Many voters in rural America cast their ballots for Republicans in the last election because they believed their values would be defended — and their communities prioritized over wealthy elites and urban power centers.
But recent policy decisions have made one thing clear: Rural America was not protected. It was sacrificed.
From criminal investigations to economically backward tariffs, and now the dismantling of critical health care infrastructure, the betrayal is not accidental. It is the inevitable result of long-held priorities — polished for voters but designed for donors.
At the center of this betrayal is a bill wrapped in classic Orwellian doublespeak: the so-called “One Big Beautiful Bill.”
Behind the grandstanding lies the reality — brutal cuts to Medicaid that will devastate rural hospitals, strip healthcare from vulnerable families and stall already-precarious local economies.
Just months ago, less than two weeks after President Trump’s inauguration on Jan. 20, Americans were promised by Trump that programs like Medicaid and SNAP would be loved and cherished.
But that promise was quietly discarded. The legislation that ultimately passed, according to the nonpartisan Congressional Budget Office, would add $3.4 trillion to the national debt while slashing more than $1 trillion from Medicaid.
To sell this, party leaders dusted off the same tired excuse: waste, fraud and abuse. But rural Americans know what that really means: clinic closures, darkened emergency rooms and a 40-mile drive to deliver a baby or for addiction or mental health care — if it’s available at all.
According to the Government Accountability Office, rural patients already travel 20 to 40 miles farther for care after hospital closures. That delay translates into worse outcomes and, in too many cases, preventable deaths.
This isn’t abstract. In Montana, as of July 1, 50 out 56 counties are classified as medically underserved. In addition, 25 out of 55 rural hospitals are listed as facing “risk” or “immediate risk” of closing.
And it’s not just Montana. Since 2010, over 130 rural hospitals have closed. Today, over 300 more are at immediate risk, and as former Sen. Bill Frist (R-Tenn.) has warned, 600 additional hospitals may not survive the blow this legislation delivers to their budgets.
This isn’t just a crisis — it’s a collapse in motion.
Rural hospitals were already strained. They serve communities that are older, poorer and sicker, and rely heavily on Medicaid.
Yet while demand grows, federal support is being pulled away. CEOs like Steven Fontaine of Penn Highlands Healthcare have been blunt: “Without immediate and sustained support, the services we provide are at risk.”
Let’s be clear: This wasn’t an oversight. It was a choice. A choice to prioritize tax cuts for the wealthy over health care for working Americans. And it was made by the same political machine that claimed to fight for the forgotten heartland.
In 2024, 63 percent of rural voters backed this version of the GOP — one increasingly unrecognizable from the principles of conservatism it once claimed. These voters believed they were being heard.
But this law tells a different story: one of betrayal, opacity and harm inflicted on the very people who believed most deeply in the promise of change.
Rural America is now paying the price. Either Congress acts to repair the damage or it will answer for it at every town hall between now and a 2026 election season that must hold members to account.
Marc Racicot is a former U.S. Army JAG Corps officer, two-term governor of Montana and former chairman of the Republican National Committee. He now serves as the national chair of Our Republican Legacy.