Ohio emergency doc: Medicaid cuts will hurt everybody, close hospitals
Ohio emergency doctors say that low-income people won’t be the only ones to suffer amid concerns that Medicaid cuts signed by President Donald Trump will cost hundreds of thousands of Ohioans their health insurance.
Taking away insurance won’t reduce emergency-room visits, doctors say. Instead, the giant jump in the number of uninsured Ohioans will increase ER trips as those people lose access to primary care. Many will wait until they’re so sick they have to go to the emergency room to see a doctor.
“When Medicaid is cut, those people don’t stop getting sick or injured,” said Dr. Christina Campana, president of the Ohio Chapter of the American College of Emergency Physicians. “They keep showing up to the emergency department because they have nowhere else to go.”
She added that the cuts will harm hospitals in ways that will increase negative health outcomes and preventable deaths for everyone.
Trump’s “One Big Beautiful Bill Act” will cut taxes by $5 trillion over 10 years and increase deficits by $3.8 trillion, according to the nonpartisan Tax Foundation.
To get deficits down to even that high level, the bill cuts $1 trillion in Medicaid spending over the period, and about $287 billion in federal food assistance, according to KFF.
The result: The richest 1% of Americans will get $30,000 more a year on average, while the poorest 20% will get $700 less, according to the Yale Budget Lab.
The law is highly unpopular, with polls showing it to be underwater by an average of 23 percentage points. In a seeming admission of that unpopularity, the deepest of the safety net cuts won’t take effect until after the 2026 midterm elections.
After that — and possibly before — huge numbers of Ohioans and other Americans will feel the pain, advocates say.
The Medicaid cuts will cost Ohio $6.45 billion over 10 years, according to KFF. And one way that could eventually manifest is by tripping a switch that Gov. Mike DeWine signed into the state budget on June 30.
Under the Affordable Care Act, states could expand the population covered by Medicaid, with the federal government picking up 90% of the cost. Forty states, including Ohio, have subsequently done so.
Under the Ohio law signed by DeWine, if federal payments cover less than 90% of the cost of the expansion, the state can end it. That would cost 770,000 Ohioans their health coverage. Most of those people work.
Right now, advocates say, the trigger language on Ohio’s expansion group won’t be invoked by the cuts signed by Trump, but the federal cuts will still impact more than 400,000 Ohioans.
One place the hammer will fall most heavily is the emergency department. That’s because under the 1986 Emergency Medical Treatment and Labor Act, it has to treat all emergencies, whether people have insurance or not.
“Emergency departments are the safety net of our health care system,” said Campana, who is herself an emergency department doctor.
So if hundreds of thousands of low-income Ohioans are suddenly uninsured, emergency rooms will have to care for a lot more people who can’t pay.
“It’s going to leave Ohio in the lurch — especially the most vulnerable patients,” Campana said. “It doesn’t save money in the long run. It just shifts costs. Worse outcomes. Driving more people to the emergency department. It’s penny wise and pound foolish.”
Ohio hospitals generally and rural ones in particular are already struggling. The Ohio Hospital Association in May told the legislature that half of Ohio hospitals and 72% of rural hospitals have reported operating losses since 2022.
Eleven rural hospitals are listed as at risk for significant financial distress due to the cuts, Democratic U.S. Senators wrote in a letter to Trump and Republican leaders.
Campana said that if those covered by expanded Medicaid are suddenly uninsured, “it’s going to be orders of magnitude worse. We’re already on a thin sheet of ice. I think there’s going to be more unnecessary deaths and the amount of preventable things is going to be really hard for health care workers to stomach.”
She explained how all patients will be hurt. At her hospital, about 66% of the people who show up in the ER are covered by Medicare or Medicaid, or both. About 20% have private insurance, and the remaining 14% are uninsured.
“So when you cut Medicaid, you’re increasing the number of people who are uninsured, and decreasing reimbursements,” Campana said, explaining that will force hospitals to cut costs. “When you trim costs, you actually end up cutting care. So the way the hospital deals with this is they end up cutting staffing. It forces hospitals to make really hard choices. They have fewer staff, longer wait times, and in some cases, communities losing access to health care altogether. Particularly in small, rural communities.”
One consequence goes by a bland, administrative name: patient “boarding.”
It occurs when the ER doc wants to admit a patient to the hospital, but an appropriate bed isn’t available. So the patient has to wait in the ER, sometimes in a hallway — probably not where you want to lie for hours when you’re really, really sick.
“It’s like a traffic jam,” Campana said. “We can’t move people out, but there’s dozens of people coming through our doors every hour. That’s what makes for really long wait times.”
Negative health outcomes increase with wait times.
“It’s terrible care for people, but that’s what boarding does, and we’re in a boarding crisis currently,” Campana said. “They don’t get the right care because the emergency department doesn’t have the capacity and resources to perform inpatient medicine.” It “has been shown to increase mortality and increase complications. So we know that it’s not good for patients.”
For example, a 2020 paper published in Critical Care Medicine reported that especially for the sickest patients, the longer you’re boarded in the ER the more likely you are to die.
Patient mortality among those sick enough to be admitted to intensive care rose from 37.6% for those immediately admitted to 43.4% if they had to wait in the emergency department between two and 12 hours. Death rates rose steadily from there, with an appalling 57.1% of patients who had to wait 24 hours or longer never making it home from the hospital.
Similarly, mortality rates have been shown to increase the longer patients have to wait in the emergency department for initial treatment.
Campana said bad things have happened across the state as a consequence of wait times.
“Even as severe as death,” she said. “It’s crazy. This is right now, before Medicaid cuts. All of that will worsen and we’re trying to sound the alarm, but that alarm is falling on deaf ears.”
U.S. Sens. Bernie Moreno and Jon Husted, both Ohio Republicans, voted for the bill containing the Medicaid cuts. Their staffs were asked whether the senators agreed that the Medicaid cuts would increase wait times and degrade care for emergency patients throughout Ohio and close some rural hospitals.
Neither staff addressed wait times or quality of care for all Ohioans.
“Senator Moreno was proud to support President Trump’s One Big Beautiful Bill Act, which gave working families a tax cut and delivered $1.3 billion in funding for Ohio Medicaid providers and recipients as part of the multi-billion dollar support fund in the bill,” Moreno’s communications director, Reagan McCarthy, said in an email. “Liberal media hacks should tell the truth about what this bill actually does instead of parroting Democrat talking points to instill fear in their readers.”
Husted Press Secretary Olivia Tripoldi pointed to a press release in which the Ohio Hospital Association praised the Ohio senators for helping get the $1.3 billion rural-hospital subsidy into the One Big Beautiful Bill Act.
However, the extra support for rural hospitals won’t make Ohio whole.
Husted’s press release didn’t give a time frame for the disbursement of the $1.3 billion, but it’s part of $50 billion appropriated nationally over a five-year period.
That would just cover the $1.25 billion rural hospitals will lose in Medicaid over that period, according to an American Hospital Association fact sheet. Even with the additional money, Ohio will still lose nearly $2 billion in federal Medicaid payments over the same period, based on KFF’s 10-year estimates. If the rural hospital subsidy isn’t extended, Ohio would lose another $3.2 billion the five years after that.
And, despite the subsidy, 86,000 rural Ohioans will still lose Medicaid coverage by 2034, according to the American Hospital Association.
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