Salem-area hospitals are warning some of the region’s most vulnerable residents would struggle to receive needed health care under the sweeping Medicaid cuts in Congressional Republicans’ newly passed domestic policy bill.

President Donald Trump signed the “big, beautiful bill” into law on Friday, July 4, renewing his 2017 tax cuts, bolstering immigration enforcement, and slashing funding for Medicaid by nearly a trillion dollars over the next decade. 

The state could lose $718 million to $1.4 billion in federal Medicaid funding annually, and as much as $16 billion after 10 years, according to Amy Bacher, a spokeswoman for the Oregon Health Authority.

One in three Oregonians rely on Medicaid, which Oregon calls the Oregon Health Plan.

Salem Health says 27% of its patients use OHP. Santiam Hospital & Clinics, serving about 50,000 patients in the region, provided a similar estimate of just over 25%. 

Lisa Wood, Salem Health spokeswoman, said in an email the cuts could lead to “overwhelmed emergency departments, more untreated conditions, and a wider gap in health equity.”

Melissa Baurer, a spokeswoman for Santiam Hospital & Clinics, said the hospital, like many others in Oregon, relies on federal Medicaid funding. 

“Proposed cuts to Medicaid would be financially devastating, not only to hospitals statewide but also to the patients who depend on OHP for essential health care services,” Baurer said in an email. 

The bill introduces stricter eligibility requirements for Medicaid recipients. 

Able-bodied adults without children 13 or under would have to prove they’re working, volunteering or attending school 80 hours per month. States would check people remain eligible for Medicaid every six months. Oregon currently checks every two years, which is intended to make sure people have stable health care if their income fluctuates slightly. 

OHA estimates that as many as 200,000 Oregonians could lose coverage under the new requirements.

The bill will also limit Medicaid coverage for visa and green card holders. 

Federal Medicaid money can’t be used to insure undocumented immigrants. Oregon is one of a few states that allows undocumented people to enroll in state-funded insurance and pays for their care with state money.

An earlier draft of the federal bill would have fined states like Oregon for providing that health care, but it was removed from the final version. This means undocumented Oregonians would remain eligible for the Oregon Health Plan unless state policymakers change current practice.

Eligibility changes for Medicaid would take effect in late 2026 after midterm elections.

Much of the impact depends on how the state chooses to respond to the cuts, and whether Oregon lawmakers allocate more money toward Medicaid to make up for federal cuts. But states also have limited resources to absorb the costs. 

“You don’t take a trillion dollars out of the Medicaid system and not have it show up everywhere,” U.S. Rep. Andrea Salinas, a Democrat, said in an interview. “There will be a cost shift now.”

Oregon hospitals that accept OHP are reimbursed by federal Medicaid funding. Without these reimbursements, patients may lose access to services as hospitals lay off staff, downsize or close altogether, health care leaders warned.

Rural hospitals could bear the brunt of these cuts, since a higher share of their patients rely on Medicaid.

Four rural Oregon hospitals were identified to be at risk for downsizing or closure in a June 12 letter to Republican leaders from four Democratic senators, including Oregon Sens. Ron Wyden and Jeff Merkley. Legacy Silverton Hospital was among the four. 

That analysis from the Sheps Center for Health Services Research considered hospitals that have a large share of patients whose care is covered by Medicaid and have reported losing money over the past three years.

A Legacy spokesperson referred questions about the bill’s impact to the Hospital Association of Oregon.

“Medicaid policy and budget choices matter to us all, because the health care system is propped up on a shaky foundation that blends private payments with government funding,” Becky Hultberg, CEO of the hospital association, said in a Thursday press release. “When Medicaid falters, the structure begins to shake, risking the collapse of the entire system.”

Salinas, whose district includes Salem, recalled standing on the House floor when representatives voted to approve the bill along party lines July 3.

“As I recognized that this bill was inevitable, I got really emotional,” Salinas said in an interview. “I was so angry because I knew that not just my constituents, not just Oregonians, but people across the United States, 17 million people, could lose access to health care in some way, shape or form, and that that’s an overwhelming number.”

“I feel like my rural communities are already hard-hit,” Salinas said. “Almost 60% of kids are on Medicaid and 50% of births are covered by Medicaid, and so I’m afraid that we are going to start seeing labor and delivery units close.”

The bill also includes a one-year freeze on Medicaid funding for Planned Parenthood. Federal law already bars federal Medicaid money from paying for abortions, but the law freezes money for other services like contraception. In a July 4 press release, Planned Parenthood called the move a “backdoor abortion ban” that could shut down nearly 200 clinics nationwide. 

Salinas called the freeze political and a “betrayal of women who get their health care through Planned Parenthood.”

U.S. Rep. Cliff Bentz, a Republican from Ontario, was the only member of Oregon’s Congressional delegation to vote for the bill. He and other Republican lawmakers said the bill is aimed at reducing government waste and lowering taxes.

In June, Bentz told the Oregon Capital Chronicle that the bill includes benefits like tax breaks, but evaded questions about its impact on rural clinics.

CORRECTION: Cliff Bentz is a U.S. representative from Oregon. An earlier version of this story referred to him as a senator. Salem Reporter apologizes for the error.

Have a news tip? Contact reporter Hailey Cook: [email protected] or (208) 515-4097.

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