system more efficient. We should have confidence that it will also allow us to do what we all agree is possible. If the whole challenge to a work requirement is that you don't have confidence in our ability to accomplish it, that's a separate question, because I do have confidence in the American people, and we have confidence we can pull this off. Look at the passport system, Margaret. Right now, you can go and get a passport in two weeks without having to go to the post office, send pictures, and all that's gone. It's fixable. Let's use technology. MARGARET BRENNAN: I'm still confused on how someone who is in the throes of substance abuse is going to use an app to say, I'm in the throes of substance abuse every week, to file on online— DR. OZ: —When they go in to get their help for their substance abuse treatment, assuming they're going for help on that, they can also get enrolled in, in those requirements, can be fulfilled. We want to talk to them in as many ways as possible. It's not going to happen just because we put an app out there, you, you have social workers and other folk elements who care a lot about this population, who are coming together, but they have to have some mechanism to report back. That just has not been done well. MARGARET BRENNAN: Well, and this is incredibly detailed, and that's why we wanted to have you on. I have so many more questions for you on rural hospitals and some of the other criticisms. I have to leave it there for now. But thank you, Dr. Oz-- DR. OZ: Can I give you 30 seconds on rural hospitals, because this is important. You have 7 percent of Medicaid money going to rural hospitals. We're putting 50 billion dollars the president wants us to, Congress wants to— MARGARET BRENNAN: There are a lot questions on how you're going to duel that out, and whether you have already made promises. Do you have any specifics for us? DR. OZ: Yes. Wait, wait, it's going to be, they'll get the applications in early September. The money is designed to help you with workforce development, right sizing the system and using technology to provide things like telehealth that can change the world. Imagine if we can change the way we think about the delivery of health and make it more about getting people healthy so they can thrive and flourish and be fully present in their own lives and as Americans. MARGARET BRENNAN: Dr Oz, we'll leave it there. We'll be back in a moment. Black swimmers teach others amid history of aquatic segregation How safe is our Social Security safety net? In Gaza, hunger forces impossible choices as Hamas releases propaganda video of hostage Solve the daily Crossword
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Dr. Oz touts investment in Medicaid: 'I'm trying to save this beautiful program'
Centers for Medicare and Medicaid Services (CMS) administrator Dr. Mehmet Oz says the Trump administration plans to invest more than $200 billion "more dollars" into Medicaid following the passage of the "One Big Beautiful Bill." "I'm trying to save this beautiful program, this noble effort, to help folks, giving them a hand up," Oz told CBS' "Face the Nation" on Sunday. "And as you probably gather, if Medicaid isn't able to take care of the people for whom it was designed, the young children, the dawn of their life, those who are twilight of their lives, the seniors, and those who were disabled living in the shadows, as Hubert Humphrey said, then we're not satisfying the fundamental obligation of a moral government," he continued. Oz, the 17th administrator for CMS, said the government wants "an appropriate return" on the Medicaid investment. He addressed the difference in drug costs between the U.S. and Europe, adding that work is being done by the administration in an attempt to bring drug prices down. Last week, the Trump administration announced it is launching a new program that will allow Americans to share personal health data and medical records across health systems and apps run by private tech companies, promising that this will make it easier to access health records and monitor wellness. CMS will be in charge of maintaining the system, and officials have said patients will need to opt in for the sharing of their medical records and data, which will be kept secure. Those officials said patients will benefit from a system that lets them quickly call up their own records without the hallmark difficulties, such as requiring the use of fax machines to share documents, that have prevented them from doing so in the past. "We're going to have remarkable advances in how consumers can use their own records," Oz said during the White House event. CMS already has troves of information on more than 140 million Americans who enroll in Medicare and Medicaid. Earlier this month, the federal agency agreed to hand over its massive database, including home addresses, to deportation officials.
