The spending cuts one state could face if Trump's massive bill becomes law

Summary

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."

Transcript

[Scott Detrow]

Joe Sanka and Sylvia Goodman are both Kentucky natives, but neither of them had spent too much time in eastern Kentucky or Perry county before their recent reporting trip for Kentucky Public Radio. They went looking for people to talk to them about the budget reconciliation bill, or as President Trump calls it, the big beautiful bill, which passed in the US House last month. More specifically, they wanted to talk to people about the Medicaid cuts it proposes.

[Joe Sanka]

How they would affect the healthcare industry, the various groups that are trying to help people in this region access food, access health care, how it would affect things like opioid treatment. You know, this is one of the epicenters of the opioid epidemic. So we're just hoping to figure out exactly how providers are looking at some of these proposed cuts.

[Scott Detrow]

Providers like Tanya Brock. She worked as a nurse in the Appalachian region for decades and now serves on the boards of the Kentucky Rural Health association and the national association of Rural Health Clinics.

[Sylvia Goodman]

I've never seen as much concern and turmoil in health care as what I'm seeing now. And I've been doing this since 1978.

[Scott Detrow]

And in the case of Perry County, Kentucky, the effects could be bigger than just insurance. Greg Burke runs a substance abuse rehab center and he told Sylvia and Joe a concern they heard again and again that the work requirements the bill would put in place could have broader ripples of not just knocking people off Medicaid, but but destabilizing an already fragile community.

[Joe Sanka]

Listen, I'm going to tell you right.

[Greg Burke]

Now, you take Medicaid away from this.

[Joe Sanka]

Area and it's nothing but dust.

[Tanya Brock]

You're going to be left with basically.

[Sylvia Goodman]

Abandoned little towns and probably some very, very sick people.

[Scott Detrow]

Consider this. Sometimes to understand a big bill, it helps to go small. For our Reporter's Notebook series, we are zooming in on what Republicans propose Medicaid cuts could mean to one county in Kentucky. From npr, I'm Scott Detrow.

[Megan Lim]

This message comes from Strawberry Me. You've worked hard to get where you are, but what's next? Strawberry Me Career coaching helps professionals like you take the next big step with confidence by matching you with a certified career coach who understands your goals and challenges. This isn't just advice. It's a personalized, results driven approach to uncover hidden strengths, overcome obstacles, and accelerate your career growth. This Visit Strawberry Me, NPR. To claim your $50 credit, the house.

[Greg Burke]

Of Representatives has approved a White House request to claw back two years of previously approved funding for public media. The rescissions package now moves on to the Senate. This move poses a serious threat to local Stations and public media as we know it. Please take a stand for public media [e-mail] thank you.

[Scott Detrow]

It's consider this from NPR. The entire country has been watching the progress of the Republican budget reconciliation bill in Washington. But Kentucky Public Radio's Joe Sanka and Sylvia Goodman told me why one region of Kentucky could take it particularly hard. What was it about this specific region.

[Tanya Brock]

That jumped out to you? You could have gone many directions. This is a far reaching bill. It affects people all over the country. What was it about this place that you picked?

[Sylvia Goodman]

Well, 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. So if you look at the Congressional Budget Office estimates of what this bill would do, the final version that passed the House, this could mean 20% of those on Medicaid being dropped in Kentucky. This could be a $2 billion annual cut. So Kentucky currently gets about $15 billion from the federal government for Medicaid.

[Joe Sanka]

And just to put that in perspective, we currently spend about $3.2 billion annually, roughly on education per pupil in the state. That's the state's input to the education system. So $2 billion is nothing to sneeze at for Kentucky, definitely.

[Sylvia Goodman]

And 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. So top all of that, they have this bill coming and the potential impacts that it could have.

[Tanya Brock]

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. And you really paint this picture of health care facilities really filling the gap of other industries that have eroded. Like this is this is a big economic driver for this region.

[Joe Sanka]

Oh, I mean, 100%. One of the things we were really struck by reporting this story as we were driving out is just the number of healthcare clinics that are advertising, you know, on the side of the highway. You know, we went to a few of these clinics and the number of services that they're able to provide. And, you know, talking to providers, it's really clear that that is because of Medicaid. One of the places we went to was Hazard, Kentucky. You know, in eastern Kentucky, there used to be tens of thousands of coal miners, and that number has struck to just a couple thousand or, you know, 2,500. And then in its place, and to some extent is healthcare. It's this expansion of Medicaid, and it's a population that needs it. That, you know, like Joe was saying, it's historically unhealthy. There's a lot of chronic illnesses that people are dealing, and Medicaid allowed a lot of those people to get care. And especially expansion allowed them to get care for the first time.

