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MANSFIELD, La. — When Desoto Regional Health System took out $36 million in loans last year to renovate a rural hospital that opened in 1952, officials were banking on its main funding source remaining stable: Medicaid, the joint federal-state health program for low-income people and the disabled.

But those dollars are now in jeopardy, as President Donald Trump and the GOP-controlled Congress move to shrink the nearly $900 billion health program that covers more than 1 in 5 Americans.

Desoto CEO Todd Eppler said Medicaid cuts could make it harder for his hospital to repay the loans and for patients to access care.

“I just hope that the people who are making these decisions have thought deeply about it and have some context of the real-world implications,” he said, “because it’s going to affect us as a hospital and going to affect our patients.”

One of the decision-makers is Eppler’s representative in Congress: House Speaker Mike Johnson, who lives about 35 miles north of here. He said he knows the Republican leader and his staff understand hospitals’ plight: The mother of is CEO of a .

“I’ve never met a congressman yet that wanted a rural hospital in their district to close, and certainly Mike is no exception to that rule,” Eppler said.

Last year nearly 290,000 people in Johnson’s district were enrolled in Medicaid, about 38% of the total population, according to data compiled by KFF, the health information nonprofit that includes ���ϳԹ��� News.

About 118,000 of them are in the program thanks to the Affordable Care Act, which allowed states including Louisiana to expand Medicaid to cover low-income adults, many of whom were working in low-paying jobs that don’t provide health insurance.

Louisiana ranks second in Medicaid enrollment, at nearly 32% — a reflection of the state’s high poverty rate. As Republicans weigh cuts, their actions could have dramatic consequences for their constituents here. Of the eight GOP-held House districts with the most Medicaid enrollees due to the expansion, four are in Louisiana. Johnson’s largely rural district ranks sixth in expansion enrollees.

Among them is Chloe Stovall, 23, who works in the produce aisle at the SuperValu grocery store in Vivian, Louisiana. She said her take-home wage working full time is $200 a week. She doesn’t own a car and walks a mile to work.

The store provides health coverage, but she said she won’t qualify until she’s worked there for a full year — and even then, it will cost more than Medicaid, which is free.

“I’m just barely surviving,” she said.

In February, Johnson pushed a budget resolution through the House that calls for cutting at least $880 billion over a decade from a pool of funding that includes Medicaid, to help fund an extension of Trump’s tax cuts and his border priorities. Republicans in Congress are now considering where to make cuts, and Medicaid is likely to take a big hit.

Defending the plan, Johnson said that Medicaid is “not for 29-year-old males sitting on their couches playing video games.”

Stovall said almost everyone she knows on Medicaid works at least one job. “I don’t even own a TV,” she said.

Contacted for comment, Johnson’s office pointed to his remarks at a conference in Washington last month. “We’re going to be very careful not to cut a benefit for anyone who is eligible to receive it and relies upon it,” Johnson said.

���ϳԹ��� News spoke with two dozen Medicaid enrollees in Johnson’s district. Most said they were unaware their congressman is leading the Republican charge to upend the program. Those informed of the Republican plan said it scares them.

Some GOP members of Congress want to eliminate the ACA’s Medicaid expansion funding, which led to 20 million working-age adults gaining coverage and helped slash the nation’s uninsured rate to its lowest level in history. Forty states and the District of Columbia have agreed to the change, which promised extra federal funding in exchange for expanding eligibility.

In this heavily Republican district, where Johnson won with 86% of the vote in November, 22% of residents live in poverty.

Like Trump, Johnson says he wants cuts to Medicaid but hasn’t elaborated other than saying the program should not cover “able-bodied” adults without imposing a work requirement.

“Everybody is committed” to preserving Medicaid benefits “for those who desperately need it and deserve it and qualify for it,” Johnson said at a news conference in February. “What we’re talking about is rooting out the fraud, waste, and abuse.”

Medicaid recipients in Johnson’s district, told about GOP plans to cut the program, said their lives are hard enough in a state where the minimum wage is $7.25 an hour. Without Medicaid, they said, they couldn’t afford health coverage.

