Consider This from NPR: The Spending Cuts One State Could Face if Trump's Massive Bill Becomes Law

Release Date: June 14, 2025

In this episode of NPR's Consider This, host Scott Detrow delves into the profound implications of President Trump's budget reconciliation bill—dubbed the "big beautiful bill"—on Medicaid funding in Kentucky, particularly focusing on Perry County. Through the diligent reporting of Joe Sanka and Sylvia Goodman from Kentucky Public Radio, listeners gain an in-depth understanding of how proposed federal spending cuts threaten to destabilize already fragile communities in one of America's most economically and health-challenged regions.

Choosing Perry County: A Microcosm of Broader Impacts

Joe Sanka and Sylvia Goodman embarked on their reporting journey to Perry County, a region highly dependent on Medicaid. Sylvia explains, "It's a region that's especially dependent on Medicaid. About a third of Kentucky is on Medicaid, but it's especially true in eastern Kentucky. There are a dozen counties where over half of the population, majority of the population is on Medicaid" (03:25). This dependency makes Perry County a focal point for understanding the potential fallout from the budget cuts.

Quantifying the Potential Cuts

The proposed bill could result in a 20% reduction in Medicaid coverage in Kentucky, translating to a staggering $2 billion annual cut (03:58). To put this into perspective, Joe Sanka remarks, "We currently spend about $3.2 billion annually, roughly on education per pupil in the state. So $2 billion is nothing to sneeze at for Kentucky, definitely" (03:58). This comparison underscores the magnitude of the financial impact on the state's budget and its essential services.

Historical and Socioeconomic Context

Sylvia Goodman paints a bleak picture of Perry County's circumstances: "This is a historically poor and unhealthy region. It's a region that snake bit and can't catch a break. Over the past four decades, the coal industry, which was once thriving, has kind of evaporated. It was the epicenter of the opioid epidemic with the pill mills there. And also in recent years, it's been hit by natural disaster after natural disaster with major flooding" (04:17). These longstanding challenges amplify the potential adverse effects of Medicaid cuts, threatening to exacerbate existing social and economic woes.

Healthcare as an Economic Pillar

Tanya Brock, a nurse and board member of the Kentucky Rural Health Association, emphasizes the critical role of healthcare facilities in the region's economy. She states, "One of the other interesting aspects of your reporting is the way that you underscore when you talk about potential cuts to Medicaid. Obviously that affects people on coverage, but it also affects whole industries" (05:08). As traditional industries like coal decline, healthcare has stepped in as a primary economic driver, providing jobs and essential services that keep the community functioning.

Joe Sanka adds, "We went to a few of these clinics and the number of services that they're able to provide... it's really clear that that is because of Medicaid" (05:08). The expansion of Medicaid has not only provided healthcare to millions but also supported the local economy by sustaining clinics and healthcare providers.

The Ripple Effects of Work Requirements

A significant concern revolves around the bill's proposed work requirements for Medicaid recipients. Greg Burke, who runs a substance abuse rehab center, shares a poignant observation: "Now, you take Medicaid away from this area and it's nothing but dust" (01:28). The introduction of work requirements could disqualify individuals who are unable to meet these criteria due to chronic illnesses or economic hardship, leaving them without essential healthcare.

Sylvia Goodman warns, "In the case of Arkansas in 2018, when they set up a work requirement for Medicaid, a lot of people who were working, they were the working poor, just fell through the cracks in the red tape and weren't able to report correctly and lost their Medicaid" (07:11). This scenario highlights the potential for significant numbers of individuals to lose coverage inadvertently, further straining community resources.

Legislative Perspectives and Community Discrepancies

Despite the evident risks, the bill has received support from local legislators. Sylvia explains, "Four of the five Republicans in the House voted for this and they said, no, we're actually preserving Medicaid" (07:43). Representatives argue that the work requirements are a means to sustain Medicaid by ensuring that only those who truly need assistance remain enrolled. Tanya Brock notes, "This could have been so much, much worse and just completely devastated all hospitals and everyone, but this was not so bad when you compare that" (08:49). However, this perspective is at odds with the on-the-ground realities faced by healthcare providers and residents.

Personal Stories: The Human Impact

Joe Sanka shares a compelling story that encapsulates the human cost of these proposed cuts. He recounts his conversation with Leanna Newsom, a community health worker in Martin County: "She was just telling us those are some of the people that are going to fall through the cracks with additional eligibility checks. And it's also people like her that help those people, you know, who are going to help those people deal with the eligibility checks" (08:54). Leanna's already busy schedule could become even more strained as she strives to assist individuals facing potential loss of Medicaid coverage, highlighting the broader systemic challenges that could arise from the bill.

Economic and Community Stability at Stake

The potential Medicaid cuts threaten not only individual health outcomes but also the stability of entire communities. Greg Burke expresses deep concern: "Now, you take Medicaid away from this area and it's nothing but dust" (01:28), emphasizing that the removal of Medicaid could lead to abandoned towns and severely ill populations, as Sylvia poignantly puts it, "Probably some very, very sick people" (01:35).

Looking Forward: Reporting and Community Resilience

As Sanka and Goodman continue their reporting, they shed light on the resilience of Perry County's communities in the face of adversity. Their upcoming stories promise to explore both the challenges posed by federal policy changes and the grassroots efforts underway to mitigate these impacts.

Conclusion

This episode of Consider This offers a comprehensive exploration of how federal budgetary decisions resonate at the local level, particularly in regions like Perry County, Kentucky, where the stakes are extraordinarily high. Through detailed reporting and personal narratives, Scott Detrow and the team underscore the intricate balance between federal policy and community well-being, providing listeners with a nuanced understanding of the true cost of legislative actions.

Notable Quotes:

• Joe Sanka (01:28): "Area and it's nothing but dust."

• Sylvia Goodman (01:35): "Abandoned little towns and probably some very, very sick people."

• Tanya Brock (05:08): "This is a big economic driver for this region."

• Sylvia Goodman (07:11): "People... just fell through the cracks in the red tape and weren't able to report correctly and lost their Medicaid."

• Joe Sanka (08:54): "One of the people that are going to fall through the cracks with additional eligibility checks."