When Republicans passed their mega tax-cut bill more than a year ago, they timed most of its more than $1 trillion in health care cuts to kick in after the midterm elections, perhaps staving off possible electoral impacts.
Nebraska, however, decided to launch early, rolling out new Medicaid work requirements in May and beginning enforcement in July, well before their mandated Jan. 1, 2027 start.
The decision turned the prospect of people losing access to health care from speculative to actual for more than 1,000 Nebraskans so far. And health care leaders, Republican observers and others now think it’s a contributor to a political climate that suddenly has GOP leaders on the defensive in a state that is reliably red.
Bob Ward, a pollster with the Republican firm Fabrizio Ward, found Medicaid cuts to be one of the most “resonating negatives” in recent surveys of rural Republicans.
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“One out of two Republicans either are, have been or have a family member that is or has been on Medicaid,” Ward said, adding that the number comes from polling he conducted while Republicans were negotiating the tax bill. “I mean, it touches a lot of people or has touched a lot of people. So it’s not like a theoretical thing.”
All five Nebraska Republicans in Congress backed the tax-cutting “One Big Beautiful Bill Act”, now generally referred to as HR 1, which will reduce projected Medicaid spending by about $1.2 trillion over the next decade, according to the Congressional Budget Office.The cuts are offset only by a $50 billion Rural Health Transformation Fund.
Ward’s polling observation about the Medicaid cuts is shared by people who deliver care in Nebraska, and it feeds into growing concerns about health care in the state generally, said Jeremy Nordquist, president of the Nebraska Hospital Association and a former Democratic state legislator.
“The broader public understands the cuts that were implemented in HR 1 to Medicaid and the impact that can have,” Nordquist said. “Doesn’t matter if it’s in Omaha or it’s in western Nebraska … they know what’s coming in terms of cuts to Medicaid and what that means for our rural health care system in this state.”
Nordquist said funding for rural hospitals is particularly salient in Nebraska, where many of the institutions typically receive between 60% to 80% of their funding from government payers –– namely Medicare and Medicaid.
A study by his association found that55% of Nebraska hospitals described their financial conditions as “challenging” in January.
“It used to be this program that was kind of seen as an afterthought to Medicare, but now it’s much more fundamental to the financial and health care well-being of Nebraskans,” Nordquist said. “They’re much more attuned to it, and they may end up voting with Medicaid more in mind than they have before.”
Such sentiments help explain why important Republican leaders have been visiting the state, where Sen. Pete Ricketts leads his challenger, independent Dan Osborn, by just a few points. The governor’s race is also closer than many Republicans expected, with recent polls showing Gov. Jim Pillen’s lead shrinking.
Both President Donald Trump and Dr. Mehmet Oz, the Centers for Medicare and Medicaid Services director, visited Nebraska in recent weeks, fueling speculation that Republicans are concerned about a race where Osborn often attacks Ricketts over his vote for the tax bill.
“I wouldn’t have allowed the One Big Beautiful Bill Act to strip a trillion dollars away from Medicaid and people’s health care is going to be hurting,” Osborn said in a September debate with Ricketts, blaming the legislation for the closure of a dialysis clinic in Chadron, Nebraska.
Denise Powell, the Democrat favored to flip retiring Republican Rep. Don Bacon’s Omaha district, has also spotlighted rural health care issues, calling on Congress to reverse last year’s Medicaid cuts.
“Cutting Medicaid, raising health insurance premiums, the tariffs, the war in Iran — Brinker Harding supports Trump on all of it,” Powell says in one TV ad attacking the Omaha City Council member running on the GOP ticket
And Democratic gubernatorial nominee Lynne Walz has similarly targeted Pillen for health care spending cuts in the state, telling the Nebraska Examiner in July that “it’s going to bring about really bad outcomes in the future.”
A Ricketts loss would perhaps be the most consequential, impacting control of the Senate. His campaign told The Washington Sun that the senator has worked to protect the health care system from fraud and pointed to the funding in the Rural Health Transformation Fund as a counter to the much greater cuts.
“He delivered $50 billion for rural healthcare,” a spokesperson said in a statement. “Dan Osborn says he would have voted against the Working Families Tax Cut. Osborn wants higher taxes on your Social Security to pay for medicaid for illegal immigrants.”
Republicans in the state have largely agreed that Democrats have successfully framed the Medicaid cuts in Nebraska, particularly as the cost of living continues to rise.
Perre Neilan, a Republican strategist, said his party has not done enough to explain the changes that were made as part of last year’s tax bill, even after Oz visited the state to discuss the rural hospital fund.
“I think Republicans have done a poor job of talking about how able-bodied men should be working,” Neilan said, referencing the new work requirements for Medicaid. “It’s gotten cast as you’re kicking people off health insurance and kicking people off government help.”
And Republican Ken Schilz, another former state legislator, said that although he expects health care cuts will continue to be a problem for whichever party is in power in Washington, Republicans need to find an answer on Medicaid cuts, especially while Democrats “smell blood in the water.”
“We’re seeing a lot more stress on those smaller hospitals, critical access hospitals and things like that,” Schilz said. “Rural health care was trending in this direction anyway, so something needs to change no matter what. Waiting until there’s nothing left but a crater and dust doesn’t do anything.”
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