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“They are so thankful they don’t have to drive to Stillwater to have those pumps taken off, which takes me actually five minutes,” Botts says.
But steep cuts to Medicaid funding are creating a new wave of uncertainty for small hospitals such as the one in Blackwell, which sits down the street from the local elementary school, with churches minutes away in either direction.
Oklahoma hospitals are projected to lose $6.7 billion over10 years as a result of the funding changes, which were approved by Congress in July as part of the GOP-backed spending and tax megabill. Rural hospitals – and the people who rely on them – are expected to be among those hardest hit.
Historically, rural Americans rely on government-funded health insurance more than people in urban areas, and rural health care providers and facilities often need Medicaid reimbursements to stay afloat.
The cuts will make it harder for hospitals and clinics to keep their doors open or offer certain types of care. Patients enrolled in Medicaid also will have a more difficult time accessing care, said Shawn Howard, Stillwater Medical’s rural emergency hospital administrator and vice president of business.
“We’re talking about the health of communities,” Howard said. “This is how big this one is going to impact communities – communities that are already at risk.”
More than 1 million Oklahomans were enrolled in SoonerCare, the state’s Medicaid program, as of July. Of the people enrolled, 53% were children.
In nearly all measures of public health, Oklahoma ranks near the bottom. Oklahomans generally are more likely to be diagnosed with heart disease, diabetes and cancer. At the same time, the hospitals treating them struggle to recruit doctors and stay afloat.
Two-thirds of rural hospitals, including Stillwater Medical in Blackwell, already are operating with losses on patient services.
Blackwell Mayor Pat Hullett said she prays the cuts do not hurt the city’s hospital, but it’s a scary feeling not knowing what could happen. Blackwell, a city of about 6,000 people, is small and tight-knit.
“We’re all just kind of sitting around waiting to see what actually happens,” she said. “We’d hate to lose those services.”
Funding cuts will unfold over a decade
Like many rural hospitals, the hospital in Blackwell has weathered a fair share of complications, from changes in ownership to discussions of closure.
The hospital now stands to lose more than $5 million over a decade because of the Medicaid cuts, projections by the Oklahoma Hospital Association show.
The megabill, also known as the One Big Beautiful Bill Act, will begin decreasing state-directed Medicaid payments by 10% every year starting in 2028 until they reach 100% of the Medicare rate.
A state-directed payment is what allows states to increase reimbursement rates to hospitals so they’re not being paid below costs.
Hospitals across the state will lose about $600 million a year, said Emily Long, spokesperson for the Oklahoma
SHAWN HOWARD
STILLWATER MEDICAL’S RURAL EMERGENCY HOSPITAL ADMINISTRATOR AND VICE PRESIDENT OF BUSINESS
Health Care Authority.
The state is not required to make up that difference, said Christina Foss, when she was Oklahoma’s Medicaid director. She left that role in October.
Oklahoma’s Republican federal delegates in the House and Senate all voted in favor of the cuts as part of the broader Trump-backed bill. Sen. James Lankford defended the bill’s Medicaid cuts, saying Oklahoma hospitals won’t feel them for five years.
Hospital administrators, however, say the cuts eventually will reach every Oklahoman.
“Reduction in funding equals reduction in services for all, not just Medicaid, so it’s an issue everybody should be interested in,” said Bennett Geister, the president of Mercy Hospital Oklahoma City Communities.
Geister said he expects Oklahoma’s health care deserts to become wider when the cuts begin.
What happens when a hospital closes
Many communities in Oklahoma already have experienced how devastating it can be to lose a hospital, even if just temporarily.
Clinton Regional Hospital closed for several months in 2023 after it had been open continuously for more than a century.
“For many, it was devastating,” Clinton Mayor David Berrong said.
Residents had to travel 25 to 50 miles round trip for routine medical care, and people in need of life-saving care had to wait longer to get treated.
While the hospital eventually reopened, Berrong expects it to face another funding crunch because of the Medicaid cuts.
“It would certainly, of course, put pressure on rural hospitals and Clinton Regional,” Berrong said.
Blackwell residents brace for cuts to care
Petro but aren’t as certain if they can continue offering as many types of care, Howard said.
In addition to cutting federal spending on Medicaid, the megabill makes changes to Medicaid eligibility. That has created an extra layer of unknowns for Stillwater Medical, Howard said.
“Obviously there’s a fear of what service lines will be able to stay open? What clinics will be able to stay open?”he said.
“But it’s hard to tell, because we don’t know who’s going to lose Medicaid and who’s going to lose eligibility.”
The megabill requires enrollees who are between the ages of 19 to 64 to work 80 hours per month unless they meet certain exemptions, such as for pregnant women. As many as 171,000 Oklahomans could lose SoonerCare coverage due to the bill’s provisions, according to data from independent health policy group KFF.
“One of our biggest concerns is now that people will be losing eligibility, they’ll stop going to the doctor,” Howard said.
But for people living in Blackwell who could lose their Medicaid coverage, it seems like they’ll have two choices, Hullett said.
“You either go to the hospital and know you can’t pay because Medicaid can’t help you, or you don’t go,” she said. “If you go and you know you can’t pay, that’s not good for the hospital. But if you don’t go, it’s not good for my citizens.”
Cuts to Medicaid won’t fully take effect until 2027, giving Stillwater Medical in Blackwell a bit of a runway to plan for them, Howard said.
It’s difficult to quantify what the full impact will be in two years, he added, and the worst-case scenario is the hospital would lose some services.
The unpredictability of what will happen carries an extra weight for doctors, nurses and patients because of the community ties that extend beyond the hospital.
“You have much trust in them, because you’ve known them,” the mayor said.
“You’ve gone to church with them, you’ve shopped at the grocery store with them. If they come in and say, ‘Guess what? We need to transfer you for whatever it is, an appendectomy, or whatever,’ it’s just a more comforting feeling than a huge giant hospital where you know no one and they come in and give you the bad news then walk out.”
Botts said she’s most proud of the hospital’s staff and their willingness to help wherever they’re needed.
They spend every day taking care of the community’s elderly patients or the farmers who require flexibility and close proximity to medical services.
“We’d be lost without this little hospital,” Botts said.
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