[Tanya Brock]

I covered state capitals, I covered Congress. And it was always interesting to me that when you're covering a major bill like the one we're talking about here, you talk to legislators in the hallway.

[Scott Detrow]

You cover committee meetings, but then you.

[Tanya Brock]

Go out and you interview people out in the real world about it, and it's often such a different perspective. So again, you are in this part of Kentucky where this bill is incredibly relevant. We're talking about a proposal that, as of right now, would. Would trim down Medicare mostly through these work requirements.

[Scott Detrow]

This would affect directly a lot of.

[Tanya Brock]

The people in Perry County. What were the conversations like that you had?

[Joe Sanka]

Yeah, I mean, one of the providers we talked to said that she thought that many of her clients might fit into the work requirement category in the sense that they would not meet the work requirement. You know, they're not fully disabled. They might have a chronic illness or other health issues, but they might not be fully disabled. But maybe they were a former coal miner, lost their jobs sometime in the last decade, and they don't have another education, they don't have another career they feel they can go into. And there might not be a lot of jobs. There aren't a lot of jobs in this area. And these are the people that could get kicked off of Medicaid. And she was just, you know, saying that that's a disappointment to her.

[Sylvia Goodman]

And there's also, you know, not everyone has a computer. Not everyone has an Internet access or strong Internet. And it's not just the work reporting requirements, it's the eligibility checks. And 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, though.

[Tanya Brock]

The lawmakers who represent these districts voted for the measure.

[Sylvia Goodman]

Right.

[Tanya Brock]

How did they reconcile these two facts?

[Sylvia Goodman]

Yeah. Four of the five Republicans in the House voted for this and they said, no, we're actually preserving Medicaid. And they also touted the Kentucky Hospital association, which put out a statement saying the same thing, that this vote was actually preserving Medicaid. And I think the reasoning there is that in D.C. republicans were talking about many different options of what to do with Medicaid. Some were saying, well, let's end the Medicaid expansion completely. Some were saying, let's change the split of what the federal government covers and what state covers when it comes to the expansion population. So there were many different parts of the bill that people were considering but ultimately didn't, and they stuck with the work requirements. So I did talk with one hospital executive who's from kind of northern Kentucky, and he said he traveled with the hospital association, the D.C. and he says that's really what it was. 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.

[Scott Detrow]

I'm curious if either of you had.

[Tanya Brock]

A moment that really stood out to you that's sticking in your mind from this reporting trip.

[Joe Sanka]

One of the scenes that really stuck out to me, we talked to a community health worker named Leanna Newsom who works with some of the sickest patients, she said, in Martin County, Kentucky. And you know, she's the one who helps them connect to benefits so that they can get better, so they can get some of their chronic illnesses dealt with. And, you know, 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. And, you know, she's already totally booked up. Her schedule is packed, you know, visiting people and helping them as is.

[Tanya Brock]

That is Joe Sanka and Sylvia Goodman from Kentucky Public Radio. You can hear their reporting on the story next week. Thank you so much to both of you.

[Joe Sanka]

Thank you.

[Sylvia Goodman]

Thank you.

[Scott Detrow]

This episode was produced by Megan Lim and edited by Adam Raney. Sami Yenigun is Art executive a producer. It's consider this from npr, I'm Scott Detrow.

[Greg Burke]

Like the climate, our idea of home is constantly changing. So NPR is devoting an entire week to rethinking home with stories and conversations about the search for solutions, from planting trees to reducing energy use to disaster proofing your house. Explore stories that hit close to home during this year's Climate Solutions Week, visit.

[Leanna Newsom]

Npr.Org climateweek Decades ago, Brazilian women made a discovery they could have an abortion without a doctor thanks to a tiny pill. That pill spawned a global movement helping millions of women have safe abortions regardless of the law. Hear that story on the network from NPR's Embedded and Futuro Media. Wherever you get your podcasts.

[Greg Burke]

Want to hear this podcast without sponsor breaks? Amazon prime members can listen to Consider this sponsor free through Amazon Music. Or you can also support NPR's vital journalism and get consider this [e-mail] that's plus.NPR.org.