A clinic in rural Nebraska has become a political flash point after tying its looming closure to Trump's law cutting Medicaid.
Curtis, Nebraska -- The only health clinic here is shutting down, and the hospital CEO has blamed Medicaid cuts in President Donald Trump's signature legislation. But residents of Curtis -- a one-stoplight town in deep-red farm country -- aren't buying that explanation.
"Anyone who's saying that Medicaid cuts is why they're closing is a liar," April Roberts said, as she oversaw lunch at the Curtis Area Senior Center.
The retirees trickling in for fried chicken and soft-serve ice cream will be hit hardest when the clinic closes this fall, Roberts fears. Seniors who sometimes go in multiple times a month to have blood drawn will have to drive 40 miles to the next nearest health center. Sick people, she worries, will put off checkups and get sicker.
Arriving for lunch, retired Navy veteran Jim Christensen said he'd read an op-ed that "tried to blame everything on Trump."
"Horse feathers," he said, dismissing the idea.
Curtis has become an early test case of the politics of Trump's agenda in rural America, where voters vulnerable to Medicaid cuts in Trump's "One Big Beautiful Bill" law are reluctant to blame the president or congressional Republicans who approved it. Many people in Curtis have directed their frustration at their hospital system instead of their representatives in Washington.
Democrats and health care advocates are pointing to the town -- population 806 in the last census -- as a first casualty of Republicans' health care overhaul. Sen. Bernie Sanders (I-Vermont) and others have referred to the town on social media as a model of what's to come for rural hospitals around the country. Close to half of rural hospitals nationwide already lose money, and analysts expect Trump's tax and spending law to add more strain.
Community Hospital, the nonprofit that runs the clinic known as the Curtis Medical Center and a couple of other facilities in the region, plunged into the center of that national story when it announced on July 2 -- one day before the bill's passage -- that a confluence of factors had made its Curtis outpost unsustainable. It cited years-long financial challenges, inflation and "anticipated federal budget cuts to Medicaid," the public health insurance program for lower-income and disabled Americans.
On Thursday morning, 73-year-old Sharon Jorgensen was scared the clinic had already shut its doors: She called and couldn't get someone to pick up. She needed a blood draw, so she went to the health center to see if someone was still there.
It was open, after all. And now staff had a date for the closure.
"We have until Sept. 30," Jorgensen told another local, 63-year-old Jo Popp, on her way out of the small brick building. "I have to find a doctor. I don't have a doctor!"
Popp would have to start taking a day off work for checkups because of the drive. But she said she would try to follow the clinic’s nurse practitioner—one of three people on staff—wherever she went.
“She knows us,” Jorgensen said.
“Right,” Popp said. “She listens to us.”
The clinic has been here longer than many people in town can remember, and people are struggling to make sense of the shutdown. The changes coming for Medicaid are complicated, and some won't take effect for years, which makes the timing even harder for residents to understand.
Many know that Trump's bill will impose work requirements for Medicaid recipients, which seems reasonable to them, and some think -- inaccurately -- that the legislation was designed to end Medicaid coverage for undocumented immigrants. (An earlier version of the bill penalized states for using their own funds -- separate from Medicaid -- to insure the undocumented; that provision was stripped from the final bill on a technicality).
Community Hospital was already losing money, and officials said they are trying to make sure they remain financially viable for the 30,000 people they serve throughout their facilities. But the timing of their decision to announce the Curtis closure has stoked suspicions in the town, leaving some residents convinced their health provider was using the president as a scapegoat.
Popp, a three-time Trump voter, thought the president was cutting wasteful spending and didn't think he caused the closure. Jorgensen, a registered Republican who never voted for Trump, was frustrated that so few of her neighbors believed the Medicaid cuts played a role.
“They’re huge Trumpers ... and so it doesn’t matter what he does -- there’s an excuse for it,” Jorgensen said.
The retired corn and cattle farmer was used to being the odd one out in Frontier County, where 86 percent of the vote went to Trump last fall.
One of those Trump supporters walked out of the clinic.
