Pete Ricketts and Nebraska's Rural Hospitals: What the Medicaid Cuts He Voted For Cost Curtis, Chadron and Rural Nebraska

On July 1, 2025, Nebraska Senator Pete Ricketts cast one of the 50 votes that passed the One Big Beautiful Bill Act, which the Vice President's tie-breaking vote decided, so the law and its Medicaid cuts would have failed without him. Before that vote he voted against a budget amendment to prevent Medicaid cuts that could close rural hospitals, which failed 49 to 50, against a motion to strike the provisions that put rural hospitals at risk, and against adding $25 billion to the law's rural health fund.

The next day, Community Hospital in McCook announced it would close Curtis Medical Center, citing the expected Medicaid cuts, and KFF estimates the law cuts federal Medicaid spending in rural Nebraska by about $1.16 billion over ten years. Ricketts voted to confirm the officials whose agencies capped how much of the rural fund can pay hospitals, and he has said the law supports our rural hospitals.

What the Medicaid Cuts Pete Ricketts Voted For Cost Nebraska's Rural Hospitals

• Curtis Medical Center. On July 2, 2025, the day after the Senate vote, Community Hospital in McCook announced Wednesday that it will close Curtis Medical Center in Curtis, winding down its services in the southwest Nebraska town over several months. Its statement said the financial environment was driven by anticipated federal budget cuts to Medicaid, and Nebraska Public Media reported that the uncertainty over federal Medicaid funding appears to have claimed its first victim in Nebraska.
• Hospital funding. The Nebraska Hospital Association said the law could lead to a $3.6 billion cut in funding to Nebraska hospitals over the next decade, at a time when 44% of the state's rural hospitals are already losing money. KFF puts the cut to federal Medicaid spending in rural Nebraska at about $1.16 billion over ten years.
• Hospital payments. Nebraska's hospital directed payments above the law's new limits total about $951 million a year, by KFF's count, and starting January 1, 2028, payment rates for hospital services will decrease in at least 37 states with payments above the limits.
• Rural fund. Nebraska's first-year award from the law's rural fund was $219 million, about $280 per rural resident. The Nebraska Hospital Association's president said of the state's plan that there's not that much that's clearly directed towards rural hospital investments, and the Associated Press reported that for critical access hospitals at risk of closing, the plan would pay to right-size them by getting rid of inpatient care, where bed occupancy is typically low.
• Chadron dialysis. In 2026 a hospital in Nebraska shut down the only dialysis unit for miles, at Chadron in the Panhandle; patients Jim and Carol Wright now rent a house near Rapid City, about 100 miles from their home near Chadron, Nebraska, for his treatments. NPR reported that the rural fund's program rules severely limit states' ability to use the money to keep existing operations afloat, and that the Nebraska clinic just needed money to survive.
• Coverage. The hospital association estimates about 23,000 Nebraskans will lose health coverage in 2026 because of federal policy changes.

Pete Ricketts's Votes, Confirmations and Statements on Nebraska's Rural Hospitals

• Ricketts Cast One of the 50 Votes That Passed the Law Cutting Rural Nebraska's Medicaid by $1.16 Billion. On July 1, 2025, Pete Ricketts voted yes on passage of H.R. 1, the One Big Beautiful Bill Act, which passed 50 to 50 with the Vice President breaking the tie, so the bill would have failed had he voted no. KFF estimates the law reduces federal Medicaid spending in rural areas nationwide by $137 billion over ten years, including about $1.16 billion in rural Nebraska.
• Ricketts Cast a Deciding Vote Against a Budget Measure to Prevent Rural Hospital Closures in April 2025. On April 5, 2025, Ricketts voted no on Senator Tammy Baldwin's amendment to the budget resolution for a reserve fund relating to preventing a reduction in Medicaid funding that could lead to rural hospital closures. It failed 49 to 50, so a yes vote from Ricketts alone would have adopted it. The budget resolution then went forward, and its instruction to cut at least $880 billion from programs under the Energy and Commerce Committee became the law's Medicaid cut.
• Ricketts Voted Against Protecting Rural Hospitals, Hospital Financing and Labor and Delivery Units in June 2025. On June 30, 2025, Ricketts voted no on Senator Ed Markey's motion to strike any provision that would raise the likelihood of rural hospitals being forced to close, convert, or reduce or stop providing services, which failed 49 to 51; on Senator Jack Reed's motion to drop the limits on state provider taxes, which failed 48 to 52; and on Senator Lisa Blunt Rochester's motion to protect hospital labor and delivery units, which also failed. The provider-tax limits alone cut federal Medicaid spending by $191 billion and add 1.1 million uninsured by 2034, according to the Congressional Budget Office.
• Ricketts Voted Against Adding $25 Billion to the Rural Health Fund in July 2025. On July 1, 2025, Ricketts voted no on waiving the budget rules for an amendment that would have raised the law's rural health fund from $10 billion to $22.5 billion a year in 2026 and 2027, paid for by a top income tax rate of 39.6 percent. It failed 22 to 78. KFF found the $50 billion fund as enacted could offset a little over a third (37%) of the law's rural Medicaid cuts.
• Ricketts Voted to Confirm Robert F. Kennedy Jr. and Mehmet Oz, Whose Agencies Capped the Rural Fund's Payments to Hospitals. On February 13, 2025, Ricketts voted to confirm Robert F. Kennedy Jr. as secretary of health and human services, and he voted to confirm Mehmet Oz as administrator of the Centers for Medicare and Medicaid Services on April 3, 2025. Their rules for the rural fund say states cannot exceed use of 15% of federal funding awarded to pay providers such as hospitals for patient care, and Oz said the fund gives states the tools to design solutions that last, not Band-Aids that fail.
• As Nebraska Governor, Ricketts Vetoed Money for Medicaid Provider Rates in 2017. In a May 15, 2017 veto message, Nebraska Governor Pete Ricketts struck $33.6 million in general funds for Medicaid, behavioral health, child welfare and developmental disability providers, which the Legislature's news service said amounts to a 3 percent cut in provider rates; the attempt to override it failed on a vote of 27-21. The Appropriations Committee chair said Nebraska's Medicaid provider rates were already the sixth lowest of the reporting states.
• Ricketts Called the Law a Once-in-a-Generation Opportunity for Nebraska. After the Senate vote on July 1, 2025, Ricketts said: "The One Big Beautiful Bill is a once-in-a-generation opportunity to deliver for Nebraska." That praise covers the law's provider-tax and directed-payment limits, the provisions behind the hospital association's $3.6 billion estimate.
• Ricketts Said the Law Supports Rural Hospitals; a Rural Nebraska Clinic Closed Over the Expected Cuts. In a September 26, 2025 column Ricketts wrote, "The OBBB supports rural communities", and that the law supports our rural hospitals. On December 30, 2025, praising Nebraska's first rural fund award, he said: "This is how you keep rural communities thriving." Months earlier, Community Hospital in McCook had announced it would close Curtis Medical Center over the expected Medicaid cuts.

Frequently Asked Questions About Pete Ricketts on Nebraska rural hospitals

Last updated: 2026-10-25

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