By Melissa PatrickKentucky Health News As Kentucky gears up to implement the changes to Medicaid brought about by Trump’s One Big Beautiful Bill Act, Kentucky Voices for Health convened health officials, consumers and lawmakers at its annual meeting to discuss the act’s impact and what happens next. Kentucky Health Secretary Dr. Steven Stack opened the Dec. 9 meeting in Lexington by voicing his concerns about the state’s most vulnerable populations during these “challenging times,” and encouraged everyone to act with empathy and kindness as the state works to implement the new federal policies. “So while we will have difficult days ahead, whether it will be times where we see things differently or have disagreements, please, folks, we never need to be disagreeable when we disagree. … We all make a decision what kind of culture, society we live in, not because of just the people we elect or put in leadership, but by the individual choices we all make each individual day,” he said. The Big Beautiful Bill Act, also known as HR1, which was signed into law on July 4, makes significant cuts to Medicaid spending (more than $900 billion over 10 years), adds work/community engagement requirements for some starting in 2027, requires more frequent eligibility checks, reduces retroactive coverage, adds a copayment requirement in October 2028 and limits state funding options. It also ends the enhanced Affordable Care Act premium tax credits and alters federal loan programs for medical students. The long game Keynote speaker Jesse Cross-Call, senior director of strategic partnerships for FamiliesUSA, detailed the anticipated impacts of the bill and emphasized the importance of administrative advocacy, data collection, coalition work and storytelling to mitigate them. Nationwide, he said, the Center on Budget and Policy Priorities estimates that about 15 million people across the country will lose their health care coverage, with about 7.5 million of them on Medicaid. Among those on Medicaid, about 5 million are people who are going to lose coverage because they don’t meet their work reporting requirements, but he said many think this is “probably low.” Further, he said Kentucky’s federal Medicaid dollars are going to be cut by more than 13%. Furthermore, Cross-Call stressed that the scale of the cuts from HR1 is not inevitable and that the collective efforts of lawmakers and advocates can reduce the number of people losing coverage. Cross-Call also pointed to a Kaiser Family Foundation poll that shows 61% of people have an unfavorable opinion of the bill. “We just need to remind ourselves that the public is on our side,” he said. “The public wants health care to be more accessible for people. The public doesn’t want more barriers. The public doesn’t want to take health care away from people.” Impact on hospitals The Cabinet for Health and Family Services panel spent a good bit of time talking about the impact of HR1 on hospitals, including the cost-sharing that happens when a hospital has fewer insured people along with reductions to the provider tax and the Medicaid state-directed payments, both of which are used to help reimburse hospitals and providers. Emily Beauregard, executive director of KVH, who moderated the session, pointed to research that says HR1 puts 35 of the state’s 338 hospitals at risk of closure. She then recognized that most of these hospitals won’t close, but then asked the question: “Will they cut back on services? Will fewer people be served? Will people be traveling further?” David Gray, executive vice president of Med Center Health, which serves 300,000 people in 10-plus counties in South Central Kentucky, said his hospital system is facing $100 million in reduced revenue and that it is already making adjustments to deal with this loss. That, he said, involves making $25 million worth of cuts annually, which will impact staffing, services and more. This, he added, is what hospitals across the state and the nation are facing. “We fully anticipate that the emergency rooms are going to become unsustainable,” Gray said, because people without insurance come to them when they are sick if they don’t have a primary care provider. “When you eliminate a service, you eliminate the service, not just those that don’t have health insurance, not just those that have Medicaid, you eliminate the service for everyone,” he said. “So it will impact all 4.5 million Kentuckians.” Legislative panel The legislative panel hit on a number of topics, but generally agreed that they were waiting on the recommendations of the Medicaid Oversight and Advisory Board to help them figure out how to handle the cuts to Medicaid from HR1. Those recommendations were put forth the next day and include 12 findings. “We can look at being compassionate, and also being responsible, as we go forward as a commonwealth as it relates to Medicaid,” said Sen. Max Wise, R-Campbellsville. Rep. Ken Fleming, R-Louisville, who co-chairs MOAB, first noted that Medicaid is the second largest budget item, serving one in three Kentuckians. He said this is up from one in five Kentuckians five years ago. “It’s not sustainable,” he said, later adding that in addition to protecting the children’s Medicaid program, the state will be looking at “streamlining the efficiencies and operations of the program and how to leverage that.” Rep. Mary Lou Marzian, D-Louisville, told the audience that her constituents are concerned about the coming changes to Medicaid. “So, folks are scared to death to lose that health care,” Marzian said. “Remember, Medicaid is insurance, it’s not health care. But they’re scared to death to lose that ability to be able to access the provider when you’re sick, (and) when you’re not sick and you have a wellness check,” she said. 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