“My heart’s good,” he told Jorgensen.
“Yay!” Jorgensen said.
Trump repeatedly promised this year that he would not cut Medicaid. He expanded the GOP tent to include more low-income voters without college degrees, and some Republicans warned that any reduction in benefits would undercut their pitch that they are the new party of the working class.
But Trump and Republican lawmakers needed to offset some of the enormous cost of the tax cuts, deportations and other campaign promises in their tax and spending law. So they turned to Medicaid. The nonpartisan Congressional Budget Office has estimated that about 12 million people will lose health coverage because of the law, which is nonetheless projected to add trillions to the federal debt over the next decade.
Republicans say that changes like work requirements will reduce fraud and ensure Medicaid is available for those it was originally intended to serve, including pregnant women and the disabled. But researchers warn those requirements will create onerous paperwork that, in practice, will prevent eligible people from getting their benefits.
Other changes in the law will disadvantage the vast majority of states that expanded Medicaid under the Affordable Care Act, according to hospital groups and policy analysts, and will reduce payments to rural hospitals by reining in a financing mechanism they have long relied on to boost federal funds.
KFF, a nonpartisan health policy research organization, estimates the bill would cause federal Medicaid spending in rural areas to drop by $155 billion -- more than the $50 billion lawmakers set aside in the legislation to shore up rural hospitals. It's not fully clear how that $50 billion will be divided, adding to providers' uncertainty.
Community Hospital declined to comment in detail on its financial picture but said in a statement that "to ensure long-term sustainability, we must prioritize what lies ahead."
“They’re projecting where they’re going to be at over the next couple of years,” said Jed Hansen, executive director of Nebraska Rural Health Association, “and if it’s between jeopardizing the hospital or closing down a clinic, they’re going to close a clinic.”
Rural health care facilities run on thin margins to serve small communities in far-flung locations. And they tend to have more patients on Medicaid, many of them self-employed farmers, small business owners and seasonal workers more likely to need public insurance. Hospital groups and executives have warned that some rural hospitals that long operated at a loss won't be able to stay open much longer, now that the Medicaid cuts have been voted in.
Nationwide, far more people oppose Trump's bill than support it in polling, and Democrats hope the legislation will cost the GOP control of the House in the 2026 midterms.
Even in Curtis, some unease at the Medicaid cuts is percolating.
"I'm not in agreement with this bill," said 61-year-old Brenda Wheeler, a Republican who voted for Trump in 2016 but then soured on him and sat out last year's election. She was thinking about changing her registration to independent, upset at the cuts to Medicaid.
“When we talked about making America great again, I don’t think this is what we all had in mind,” she said, as she stopped by the clinic.
Down the road on the town’s main street lined with American flags, Kerri Kemp said she didn’t like the Medicaid cuts either. The 47-year-old got Medicaid coverage after Nebraska voters chose to expand eligibility for the program in 2018, adopting an optional part of President Barack Obama’s health care overhaul. But it was hard to document all her work as a bartender, county worker and rancher, and recently she’d struggled to submit the paperwork. Now she is uninsured.
Work requirements could make it harder to qualify when they take effect in 2027, just after the 2026 midterms. But Kemp, a lifelong Republican and Trump supporter, doesn’t hold that against Trump and suggested he might change course. “I really think he’s gonna do something,” she said.
Sitting at his desk across the street -- next to a miniature Trump head and a small red punching bag labeled "Obama stress reliever" -- Curtis Mayor Brad Welch called Community Hospital's comments on federal funding "irresponsible."
"I don't think the signing of the 'Big Beautiful Bill' had one thing to do with the closure of this clinic," Welch said.
Community Hospital officials said they had tried to find another group to take over the clinic, without luck. But the city administrator, Andrew Lee, was still hopeful. Roberts, the senior center director, wondered if a hospital 40 miles to the north could be persuaded.
"Maybe we need to talk to Andrew about really going and schmoozing them and trying to get them to come down here," she told a senior who stopped by the counter to get some fried chicken to take home.
"Do something," the woman echoed. "I mean, it's really too bad."