KSHB 41 reporter Ryan Gamboa covers Miami County in Kansas and Cass County in Missouri. He also covers agricultural topics. Share your story idea with Ryan.
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After a 24-hour debate on Tuesday night, a tie-breaking vote from Vice President JD Vance pushed the Senate's version of the "Big Beautiful Bill" over the finish line.
One Wednesday evening, the House is voting to debate the massive piece of legislation.
The Senate's version of the bill would cut over a trillion dollars in Medicaid benefits.
The non-partisan Congressional Budget Office reports nearly 12 million Americans could be left uninsured by 2034.
"Unfortunately, the way the economy is going, most middle-class people don’t have access to healthcare," Jessica Thomas, a rural Cass County and Missouri Medicaid recipient, told KSHB 41. "Just being able to have access to healthcare is super important."
Cass Regional Health Center is home to the last emergency room on Interstate 49 until Butler, Missouri, 30 miles south.
South on Missouri Highway 7, Golden Valley Memorial Hospital in Clinton, Missouri, is the next nearest emergency room, 41 miles away.
"When you're out here in the middle of nowhere, it takes forever to get to anywhere," Thomas said.
Thomas is an expectant mother and is due in November.
She is also a Medicaid recipient while being a stay-at-home mom.
"We're lucky right now to be able to have access to that," she said.
Thomas explained she is a high-risk pregnancy patient.
When her first child was born, the nearest hospital was 30 minutes away in Warrensburg, Missouri.
Her health needs force her family to deliver their child in Kansas City.
"It's difficult when you're pregnant and expecting to deliver, you could potentially be delivering in a car," she explained. "An hour's drive could change a lot of things."
According to the Missouri Hospital Association, changes introduced in the U.S. Senate would harm Missouri’s financing mechanism for Medicaid, leaving the state with a $1 billion hole in its budget.
Including provider taxes, Missouri has used since 1992 to secure additional funding for its Medicaid program.
The national cap on provider taxes is set at 6% of net revenue from providers.
The current assessment rate is 4.2%, which is below the ten-year average.
The Senate's bill would aim to reduce the provider tax cap to 3.5%.
The $1 billion in state revenue losses annually would impact Missouri's general revenue budget, and the state would be forced to reallocate funds from other programs.
"We think this kind of reducing the system that is foundational to how Missouri pays for Medicaid. It's going to create challenges for individuals who are enrolled in the Medicaid program. It's going to create challenges for other members of the community as those cuts potentially reverberate around all hospital infrastructure and healthcare infrastructure. It's going to hurt providers and their ability to offer services," Dave Dillon, a spokesperson for the Missouri Hospital Foundation, told KSHB 41.
Dillon also says another change that could hurt providers is State-directed payments, which often focus on hospitals that serve a large number of Medicaid patients.
These reimbursements help keep rates below the cost of care.
It could force hospitals to cut services.
Additionally, the new legislation would establish a $50 billion rural transformation fund, which would provide financial support to rural hospitals to help offset Medicaid cuts and provider taxes.
Half would be allocated funds through state grants, and a percentage through rural populations within each state.
That funding is limited to five years, and it would create a slight positive impact on rural hospitals.
Dillon says that when the funding period ends, there could be greater financial pressure for rural hospitals, but it's merely a temporary relief measure.
"We could be looking at a fairly large crisis relative to overall funding for hospitals through Medicaid," Thomas added. "More specifically, the structure of our rural health delivery system."
According to a May 2025 report by the Kaiser Family Foundation, 1.2 million children and adults are enrolled in Missouri Medicaid.
50% of Missouri Medicaid recipients are children, and 2 in 7 live in a rural area.
Missouri has $15.9 billion in Medicaid spending. 78% of that funding is federally funded.
The Missouri Capitol in Jefferson City.
"Rural populations tend to be older, which means a higher population is on Medicare," Dillon said. "They tend to be poorer, which means a higher percentage are Medicaid eligible... If you are looking at rural versus urban demographics and compare that to what the needs of the healthcare systems are to remain viable, it becomes more difficult for a rural hospital if there's over representation of payers like Medicare and Medicaid that don't pay the full freight of what it costs to provide the care."
It's why Thomas says the current reimbursement program suffices.
"We go to Cass Regional for everything," Willie Ogden told KSHB 41.
Ogden, a Garden City, Missouri, resident, picked his mother up from the hospital in Harrisonville on Wednesday night, following surgery.
"I wouldn’t go anywhere else, brotha! They take care of ya, they look after ya, you need something, they’re right there," he said.
Ogden's parents are Medicare recipients.
The federal health insurance program is also experiencing $170 billion in cuts through the Senate's portion of the bill, according to an NBC News report.
"They need to have more common sense in the office," Ogden exclaimed. "They need to look out for people who don’t have as much money as they do."
Ogden fears for the older generation overall, but is also concerned for his own adult children and their access to healthcare.
"Medical insurance and stuff like that is just so high," he said. "Put yourself in our shoes. Rural communities don’t have a lot of money. We work hand to mouth. Put yourself in our shoes, who don’t make a lot of money. Maybe you’ll understand something."
According to Dillon, Missouri has closed 12 hospitals since 2014.
Medicaid's safety net for service reimbursement could put more strain on rural hospitals' lifespan.
"That is bad for Missouri and bad for the communities in Missouri," Dillon added.
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