The House’s passage of President Donald Trump’s sweeping “One Big Beautiful Bill” is a clear turning point for healthcare providers across the country. As a healthcare CEO, I feel compelled to voice both the strategic and ethical implications of this legislation — particularly the proposed $880 billion in Medicaid cuts and eligibility changes that will reshape our delivery system for years to come.
The unspoken reality for providers
Federally qualified health centers (FQHCs) and rural hospitals like mine serve on the front lines of America’s healthcare safety net. We care for patients no one else will — often regardless of insurance, status or ability to pay. The proposed Medicaid reforms, including work requirements and tightened eligibility, threaten to displace millions from coverage, driving up uncompensated care and crippling already razor-thin margins.
A false promise of fiscal responsibility
While the bill is marketed as fiscally responsible, the unintended cost shift is real. Hospitals and FQHCs will absorb the burden, not Washington. Emergency departments will become the last refuge for care, leading to overcrowding, delayed treatment and worse outcomes. Additionally, cuts to Planned Parenthood and preventive health services will compound strain on public health infrastructure, especially in underserved communities where resources are already scarce. This is not to say that healthcare doesn’t have room to significantly improve efficiency — it does, and that must be a priority, but the solution isn’t simply cutting funding and expecting better outcomes.
What we need now
Healthcare leaders must unite in advocacy, not for politics, but for patients. We must urge the Senate to preserve Medicaid as a stabilizing force, not as a political bargaining chip. Legislators must consider the real-world impacts of sweeping budget cuts on provider sustainability, community health and long-term national costs.
Our mission is simple: to heal, to serve and to lead. We need policies that strengthen, not undermine or negatively impact, that mission.
About the Author:
Jeremy Riley of GML Healthcare provides interim CEO assignments and consulting services for critical access hospitals and federally qualified health centers. He is committed to sustainable access, operational excellence and advocating for underserved populations.