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Transcript: New Mexico Gov. Michelle Lujan Grisham on "Face the Nation with Margaret Brennan," Aug. 3, 2025
The following is the transcript of an interview with Democratic New Mexico Gov. Michelle Lujan Grisham that aired on "Face the Nation with Margaret Brennan" on Aug. 3, 2025. _______________________________________________________________________________________________________________________ MARGARET BRENNAN: We turn now to New Mexico's Democratic Governor Michelle Lujan Grisham. She joins us from Santa Fe. Governor, two out of five New Mexicans are on Medicaid. You've got a lot of rural hospitals. Have you figured out how to implement everything Dr. Oz just laid out? GOV. LUJAN GRISHAM: Absolutely not. There is no real way to implement this. It's more paperwork for everyone. It's more paperwork for federal government, for state governments, for county governments, for local hospitals, for independent providers. And you know what Americans really hate, Margaret? When you go to your primary care physician and you spend 20 minutes sitting at a chair, not even on the exam table, while they are inputting data into a computer. So this doesn't make any sense. We should be a society and a country that is connecting people to healthcare providers. I think the one thing that Dr. Oz represents that's a fair representation, is we should be healthier as Americans. All right. We need to be moving out of poverty. We need drug prices- we should talk about that, to come down. So go after insurance companies. Do manufacturing here. Make sure we can negotiate fair prices. Let states do that, because I guarantee you, we'll do a better job than the federal government. And lastly, get people early, easy access today, more than half, or about half, our small businesses don't even offer health care coverage. So you can get a job. but now what? MARGARET BRENNAN: Yeah, well, you said, though- in your state, because as a governor, you're going to have to figure this out. You have reserve cash from some oil and gas revenues, as I understand it, that have been put aside. Doesn't that show it is possible for the federal government to shift more responsibility back to the states? That's the argument conservatives are making. GOV. LUJAN GRISHAM: They are and it's temporary. There is no way any state, including this one—which, frankly, I am really proud of, we are in really good financial shape that takes planning and effort. You know, our job projections continue to be met and exceed, unlike the federal jobs report, which is going in the opposite direction. So I don't know where all these jobs are going to be in this anemic economy. I mean, it's so bad. The last time it was this bad, I was in college, and let me tell you, that was a very long time ago. And so yes, temporarily we can do that. But you can't do it over the long haul. The lost minimally to New Mexico over less than a decade is between 12 and $13 billion dollars and when, not if, rural hospitals and local providers close their doors. I can do this better than any other state. The last governor completely canceled behavioral health. Six years later, we are still reeling from trying to rebuild. We put a billion dollars into behavioral health just this last legislative session. It is not so easy to rebuild something out of nothing. MARGARET BRENNAN: Well, the $50 billion Rural Health Care Fund under this Republican law is supposed to give people the— your—states like yours, the ability to come and say, we need this extra cash. Are you going to have to ask for that? GOV. LUJAN GRISHAM: I'm going to ask for every dollar the federal government has put aside anywhere that benefits a New Mexican. So you got 50 billion. That's $1 billion for each state, if it was even. Do you know how much money it would take to shore up rural hospitals? More than a billion. And to put that in perspective—let me do this, it's a billion just for behavioral health, it's a billion plus just to keep people's coverage, it's another billion for prescription drugs, it's a billion dollars for rural provider delivery investments, and that's only 50 hospitals. You have hundreds of hospitals. Hundreds. 400 rural hospitals across America that will shutter. So that's the number at it is. We are- how do we pick these rural hospitals? And if you pick a Southeastern rural hospital in New Mexico, what about the rural hospital in western New Mexico. Economies fail. People have to move away. You don't have any OBGYN care. That whole area collapses, and they are reducing rural health care delivery by about 134 billion. So the 50 billion is just to make someone somewhere feel like they recognize that this is a disaster. $900 billion out of Medicaid is catastrophic, straight up. MARGARET BRENNAN: Governor, we ran through a lot of material here. I have more questions for you, but very quickly—can you tell me—you deployed the National Guard to counter unrest in New Mexico. How is that different from what the president did in California? GOV. LUJAN GRISHAM: Well, they're not policing. They're doing the back end work so that trained community policing, and members of that training, right—those local police officers, they're on the streets. What we have in this country is a shortage of police officers. What I have in New Mexico is a partnership. So they're doing all of the—they answer all of the emergency calls. They handle all the traffic clearance when we've got a crash. And it is working, we're beginning to see more productive fentanyl drug dealing high end arrests than we did without the guard. And I'm really proud of that work. This is about partnering and leveraging, not about indiscriminately going after individuals who have not committed serious crimes. MARGARET BRENNAN: Thank you for your time today. 'Face the Nation' will be right back.
