Patients begin lining up before dawn at , an annual five-day health clinic in Texas Rio Grande Valley. Many residents in this predominantly spanning the Mexican border lack insurance, making the health fair a major source of free medical care in South Texas for more than 25 years.
Until this year. The Trump administrations plan to strip in federal public health and pandemic funds from Texas helped prompt just before its scheduled July 21 start.
Some people come every year and rely on it, said Hidalgo County Health and Human Services Director Dairen Sarmiento Rangel. Some people even camp out outside of Border Health so they can be the first in line to receive services. This event is very important to our community.
States and local governments have made painful program cuts in the wake of in federal health funding that have already taken effect. Now, theyre sizing up the to come some not until late next year or beyond from the , the tax and spending law congressional Republicans passed in July that enacts much of President Donald Trumps domestic agenda.
Texas, for instance, expects to see its federal Medicaid funds reduced by as much as over 10 years due to new barriers for enrollment, such as more frequent eligibility checks, according to a July analysis by KFF.
Taken together, the reductions amount to a seismic shift in how state health programs are provided and paid for. The administration is, in effect, pushing a significant amount of health costs to states. That will force their leaders to make difficult choices, as many state budgets are already strained by declining tax revenues, a slowdown in federal pandemic spending, and economic uncertainty.
Revenue forecasters have lowered expectations for the coming year, according to a .
Its almost inevitable that states will enact a number of cuts to health services because of the fiscal pressure, said Wesley Tharpe, senior adviser for state tax policy at the left-leaning .
Some are proactively trying to stanch the impact.
Hawaii lawmakers are looking to aid nonprofits that are already contending with federal funding cuts. Theyre in grants to health, social service, and other nonprofits hit by federal funding cuts. To get the money, nonprofits must show a termination or drop in funding, or that they have otherwise been harmed by the cuts.
It is not fair that organizations dedicated to supporting the people of Hawaii are being forced to scale back due to federal funding cuts, Democratic Gov. Josh Green .
Other states are scaling back projects to contend with cuts. Delaware Gov. Matt Meyer, a Democrat, received notice in March that the Trump administration was in public health funding from the state. The next month, state legislative leaders halted a planned project to upgrade and expand the Capitol complex as a result.
We recognized that the reckless federal cuts to the social safety nets of thousands of Delawareans called for us to hold back resources to protect our most vulnerable, said , president pro tempore of the Delaware Senate.
In New Mexico, the state with the , a bipartisan group of lawmakers voted to create a trust fund to boost funding for the program. About 10% of the more than covered by Medicaid and the related Childrens Health Insurance Program could lose their health coverage under the federal spending law, based on .
Some state leaders are warning constituents that the worst may be yet to come.
At an Aug. 18 event at a hospital in the South Bronx section of New York City, New York Gov. Kathy Hochul, a Democrat, stood on stage among health care workers in white coats to skewer Trumps new law.
What Republicans in Washington have done through the Big Ugliest Bill Ive ever seen is literally screwing New Yorkers, she said. The states health system is bracing for in annual cuts.
And in California, lawmakers weighed the impact of the coming cuts from the federal law at a general assembly , where some Democratic legislators said state efforts to protect reproductive health services and other programs were in jeopardy.
Weve been bracing for this reality: President Trumps so-called Big, Beautiful Bill is now law, Democratic lawmaker Gregg Hart said at the hearing, calling it a direct assault on California's core programs and our values.
Sadly, the reality is, the state does not have the capacity to backfill all of these draconian federal funding cuts in the current budget, Hart said. We cannot simply write a check and make this go away.
, which passed without any Democratic support, will reduce federal spending on Medicaid by about over the next decade, based on estimates from the . The spending reductions largely come from the imposition of a on people whove obtained Medicaid under the Affordable Care Acts expansion, as well as other new barriers to coverage.
The law will mean more than 7.5 million people will lose Medicaid coverage and become uninsured, according to the Congressional Budget Office, while extending tax cuts for wealthy people who, Democrats say, dont need them. Republicans and Trump have said the spending package and its accompanying program cuts were necessary to prevent fraud and waste, and to sustain Medicaid, a state-federal program for people with disabilities and lower incomes.
The One Big Beautiful Bill removes illegal aliens, enforces work requirements, and protects Medicaid for the truly vulnerable, the White House said in a .
The Medicaid cuts wont begin until after the midterm elections in November 2026, but other cuts have already hit.
The Trump administration has sought to claw back earmarked to states because of the pandemic, spurring a with a coalition of Democratic-led states. It also in for mental health services in schools, and halted grants from the National Institutes of Health that provided money to more than .
HHS press secretary Emily Hilliard said the agency is prioritizing investments that advance Trumps mandate to confront chronic disease. She defended some of the cuts and said, erroneously, that the spending law doesnt cut Medicaid.
The covid-19 pandemic is over, and HHS will no longer waste billions of taxpayer dollars responding to a crisis that Americans moved on from years ago, she said.
State leaders say the pandemic funding the administration wants returned was earmarked for other public health measures, such as tracking emerging diseases, outbreak responses, and staffing. State attorneys general in May won a against the administration.
What were seeing now is states anticipating big cuts in Medicaid coming, but theyre also dealing with a whole variety of federal cutbacks in public health programs that are smaller but still quite meaningful, said , executive vice president for health policy at KFF, a health information nonprofit that includes 窪蹋勛圖厙 News.
Part of the challenge for states is simply understanding the changes.
I think its fair to say there is concern, confusion, and uncertainty, said Kathryn Costanza, a Medicaid expert at the National Conference of State Legislatures.
States are struggling to sort it all out, forming that are , suing to try to block the cuts, and reallocating funding.
In Colorado, lawmakers to let state Medicaid dollars pay for non-abortion care at Planned Parenthood of America clinics after Trumps law banned federal funding for such care. Whether the ban holds up in court .
The Louisiana Legislature to state universities to make up for cuts to federal research funding, much of which goes to health-related research.
And in South Dakota, the states largest food bank has to make up for funding cuts to the U.S. Department of Agriculture.
States must balance their budgets every year, so cuts put many services at risk if state lawmakers are unwilling to raise taxes. The work will begin in earnest in January, when many states begin new legislative sessions.
And the tough choices are likely to continue. Congressional House Republicans are considering legislation that could , including by slashing the generous cost sharing the federal government provides for 20 million adults who enrolled in Medicaid under the ACAs Medicaid expansion.
Some states will roll back their Medicaid expansions and cut more health programs as a result.
窪蹋勛圖厙 News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFFan independent source of health policy research, polling, and journalism. Learn more about .