Many voters in rural America cast their ballots for the Grand Old Party (GOP) in the last election because they believed their values and their communities would be defended. But the evidence is plain and certain: rural America was not protected. It was sacrificed.
From criminal investigations to economically erratic tariffs, and now the dismantling of critical healthcare 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 “Big Beautiful Bill” (BBB). Behind the grandstanding lies the reality—brutal cuts to Medicaid and the Supplemental Nutrition Assistance Program (SNAP) that will devastate rural hospitals, disassemble healthcare systems and nutrition programs serving millions of vulnerable families and veterans, substantially increase administrative costs for states and stall already precarious local economies.
Less than two weeks after the Inauguration of Donald Trump on January 20, 2025, rural Americans were promised by the President that programs like Medicaid and SNAP would be, in his words, “loved and cherished.” But, in the end, it was another bait and switch. The President’s promise was quickly forgotten and the BBB was just as quickly passed, with the unanimous support and votes of Montana’s entire Congressional delegation.
To compound matters even worse, the passage of the BBB will add another $3.4 trillion to the national debt, slash an estimated $1 trillion from Medicaid and SNAP, and then redirect it to cover the cost of more and larger tax reductions for those at the top end of the income bracket.
To sell all of this to a confused and fearful constituency, the President and party leaders dusted off the same, old, tired explanation— “waste, fraud, and abuse.” But what it really means for Montanans and other rural Americans is clinic closures, darkened emergency rooms and a 40-mile drive to deliver a baby or receive 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 across the country. That delay translates into worse outcomes and, in too many avoidable cases, preventable deaths.
This isn’t abstract. According to the U.S. Department of Health and Human Services, all 56 counties in Montana are classified as medically underserved. In addition, 25 out of 55 rural hospitals, 45 percent, are facing “risk” or “immediate risk” of closing and 30 percent continue to experience losses for services rendered.
This emerging disaster is not confined to Montana. Since 2010, over 130 rural hospitals have closed across the country. Today, 300 more are at immediate risk, and as former Republican Senator and Majority Leader Bill Frist has warned, 600 additional hospitals across the country may not survive the blow the BBB delivers to their budgets. This isn’t just a crisis. It’s a catastrophic collapse in motion.
Rural hospitals were already strained. They serve communities that are older, poorer, and sicker, and they rely heavily on Medicaid for survival. Yet while demand grows, federal support disappears. CEOs like Steven Fontaine of Penn Highlands Healthcare have been blunt: “Without intervention, they won’t make it.”
In 2024, 69 percent of rural voters supported this version of the GOP; one that doesn’t even vaguely resemble the conservative principles it once claimed. These voters believed they were being heard. But the BBB tells a different story: it’s one of betrayal, opacity, and harm inflicted on the very people who believed most deeply in the promises made by the President and Republicans in Congress they elected to serve them.
Let’s be clear: this wasn’t an oversight. It was a conscious and deliberate choice. A choice to prioritize more and larger tax cuts for the wealthy over healthcare and food for vulnerable Americans. And the choice was made by the same political machine, including the Congressional delegation from Montana, that pledged to fight for the forgotten heartland. So much for their hollow promises!
Marc Racicot is the former Republican Montana Attorney General and Governor.