In Vivian, near the borders with Arkansas and Texas, close to half of the 2,900 residents live in poverty. The main-street shops are mostly shuttered, except for a thrift store and a mom-and-pop restaurant that specializes in fried pork chops.

“Most everybody you know is on Medicaid here,” said Doris Luccous, 24.

Luccous said she makes $250 a week after taxes as a housekeeper at a nursing home while raising her 2-year-old daughter in her childhood home. While shopping with her father — who doesn’t work, because of a disability — she said she counts on Medicaid for her bipolar medicines and to pay for therapy appointments.

“I don’t know where I would be without it,” she said.

Neither Luccous nor Stovall said they voted in the last election, and neither knew that Johnson is their representative in Congress.

Vivian has few large employers, and most employers pay the minimum wage, which hasn’t changed since 2009. “We are just stuck,” Stovall said.

Still, she said, “it’s a community where everybody knows everybody, and people are always willing to lend a hand because so many are in difficult financial circumstances.”

Willie White is CEO of David Raines Community Health Centers, which operates six outpatient clinics in northwestern Louisiana that serve primarily Medicaid enrollees. He said that Louisiana already ranks among the worst states for people’s health and that Medicaid cuts would only worsen the situation.

“You cannot expect health outcomes to improve if people can’t afford to access care,” White said.

While the clinics provide primary and dental care on a sliding fee scale for uninsured patients, signing them up for Medicaid gives them better access to specialists and brings the health centers revenue to cover the cost of delivering care.

Many of the centers’ patients gained coverage through Medicaid expansion. Afterward, rates of screenings for colon and cervical cancer went from 10% to 50%, White said.��

But if Congress cuts Medicaid, the health centers would be forced to cut services, he said.

“Mike Johnson has been here and knows us, and he and his office have been responsive about our issues,” White said. “The message in prior years was, ‘We need additional funding,’ but now it is asking for no cuts.”

Community health centers, which in 2023 provided care nationally to more than 32 million mostly low-income people, have seen funding increases from Republicans and Democrats for decades.

“Everyone is supportive, but the question remains what that support will look like under the current administration,” White said. “If there are to be reductions, they need to be done with a scalpel.”

Expecting cuts, the health centers have already restricted travel and put a hold on filling vacant positions, White said.

Sitting in a David Raines clinic in Bossier City, Benjamin Andrade, 57, said having Medicaid has been a lifesaver since he needed heart surgery in 2020. Andrade is a chef and said he supports his wife and two children on $14 an hour.

He had not heard about any potential cuts to the program. Without Medicaid, he said, “it would be very hard for me to pay for all the medicines I take.”

Dominique Youngblood, 31, who was at the clinic for a dental checkup, said she’s had Medicaid most of her life. “Medicaid helps me so I don’t have to pay out-of-pocket going to the doctors,” she said.

Youngblood, who has two children, makes $12 an hour at a day care center. Asked about GOP efforts to scale back the program, she said, “It’s not fair, because it helps a lot of people who cannot afford medications and emergency room trips, and those are costs you can’t control.”

Back in Mansfield, Eppler’s hospital is more than just a health facility — it’s where many people in town come for lunch. The cafeteria was packed on a recent Friday as workers served boiled shrimp, fried okra, and baked fish.

Eppler said he’s aware Republicans in Congress are targeting a system of taxes that some states, including Louisiana, levy on hospitals and other health providers to draw down more federal Medicaid funding. That money helps finance what are known as supplemental payments to providers. Some conservatives belittle the extra funding as “money laundering.”

But that money accounts for about 15% of the DeSoto health system’s budget, said Eppler, a retired Air Force lieutenant colonel who has been CEO for a dozen years. “We are using that money to invest in the next 50 years of Desoto Parish, to build a hospital that they can have that will be sustainable,” he said.

The supplemental payments, for example, help pay to provide mental health services at three outpatient clinics. “If that $4 million went away, we would have to limit services — it’s just that simple,” he said.

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