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Kentucky health advocates are urging the U.S. House to reject Senate changes to a sweeping budget bill, warning the measure will leave many Kentuckians without access to medical care or food assistance.
The One Big Beautiful Bill Act passed 51-50 thanks to a tiebreaking vote from Vice President JD Vance. It would make deeper cuts to Medicaid than the House version while raising the debt limit by $5 trillion.
Kentucky Sen. Rand Paul was one of three Republicans voting against the bill because it would be “adding to our debt.” The measure now returns to the House where some Republicans are unhappy with the Senate changes to safety net and green energy programs.
Jason Bailey, executive director of the Kentucky Center for Economic Policy, said the proposal will “strip health care and food assistance from millions of Americans and hundreds of thousands of Kentuckians, while ensuring the wealthiest households benefit from a bounty of new tax cuts.”
“As Kentucky’s U.S. House delegation prepares to consider the Senate version of this bill, we urge the members to prioritize the vast majority of Kentuckians and oppose cuts to vital health care, food assistance, and education programs that are crucial to Kentuckians’ health and well-being and critical for our state’s economy,” Bailey said.
The measure squeaked through the House 215-214 on May 22 along mostly party lines. Republican Rep. Thomas Massie of Kentucky split with the GOP to vote against the bill, saying it would increase federal deficits and debt.
The four other Republicans in Kentucky’s delegation voted for the bill, including Rep. Hal Rogers, whose Eastern Kentucky district is heavily dependent on Medicaid. Among Rogers’ constituents, 44 % are covered by the federal-state program that pays for 1 in 3 Kentuckians’ health care.
Alexus Richardson, the director of communications for the Louisville-based Dare to Care food bank, said the federal government would be “kicking people while they’re already down” if Congress gives final approval to the proposals, which is “the wrong message.”
“Many families are already struggling. People have not caught up from the pandemic. That’s why we’re seeing long lines as it is,” she said.
Here’s how advocates and health experts say the budget bill would affect Kentucky, by sector.
Food assistance
Both the House and Senate versions of the bill are “unacceptable,” Richardson with Dare to Care said. The Senate version proposes deeper cuts than the House’s, though. Among other proposals, the bill would shift costs of the Supplemental Nutrition Assistance Program, better known as SNAP, to states.
Food banks, Richardson told the Lantern, are “already stretched to meet current needs” and “cuts to SNAP and Medicaid not only deepen food insecurity and poverty across our community, they also increase demand on food banks.”
About 753,410 Kentuckians are food insecure, according to a May report from Feeding America. In 2019, before the COVID-19 pandemic, that number was 644,540. Being food insecure means a person may not have enough to eat and may not know where their next meal will come from.
The bill heads back to the House for any revisions and another vote.
“We urge our lawmakers to protect these critical programs, not cut them,” Richardson said.
If these proposed cuts make it through, Dare to Care could have to turn people away or add new requirements to qualify for food aid.
“We don’t want to do that. We really don’t want to have to place any kind of restrictions for what we know families need,” Richardson said. But, the organization needs resources to avoid that. “We’re here to fill in the gaps. We’re not here to replace federal programs like SNAP.”
Kentucky hospitals
After the Tuesday vote, the Kentucky Hospital Association sent a letter to the Kentucky’s House delegation, saying its members support the House’s version of the “big beautiful bill” but not the Senate’s.
Nancy Galvagni, the Kentucky Hospital Association’s president & CEO, was joined by a slew of health organizations from around the state, including UK Healthcare, Baptist Health, UofL Health, St. Elizabeth Healthcare, Appalachian Regional Healthcare and many others.
“The carefully negotiated House bill achieved its Medicaid savings target while still protecting Kentucky’s hospitals and their patients,” the letter states. “Our programs are value-based and have delivered not only quality improvements but real savings for the Medicaid program. The Senate bill would reverse course by punishing Kentucky by ending – not just cutting – these programs by reducing them to Medicare levels.”
KHA and the other signers said the proposed cuts would likely hurt rural populations the most.
“The human toll that these sweeping reductions will have on one of the poorest and most health challenged states is unfathomable. Hospitals will have no choice but to eliminate services, such as obstetrics, mental health, cancer treatment, and emergency care,” the letter states. “Kentuckians already face challenges in accessing health care when services are not available close to home. Many will simply go without care and those that seek it will have to travel long distances to overcrowded urban hospitals that will be overwhelmed and challenged to meet the need. Without access to care, the health of Kentuckians will deteriorate, and the state’s economy will face serious setbacks.”
