Proposed Medicaid cuts could seriously impact New York hospitals and health-care workers. President Donald Trump and congressional Republicans are proposing $880 billion in cuts, ending health-care access for around 73 million Americans. More than a quarter of New Yorkers use Medicaid for their insurance.

Amy Lee Pacholk, a surgical and trauma critical-care nurse at SUNY Stony Brook Hospital, said losing these funds means hospitals can't maintain proper staffing levels to care for patients.

"Corners are often cut with staffing," she said. "For a long time, we have been working toward minimum staffing standards and safe patient ratios so that nurses can take care of patients at safe environments both for themselves and for the patients."

But, a New York State Nurses Association report finds between January and October 2024, hospitals failed to staff intensive-care units and critical-care patients at state-mandated ratios more than 50% of the time. These cuts will pay for extending Trump's first administration tax cuts. The Economic Policy Institute notes that private-market health plans can cost 20-percent of families more than their yearly earnings.

Statewide, hospitals are projecting zero operating margins. Although it's a mild improvement, it's insufficient for hospitals to handle patient care. But, Medicaid's low reimbursement rates are responsible for SUNY Downstate's financial issues. 90% of the hospital's patients use Medicaid or don't have insurance. Pacholk said because of reimbursement structure, the hospital hasn't gotten its due.

"Just because of the population that goes there doesn't mean they should close the institution down," she explained. "It just means that you should facilitate the money flow in a different way to continue to serve the people who live in the community."

Part of the Medicaid cut proposal would involve adding work requirements to the program. But, this is part of a common misconception about Medicaid users, that they don't work. Pacholk said these programs are too important to cut for the sake of slash-and-burn style budget cutting.

"Isn't this why we pay taxes? Isn't this why we pay Medicare insurance,?" she said. "Isn't it to protect people or to help us out in the future if something happens and we become financially destitute? Isn't that the rationale? Isn't the goal to help people here? Why do we have to take things away that are actually helping people?"

To pay for the priorities of President Donald Trump's administration, like mass deportations and tax cuts, Republicans in Congress are considering cuts to a host of programs supporting people living paycheck to paycheck.

Potential cuts include $880 billion to Medicaid over the next decade.

Adam Fox, deputy director of the Colorado Consumer Health Initiative, said 1.2 million Coloradans rely on Medicaid, including pregnant mothers, people with disabilities, working families and nearly six in 10 people in nursing facilities.

"It provides coverage to so many in our communities, it is really the foundational block in our health care and health coverage systems," Fox pointed out. "If Medicaid gets cut, it puts the entire health care system at risk."

Republicans have said cuts to Medicaid could be made without reducing benefits by overhauling and improving the program, which, according to analysis by Reuters, serves 35 million Americans in states President Donald Trump won in the 2024 election. In a recent survey, seven in 10 Trump voters said cutting Medicaid is unacceptable.

Colorado faces a $1.2 billion budget deficit, largely due to the state's tax code under the Taxpayer Bill of Rights, or TABOR. Fox acknowledged in many ways, the state's hands will be tied if Congress cuts Medicaid funding.

"Colorado cannot raise revenue, because of TABOR, to make up the difference," Fox noted. "Any cuts at the federal level will mean that Colorado has to reduce benefits, or strip people of coverage."

America's for-profit health system costs more than twice as much as other wealthy nations per capita. Fox argued what is needed is a health system covering every American and controlling costs. Compared to all other current health programs, Fox stressed Medicaid is the most efficient at meeting those goals.

"What we probably should be focusing on is really expanding Medicaid to everyone -- who is not eligible for Medicare, at least -- rather than cutting the program," Fox urged.

Wildfires are creeping closer and closer to health care facilities in California, including hospitals and nursing homes, according to a new study.

Researchers with the nonprofit Direct Relief looked at 23 years worth of data and found the distance between wildfire and the facilities is decreasing by an average of 628 feet per year.

Andrew Schroeder, vice president for research and analysis at Direct Relief and the study's coauthor, said they are seeing a steady pattern of increasing proximity.

"That raises a lot of policy issues," Schroeder pointed out. "A lot of pragmatic issues about how we operate the health care system in California, how we choose to locate health facilities and what it means to operate a truly resilient health care system."

The data also show the number of inpatient beds and acute care facilities within five miles of a wildfire zone is increasing, as development increases on and near dry hillsides in the urban-wildland interface.

Neil Singh Bedi, research scientist with CrisisReady, a collaboration between Direct Relief and the Harvard Data Science Initiative, said long-term care facilities like nursing homes are most vulnerable.

"This might mean that we need to invest more resources for those facilities to be able to evacuate more safely," Singh Bedi suggested. "Or better filtration systems, if wildfires are going to be closer to those facilities."

The Direct Relief report is the second in a three-part series. The first examined the medical implications of the state's power outages on people who rely on electricity to run lifesaving machines and refrigerate medicines. The next report will look at how medically vulnerable people in Mariposa County communicate during wildfire emergencies.

Rural communities in Missouri are bracing for a tough reality as they plan ahead for the possibility of federal cuts to programs such as Medicaid.

The poverty rate in rural Missouri stands at more than 16%, compared with a little more than 11% in urban regions of the state.

Bryan Stallings, co-founder and CEO of the rural charity Elevate Branson, said they don't get their resources directly from federal funding, but primarily from donations. However, he warned that his nonprofit will feel the ripple effects of these cuts as donors who are directly impacted will be forced to give less.

"You end up having to reduce staff - and with these cuts, you're going to see the demand go up," he said. "So, here you're going to have this big gap in staffing to be able to serve the increased need."

In Missouri, one in five children faces hunger, and in Branson, the poverty rate tops 22%. Stallings said his nonprofit serves 4,000 to 5,000 people each year.

Support includes Medicaid-funded mental-health counseling, food, clothing, housing and even assistance with obtaining birth certificates or Social Security cards. Stallings noted that transportation is a major barrier for rural residents seeking these types of services - and when one-stop charities such as his lose resources, the entire community feels the impact.

"Rural communities have very little resources for transportation," he said, "which means individuals who are in that underserved population, they really need to be able to access services all in one location."

He said the local economy in Taney County is affected by Branson being a tourist destination, with a high number of residents who work in low-wage, service-industry jobs. The county's median income is about 17% less than that of the state as a whole.


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