Health insurers, providers and advocates are bracing for the impact of the federal budget reconciliation bill. Roughly 310,000 people across Georgia are projected to lose access to health insurance by 2034 under the bill. Getty Images

As the dust settles in the wake of President Donald Trump’s “big, beautiful bill,” — the massive spending cut and tax break package signed into law early this month — it’s becoming clearer that Georgia’s health care landscape may look dramatically different in 2026.

Health insurers, providers and advocates alike are bracing for the impact that the federal budget reconciliation bill will have on health care access throughout the state over the next decade. The bill’s sweeping Medicaid cuts are expected to reduce federal health care funding in Georgia by $2.29 billion, according to data from the nonprofit health policy research organization KFF.

In addition, roughly 310,000 people across Georgia are projected to lose access to health insurance by 2034. That number could rise to 750,000 if Congress allows enhanced tax credits for those insured through the Affordable Care Act to expire this year.

The policy changes have alarmed health policy experts, who anticipate that the bill will bring drastic changes to the U.S. health care landscape over the next decade.

“This bill was not framed as a health care reform effort, but it represents the biggest change to the health care system since the passage of the Affordable Care Act 15 years ago,” said Larry Levitt, KFF’s executive vice president for health policy. “And in effect, it amounts to what is effectively a partial repeal of the ACA, erasing a lot of its gains in health coverage.”

“The scale of the change to the health care system is staggering,” he added. “This represents the biggest rollback in federal support for health coverage ever.”

A Georgia Recorder analysis found that 45 health care facilities across 35 Georgia counties risk reducing services or closing altogether due to the bill’s spending cuts. Those facilities include hospitals, nursing homes and Planned Parenthood centers across both urban and rural parts of the state, all of which will likely face funding gaps under the budget reconciliation bill.

Rural hospitals face funding shortfall

Hospitals in rural parts of the state, many of which rely on funding from Medicaid to sustain their facilities, may be among the hardest hit health care providers under the new bill.

That includes four hospitals in rural Georgia: Fannin Regional Hospital in Blue Ridge, Flint River Community Hospital in Montezuma, Irwin County Hospital in Ocilla and Washington County Regional Medical Center in Sandersville. Three of those hospitals are in counties represented by Republican congressmen who voted in favor of the bill, and all four border at least one county that lacks its own hospital.

HomeTown Health CEO Jimmy Lewis said he and his organization’s network of rural hospitals are bracing for the changes handed down by Washington, though they are not sure yet what the full impact will be.

“The ability to plan around the uncertainty is a nightmare,” he said. “The only thing we can tell [hospitals] on this particular occasion is that you just must be prepared for the most draconian cuts imaginable as we go forward.”

For the rural hospitals in his network, Lewis said, government funding makes up the vast majority of their income. Roughly 60% of payments come from Medicare and Medicare Advantage, with Medicaid payments making up another 20%. Private insurers and self-funded payers make up only a small portion of rural hospital incomes.

“That’s a real problem, because Medicaid typically pays 85.6% of cost,” he said. “Medicare pays, at best, about cost, and any variation that occurs to that, for example, self pay, typically pays seven to 10% of cost. So over a normal matrix, we start out losing money.”

“It’s not uncommon at all for rural hospitals to operate with three to 10 days’ cash with a $30 to $40 million operation,” he added.

And when hospitals are forced to reduce services or close entirely, Lewis said, the effects ripple out into the entire community, forcing residents to drive further to access care and depleting local job opportunities. Labor and delivery unit closures, which have been on the rise nationwide since 2020, often serve as a bellwether for the broader impact of hospital closures in rural areas, Lewis added.

“We closed about 14 OB units in the last five to 10 years,” Lewis said. “That’s a real problem. Not only is that a health care delivery system for babies, but it’s an economic development system for the community. And when you lose it, you lose economic development opportunities in a big time fashion.”

The federal bill includes a $50 billion fund aimed at helping offset some of the costs for providers in rural areas, and Georgia’s Department of Community Health board voted to increase Medicaid funding to hospitals by $2 billion in an emergency meeting last month, a move that must be approved by the Centers for Medicare & Medicaid Services. But experts are skeptical that the funds will go far enough to prevent hospital closures in the long term.

The rural health fund “will certainly help in rural communities, but it won’t fully compensate for the cuts, especially since it’s temporary and the cuts are permanent,” said KFF’s Levitt.

Tax credit expirations leave Georgia families hanging

The expiration of ACA enhanced premium tax credits, which were first introduced in 2021 as part of the American Rescue Plan Act, poses another barrier for Georgia residents seeking health care access.

The credits currently help subsidize health care premiums for families with incomes up to 400% of the federal poverty line (which comes out to $62,600 for a single-person household and $128,600 for a household of 4), and are associated with record high ACA enrollment levels. In Georgia, which saw ACA enrollment triple between 2020 and 2024, 96% of enrollees use advanced premium tax credits to cover some or all of their health care costs.

The credits are set to expire at the end of this year, and Congress has yet to renew them, meaning families may have to start paying higher premiums for health care coverage as early as January 2026.

Data from the Century Foundation, a progressive think tank, estimates that Georgia families could end up paying an average of $528 more per year, which amounts to an 85% increase on health care premiums. Residents of some counties are projected to spend up to $900 more annually.

Health care advocates worry that the higher premiums will result in fewer Georgia residents obtaining coverage, with some families being priced out of the health insurance market entirely. Georgia already has one of the highest uninsured rates in the country.

“Because Georgia has not expanded Medicaid, we have more low-income individuals enrolled in the marketplace or Georgia Access than most states,” said Whitney Griggs, the director of health policy at Georgians for a Healthy Future, a patient advocacy group. “Those folks are going to feel the pain of these premium increases the most.”

Though certain parts of the budget reconciliation bill likely won’t impact taxpayers until 2027 or beyond, higher insurance premiums may debut as soon as January 2026.

As a result, state lawmakers will likely have to choose between directing more state funds towards health care programs or allowing service cuts to take effect, with health policy experts hoping that the state’s multibillion dollar budget surplus could be used to help supplement the federal funding gap.

“We have been operating with a budget surplus that is above and beyond our undesignated reserves,” said Leah Chan, director of health justice at the Georgia Budget and Policy Institute. “So our state has clearly shown that we are setting our revenue estimates very conservatively, and there might be an opportunity to use more of the state revenue that we’re receiving to meet people’s basic needs.”

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This post was originally authored and published by Maya Homan from Georgia Recorder via RSS Feed. Join today to get your news feed on Nationwide Report®.