Underserved communities across rural America would experience outsized negative effects to health outcomes resulting from cuts to cornerstone federal healthcare funding programs.

Lists of potential healthcare spending cuts to include in a reconciliation bill are circulating on Capitol Hill, and healthcare is getting star billing.

Proposals include many measures affecting the Medicaid program, including the imposition of block grants, major reductions in the federal share of spending for the ACA expansion population, and the imposition of work requirements. If enacted, these policies would not only reduce coverage but also transfer a huge fiscal burden to states.

Also hanging in the balance are the enhanced premium tax credits in the Affordable Health Care (ACA) marketplace, which increased both eligibility for tax credits and the size of subsidies. These enhancements greatly increase the affordability of marketplace coverage, especially in places where healthcare is expensive, but they will expire at the end of 2025 unless Congress acts to extend them.