The One Big Beautiful Bill Act cuts an estimated $137 billion in federal Medicaid funding from rural America over ten years. Congress answered with a $50 billion Rural Health Transformation Program. Does it close the gap?

In Part 3 of our OBBBA series, Jamie Bourgeois (MSN, APRN, PMHNP-BC, CNM) and Melissa Anne DuBois (PhD, RN) break down how the program works, why an "equal" split leaves a Texas resident with about $66 and a Rhode Island resident with over $6,000, and why the rules limit what struggling hospitals can spend on.

We look at who gets hit hardest: pregnant people facing longer drives as birthing units close, and people with mental illness and substance use disorders facing new work requirements and a narrower exemption. We cover what supporters and critics say, where nursing organizations stand, and our nursing take on why a one-time grant can't replace coverage.

Full show notes and sources: nursingthenation.substack.com

The views and opinions expressed on Nursing the Nation are our own and do not represent those of our employers, academic institutions, or any organization we're affiliated with.

Episode cover art created with Adobe Firefly and Canva.

By January 1, 2027, adults on Medicaid expansion will have to prove 80 hours a month of work, school, volunteering, or job training to keep their coverage. In Part 2 of our One Big Beautiful Bill Act series, Jamie and Melissa explain who Medicaid expansion covers, how the work requirement operates, now six-month verifications, and the reason states can't opt out. They also cover the "medically frail" exemption, which has no clear definition.

Through a hypothetical patient with well-controlled multiple sclerosis, we show how a 12-month claims lookback for proof of medical frailty can mistake stability for wellness. We then go through who opposes the rule and who supports it, and end with the nurses' take: social determinants of health, the cost of uncompensated care, and how we're all in the same storm but not the same boat.

Read more and join the conversation: nursingthenation.substack.com

The views and opinions expressed on Nursing the Nation are our own and do not represent those of our employers, academic institutions, or any organization we're affiliated with.

Episode image made with Adobe Firefly.

"It doesn't cut anyone's benefits."

That's the talking point — and it's technically true. In the launch of our latest six-part series on the One Big Beautiful Bill Act (OBBBA, now Public Law 119-21), Jamie and Melissa explain how a law that cuts no covered service is still projected to leave ten million more people uninsured, and why the savings depend on people losing coverage they're still eligible for.

We start with the basics then map the four changes that have already landed as of fall 2026: the ACA marketplace subsidy cliff and soaring premiums, sweeping SNAP changes, a health system cutting provider rates and closing rural units preemptively, and the states enforcing work requirements early. Nebraska and Montana are the canaries in the coal mine for how the Medicaid Expansion work requirement will pan out.

We make it human — four everyday people already caught in the gears of this law. We close with our nurse take on "administrative burden," the quiet act of rationing care through paperwork.

Head over to our Substack to join the conversation.

The views and opinions expressed on Nursing the Nation are our own and do not represent those of our employers, academic institutions, or any organization we're affiliated with.

Episode image made with Adobe Firefly.