A spokesman for the hospitals in Olean and Bradford, Pa., said the area’s healthcare community is bracing for the full impacts of President Donald Trump’s “One Big Beautiful Bill Act.”

With billions in cuts to Medicaid and to reimbursements through the Affordable Care Act, rural hospitals are likely to face hikes in uninsured patients who can’t pay for care, said Joseph Fuglewicz, spokesman for Olean General Hospital and Bradford (Pa.) Regional Medical Center, both Kaleida Health facilities.

No immediate changes are happening — but what the future holds is uncertain, he said.

“Kaleida Health has been and continues to evaluate the impact of the ‘Big Beautiful Bill’ on our operations and services,” for OGH and BRMC, he said. “The proposed cuts will force Kaleida Health — along with hospitals and healthcare systems in our region, state and country — to make many hard decisions in the coming weeks, months and years.”

The impacts are going to be universally felt in rural areas, he said.

The One Big Beautiful Bill Act, which was signed into law by President Donald Trump on Friday, includes various tax breaks, spending cuts and other Republican priorities, including new funding for national defense and deportations. Much of the funding for Trump and GOP priorities are expected to come from reducing federal spending on Medicaid.

Estimates from the nonpartisan Congressional Budget Office indicate that federal Medicaid spending will be reduced by roughly $1 trillion in the coming years, with the number of uninsured Americans increasing by roughly 11.8 million. Loss of coverage could be driven by multiple provisions within the bill, but will largely come as a result of new work requirements.

Able-bodied Medicaid recipients ages 19-64 will be required to work, volunteer or go to school for 80 hours per month in order to qualify for Medicaid under the new law. There are exemptions in place for those who are disabled, pregnant or have a child under the age of 14. The legislation defines “able-bodied” people as those not medically certified as physically or mentally unfit for employment.

States are given until Jan. 1, 2027, to enforce work requirements, though implementation may vary — with some states likely to request waivers that give them until Jan. 1, 2029, so long as they are working towards implementation.

The consequences of the package of tax and spending cuts is expected to cause harm to many by reducing healthcare service and access, Fuglewicz said.

“Millions of people will no longer have access to healthcare coverage,” he said. “These same people will still need access to emergency healthcare and will be welcomed in our facilities, but we will not be paid for the services they receive.”

Rural hospitals were begging for help before this most recent budget bill came along.

“This new law will have a massively negative impact on already struggling rural hospitals,” Fuglewicz explained. “Rural hospitals have been closing at an alarming rate over the past decade and the enactment of this bill will only exacerbate the problem.”

The bill does include a five-year, $50 billion relief fund for rural hospitals.

“While this may seem like enough money to provide the needed funding for rural hospitals, it’s not,” Fuglewicz said. “National analysis points to rural hospitals losing between $58 billion and $155 billion under this new law.”

Moving forward, Kaleida must increase funding for uncompensated emergency healthcare services. To do that, “Kaleida Health will be forced to make difficult decisions regarding potential cuts, elimination of services and even staff reductions throughout all our hospitals and facilities,” he said. “We will make these decisions with the communities we serve in mind to ensure they have the services they need most.

“We continue to advocate to our local, state and federal advocacy groups as well as elected officials to help find solutions to the challenges we face and protect our region’s healthcare organizations,” he said.

“As always, we remain focused on providing the highest quality, patient-centered care that our community deserves.”

Republicans, including U.S. Rep. Nick Langworthy, R-23rd District, say the law maintains and builds on the Tax Cuts and Jobs Act of 2017, passed during Trump’s first administration. The GOP calls it the largest middle-class tax cut in history, while eliminating taxes on tips and overtime pay, providing Social Security tax relief for senior citizens, expanding the child tax credit and lifting the cap on the State and Local Tax (SALT) deduction.

Langworthy said Friday the legislation secures the border with full funding for a wall and immigration enforcement, restores law and order and “reinstates commonsense” work requirements for able-bodied adults receiving public assistance, which he said had bipartisan support under former President Bill Clinton in the 1990s.

“The bill cuts nearly $2 trillion in reckless Washington spending, protects our safety net for those truly in need and ensures government works for taxpayers,” the congressman said last week.

He has stated he believes the cuts and closer scrutiny of who receives Medicaid benefits will actually strengthen the federal healthcare program in the long-term as “fraud, waste and abuse” is rooted out.