Kansas has more rural hospitals at risk of closure than any other state, according to the Center for Healthcare Quality and Payment Reform, and the One Big Beautiful Bill Act, for which Kansas Senator Roger Marshall cast a deciding vote, cuts federal Medicaid spending in rural Kansas by $1.08 billion over ten years. On June 30, 2025, Marshall voted against a motion to strike the provisions that make it more likely that rural hospitals close or cut services, and the next day he voted for the law, which passed 50 to 50 with the Vice President breaking the tie.
Marshall voted to confirm Robert F. Kennedy Jr., whose department limited how much of the law's rural health fund can be paid to hospitals, and he called that fund 'more than enough' to offset the Kansas Medicaid losses. A Kansas health foundation estimates Kansas hospitals losing $2.65 billion in funding over 10 years under the law.
What It Cost: Kansas Rural Hospitals Under the Medicaid Cuts Roger Marshall Voted For
- Rural hospital funding. KFF puts the law's ten-year cut to federal Medicaid in rural Kansas at $1.08 billion, and the United Methodist Health Ministry Fund found that Kansas would experience a 15% reduction in total rural Medicaid hospital reimbursement.
- Hospital losses. The REACH Healthcare Foundation estimates that Kansas hospitals lose $2.65 billion over ten years under the law.
- Hospital payments. About $257 million a year in Kansas hospital directed payments sits above the law's new limits, and Medicaid reimbursement will drop 10% each year from 2028 until it reaches the lower cap, KCUR reported.
- Hospitals at risk. An analysis Kansas Public Radio reported found that 67 out of 100 rural Kansas hospitals are at risk of closing, and the United Methodist Health Ministry Fund says 87% of hospitals are operating in the red; Public Citizen, a progressive watchdog group, lists Stanton County Hospital in Johnson as at high risk of closing or cutting services under the law.
- A hospital not built. On October 8, 2025, Freeman Health System said it had decided against building a new hospital in southeast Kansas: a $168 million Frontenac location that was originally planned to house 50 hospital beds. Freeman said its study weighed the impact of pending legislation, including the "One Big Beautiful Bill," and the Kansas Reflector later reported that the law's 'unpredictable impact' and other changes in rural health care were factors in its decision to cancel the project.
- Rural patients. 5,000 rural Kansans enrolled in Medicaid are expected to lose coverage under the law, the Kansas Reflector reported.
Roger Marshall's Votes and Statements on Kansas Rural Hospitals
- Marshall Cast a Deciding Vote for the Law That Cuts Rural Kansas Medicaid by $1.08 Billion. On July 1, 2025, Roger Marshall voted yes on H.R. 1, the One Big Beautiful Bill Act, which passed 50 to 50 with the Vice President breaking the tie, so it would have failed had he voted no. KFF estimates the law cuts federal Medicaid spending in rural areas nationally by $137 billion over ten years.
- Marshall Voted Against Three Motions to Protect Rural Hospitals, Hospital Taxes and Maternity Wards in June 2025. On June 30, 2025, Marshall voted no on Senator Ed Markey's motion to strike any provision raising the likelihood of rural hospitals being forced to close, convert, or reduce or stop providing services (49 to 51), on Senator Jack Reed's motion to drop the changes to State provider taxes and any provision that would close nursing homes (48 to 52), and on Senator Lisa Blunt Rochester's motion to preserve access to hospital labor and delivery units, which lost by the same margin. The provider-tax limits that the Reed motion would have dropped cut federal Medicaid spending by $191 billion and add 1.1 million uninsured by 2034, the Congressional Budget Office estimates.
- Marshall Cast the Vote That Defeated a Rural Hospital Protection in April 2025. On April 5, 2025, Marshall voted no on Senator Tammy Baldwin's amendment to the budget plan for a reserve fund to prevent a reduction in Medicaid funding that could lead to rural hospital closures. It failed 49 to 50, so a yes vote from Marshall would have adopted it. The same day he voted no on the amendment to strike the plan's instruction to reduce the deficit by not less than $880,000,000,000, which also failed 49 to 50. That instruction became the law's $911 billion cut to federal Medicaid.
- Marshall Voted to Confirm Robert F. Kennedy Jr. and Mehmet Oz, Whose Agencies Capped the Rural Fund's Payments to Hospitals. Marshall voted to confirm Robert F. Kennedy Jr. as secretary of health and human services on February 13, 2025 and Mehmet Oz as administrator of the Centers for Medicare and Medicaid Services on April 3, 2025. Their rules for the law's $50 billion rural fund say states cannot exceed use of 15% of federal funding awarded for payments to providers such as hospitals, and KFF estimates the fund could offset a little over a third (37%) of rural Medicaid losses nationally.
- Marshall Called the Rural Health Fund More Than Enough; Kansas's First-Year Award Was $221 Million. In an interview the Emporia Gazette published on July 10, 2025, Marshall was asked whether the law's rural fund would offset the Medicaid losses and said: "Yeah, I really do. I think it's more than enough." Kansas received the sixth-highest amount among the states at $221 million for the fund's first year, of which states cannot exceed use of 15% for provider payments.
- Marshall Told the Senate Republicans Were Increasing Medicaid Funding; Kansas Loses $3.35 Billion. On June 30, 2025, arguing against the motion to strike the Medicaid cuts, Marshall told the Senate: "We are increasing funding for Medicaid." In October 2026, KCUR reported that Marshall has denied that there were cuts to Medicaid. KFF's allocation of the Congressional Budget Office estimate cuts federal Medicaid funding for Kansas by about $3.35 billion over ten years, 9% of what the state would otherwise receive.
Frequently Asked Questions About Roger Marshall on Kansas rural hospitals
What is Roger Marshall's record on Kansas rural hospitals under Trump?
Roger Marshall cast one of the 50 votes that passed the One Big Beautiful Bill Act, which passed 50 to 50 and cuts rural Kansas Medicaid by about $1.08 billion over ten years. He voted against the June 2025 motion to strike the provisions that make rural hospital closures more likely and cast the vote that defeated an April 2025 rural hospital amendment. He voted to confirm the health officials who capped the rural fund's payments to hospitals, and he called that fund "more than enough."
Will rural hospitals in Kansas close because of the Big Beautiful Bill?
Roger Marshall voted for a law whose largest hospital cuts begin later: Medicaid reimbursement will drop 10% each year from 2028 for hospital directed payments. Kansas already has more rural hospitals at risk of closure than any other state, and one health system canceled a planned southeast Kansas hospital, citing the law among its reasons.
Is the rural health fund enough to make up for the Medicaid cuts in Kansas?
Roger Marshall said it was "more than enough", but KFF estimates the $50 billion fund offsets only a little over a third (37%) of the law's rural Medicaid cuts nationally, and the health department's rules keep states from spending more than 15% of federal funding awarded on provider payments.
Which Kansas hospitals are most at risk from the Medicaid cuts Roger Marshall voted for?
Roger Marshall's vote helped pass a law under which Public Citizen lists Stanton County Hospital in Johnson as at high risk of closing or cutting services. The analysis Kansas Public Radio reported counts 67 out of 100 rural Kansas hospitals at risk of closing.
Last updated: 2026-10-25