Family Health Centers
Dr. Bart Irwin, the CEO of Family Health Centers (FHC) in Louisville, said he’s “saddened and disappointed at the Senate’s passage of HR1.”
FHC provides health care services on a sliding-fee scale to people who are uninsured or have other barriers to getting health care. More than half of FHC’s patients have Medicaid, Irwin said.
“This bill is ugly for Kentuckians and community health centers, like Family Health Centers,” he said. “This is a double whammy for patients, who are hardworking, disabled, caring for family members, or are in school.”
He warned the bill would cause people to lose their Medicaid and become uninsured.
“Patients who lose their Medicaid don’t go away; they return to community health centers as uninsured patients,” Irwin said. “It is likely that they will lose their health care providers as well since community health centers, like Family Health Centers, depend upon Medicaid payments to sustain their operations. The loss of Medicaid revenue and greatly increased uninsured patients will make health center operations unsustainable.”
Planned Parenthood
In a Tuesday news release, Planned Parenthood said more than a third of its patients are covered by Medicaid and “blocking access to Planned Parenthood Medicaid enrollees would overwhelm Kentucky’s already overstretched safety net.”
While not mentioning Planned Parenthood by name, the bill bans Medicaid payments to clinics and providers that offer abortions even for other health care, such as cancer screenings, and family planning services they provide.
“If this bill becomes law, thousands of patients who get care at Planned Parenthood’s two health centers in Kentucky would lose Medicaid coverage at their preferred provider, and many will be left with no alternative provider,” Planned Parenthood said. The organization has clinics in Louisville and Lexington.
Rebecca Gibron, the CEO of Planned Parenthood Great Northwest, which includes Kentucky, said the Senate vote “puts millions of lives at risk across the country, including here in Kentucky, meaning if this bill becomes law, the consequences will be catastrophic.”
“Our health centers save Kentucky nearly $4.2 million each year by preventing unplanned pregnancies, catching cancers early, and controlling the spread of STIs,” Gibron said. “Stripping that care away, especially now—amid rural hospital closures, a maternal mortality crisis, and a deepening provider shortage—would push an already broken system past the brink.”
Opioid Use Disorder
In 2024, 142,312 Kentuckians received addiction services through Medicaid, according to the 2024 Drug Overdose Fatality Report.
Scottie Ellis, a spokesperson for Gov. Andy Beshear, said those services,“from medically-managed withdrawal to counseling and more,” helped Kentucky’s overdose deaths decline three years in a row.
“That progress is now at risk due to the ‘big, ugly bill’s’’ Medicaid cuts, which will cost lives and tear families apart,” Ellis said in a statement. “Gov. Andy Beshear has taken every opportunity to raise his voice about the risks and stand against these deadly cuts, including to state and federal leaders.”
Politicians react
Kentucky’s Sen. Rand Paul posted on X, formerly Twitter, that he worked all night to stop Congress from adding to our debt” and in doing so “was fighting for the American people and against our out-of-control debt.”
“I offered my vote for fiscal sanity,” Paul wrote. “Congress chose to sell out taxpayers instead. Only once the bill is released, we will know what the true price was.”
Senator Mitch McConnell, on the other hand, praised the Senate’s work.
“The American people sent President Trump and Republican majorities to Washington with a clear mandate: secure the border, restore peace through strength and American energy dominance, and give working families and small businesses relief from the Biden economy,” he said in a statement. “Our votes today are a step toward fulfilling that duty.”
Kentucky Minority Floor Leader Rep. Pamela Stevenson (D-Louisville) posted on social media that the bill would “devastate Kentucky.”
“This bill is great for those rolling in money, but not good for every day Kentuckians — terminating healthcare is devastating for children, working families, the elderly, the disabled, and veterans,” Stevenson, who is running for McConnell’s seat as he isn’t seeking reelection, said in her X post. “This is NOT what the American people voted for. This is what DC politicians voted for.”
In a video uploaded to Bluesky, Rep. Morgan McGarvey, a Louisville Democrat, called the bill “terrible” and said “I’ve landed in DC and I’m on my way to the House to do everything I can to try to stop it.”
“This means having conversations with my Republican colleagues, asking them to stand up and do in public what they’re saying in private, that this bill is bad. It’s wrong and hurts people. It shouldn’t be hard.”
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Written by Sarah Ladd. Cross-posted from the Kentucky Lantern.
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