Despite Kentucky hospitals’ warnings of “devastating” consequences, four of the six Kentuckians in the U.S. House voted “yes” Thursday to President Donald Trump’s tax and spending plan.

Republican Thomas Massie and Democrat Morgan McGarvey opposed the measure but not for the same reasons.

Republican U.S. Rep. Hal Rogers, whose Appalachian district is one of the country’s most dependent on Medicaid, issued a statement claiming the One Big Beautiful Bill Act “strengthens Medicaid and SNAP benefits.”

An independent analysis of the bill’s effects on rural health care found that Kentucky will suffer the biggest hit of any state — a decline of $10 billion in Medicaid payments to rural providers over 10 years as 130,000 rural Kentuckians are expected to lose their Medicaid coverage. The analysis is by KFF, a nonpartisan health research organization.

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The Kentucky Hospital Association has warned the legislation would eliminate 33,000 jobs as Medicaid underfunding forces hospitals to reduce services or even close.

The bill also trims future funding for the Supplemental Nutrition Assistance Program, in which 575,000 Kentuckians participate, and shifts to states part of the costs.

In his statement, Rogers hinted that the measure headed for Trump’s desk is not the final word. “Ultimately, this is not the end of our reconciliation work, and as a cardinal member of the House Appropriations Committee, I will continue working to improve funding options for our rural hospitals and clinics.”

Rogers, of Somerset, also said, “While the House-version of the bill would have been far better for rural healthcare, the Senate added a $50 billion safety net for rural healthcare providers, carving out funding specifically for rural states like Kentucky, and delaying implementation of new provider tax rates to 2028.” 

U.S. Rep. Brett Guthrie (Tom Williams/CQ-Roll Call, Inc via Getty Images)

The House version, shepherded out of committee by House Energy and Commerce Committee Chair Brett Guthrie, a Republican from Bowling Green, protected supplemental Medicaid payments that narrow the revenue gap between Medicaid and private insurance by pumping billions of dollars into Kentucky hospitals that treat a large share of low-income patients. The supplemental payments are funded by a tax on health care providers.

The House in the end adopted the Senate version. It effectively eliminates the supplemental support that Kentucky hospitals say is critical to their viability, Kentucky Hospital Association President and CEO Nancy Galvagni told the Lantern. 

In the Senate, where Vice President JD Vance cast the tiebreaking vote, Rand Paul of Kentucky was one of three Republicans who voted against the bill, objecting to its deficit-raising effects. Sen. Mitch McConnell voted for it.

The legislation makes tax cuts, including no taxes on tips, effective immediately while the cuts to benefits won’t go into effect until after next year’s midterm elections.

Guthrie hailed passage of the bill, calling it a “a victory for millions of Americans, providing a historic tax cut, securing Medicaid, and ensuring American energy dominance.”

U.S. Rep. Thomas Massie (Photo by Kevin Dietsch/Getty Images)

But his fellow Republican, Massie of Vanceburg, pointed to the bill’s effects on federal deficits and debt and the economy. The bill will add $3.4 trillion to deficits during the next decade compared to current law, according to the Congressional Budget Office. 

“Although there were some conservative wins in the budget reconciliation bill (OBBBA), I voted No on final passage because it will significantly increase U.S. budget deficits in the near term, negatively impacting all Americans through sustained inflation and high interest rates,” Massie posted on X.

Republican U.S. Rep. Andy Barr, of Lexington, who’s seeking the GOP nomination for U.S. Senate next year, issued a statement saying, “This is the latest and greatest chapter of the Trump economic comeback — and the theme is promises made, promises kept.”

Barr echoed a familiar GOP talking point: “We achieved all of these goals while protecting and strengthening Medicaid for Kentuckians who truly need it — not ineligible recipients or illegal immigrants.”

Rogers, likewise, said: “The bill protects the longevity of Medicaid benefits for our most vulnerable population by slashing waste, fraud and abuse of the program. With 4.8 million able-bodied adults receiving Medicaid, who choose not to work, the bill enforces a 20-hour weekly work requirement for those individuals who do not have small kids. Without question, we are adding integrity and strength to Medicaid and SNAP assistance for those who need it most in the years ahead.”

Rogers said the bill “reinvests in coal country, by expanding a tax credit that some coal mines will now be eligible for, including Eastern Kentucky.”

U.S. Rep. Andy Barr (Kentucky Lantern photo by Kevin Nance)

Democrat Morgan McGarvey of Louisville slammed the GOP budget bill’s priorities calling it “a slap in the face to Kentucky and all of rural America. It will kick millions of Americans off their health insurance, take food away from Kentucky families, kids, and seniors, and add trillions to the national debt. All so that Elon Musk and Jeff Bezos pay even less in taxes. It is cruel and indefensible.

“I don’t want to hear any Republican who voted for this say they care about rural America or our national debt ever again,” McGarvey said.

Kentucky Democratic Gov. Andy Beshear, who has been an outspoken critic of the measure, repeated his warnings that the changes will be “devastating” for Kentucky.

In an interview on MSNBC, Beshear said 200,000 Kentuckians stand to lose health care and states cannot possibly make up for the federal government’s retreat from funding social safety net programs.

“No state has the budget to fix what the federal government, that Donald Trump and the Republicans are about to break. No state can make up for hundreds of billions of dollars of Medicaid payments flowing through our economy. If you just look at the economy at large, health care is one of the fastest growing segments out there. And this is the Republicans just taking a hatchet to it. We’re going to see job losses across America.”