OKPOLICY.ORG
Medicaid (aka SoonerCare) doesn’t just insure people — it sustains the hospitals, clinics, and health care providers that care for entire communities. In Oklahoma, billions of Medicaid dollars keep emergency rooms open, behavioral health beds available, and rural providers afloat. House Resolution 1 (H.R. 1), the so-called One Big Beautiful Bill, threatens this foundation. By layering constant eligibility checks and new reporting rules onto an already strained system, the bill means providers see fewer insured patients, have less stable revenue, and provide more uncompensated care. The result is predictable: more hospital closures, longer drives for care, and deeper strain on the providers who remain.
When thousands of eligible Oklahomans lose Medicaid because of red tape, hospitals and clinics don’t save money — they lose it, and H.R. 1 dramatically increases that risk.
Medicaid keeps Oklahoma’s health system alive — especially in rural areas
Medicaid makes up a large share of Oklahoma’s total health care spending, and providers — particularly rural hospitals — heavily rely on Medicaid reimbursement. When eligible patients lose coverage due to paperwork, those providers lose revenue they cannot replace.
We’re already seeing how fragile the system is. In a recent interim study, the Oklahoma Hospital Association showed that if Oklahoma went back to older, lower Medicaid payment rates, 79 percent of the state’s critical access hospitals would be at risk of closure. They also reported that 53 percent of all Oklahoma hospitals fall into medium or high financial risk.
And H.R. 1’s direct Medicaid cuts only make this worse. Those cuts don’t reduce costs so much as shift them: out of the federal budget and onto states, taxpayers, and emergency rooms that must absorb the rise in uncompensated care. Rural hospitals — already running on razor-thin margins — are among the most vulnerable to this kind of financial shock.
These losses matter because many rural hospitals operate with slim operating margins. Drops in Medicaid coverage can — and will — push vulnerable hospitals toward closure. Oklahoma already has dozens of facilities at risk, and nearly every county is classified as a health professional shortage area. Providers are stretched thin after years of workforce shortages and burnout. H.R. 1 adds another destabilizing blow at the exact moment when stability is most needed.
Real-world testimony underscores the stakes. During a recent interim study, a 64-year-old disabled Oklahoma veteran, Bruce Gros, described losing his health coverage — and eventually his home, car, and savings — because he sat in the “unaffordable middle” where premiums consumed nearly half his income. When he later accessed SNAP and Medicaid, a single missed callback or unclear requirement between agencies caused him to lose a full month of benefits, even when he submitted paperwork on time.
Bruce’s experience illustrates what research already confirms: complex systems don’t just inconvenience people — they destabilize their lives. H.R. 1 would replicate those barriers at scale by increasing verification checks, creating more deadlines to miss, and amplifying the administrative friction that already causes eligible Oklahomans to lose coverage.
Red tape becomes real system strain
H.R. 1’s administrative rules — constant income checks, reporting requirements, and new verification systems — create operational chaos for both states and providers.
Many states, including Oklahoma, simply aren’t equipped to process the sheer volume of new reporting demands. Similar efforts in other states caused technology failures and spiraling administrative costs. That means longer waits for patients, delayed reimbursements for providers, and rising burnout among the staff who handle eligibility and scheduling.
And the consequences extend far beyond paperwork. Research consistently shows that strong Medicaid coverage improves health outcomes, increases early-stage diagnoses, and lowers mortality. When people stay insured, they get preventive care, manage chronic conditions earlier, and avoid costly crises. H.R. 1 moves Oklahoma in the opposite direction: with more people losing coverage, hospitals face rising uncompensated care and growing financial strain — exactly the kind of pressure that erodes margins and accelerates burnout among rural clinicians.
State agencies, too, will shoulder heavier workloads under new income checks, reporting rules, and verification requirements. Implementing H.R. 1 isn’t as simple as adding a few extra forms — states will have to overhaul their eligibility and verification systems on an extremely tight timeline. When Oklahoma restarted annual Medicaid renewals after the pandemic — a process known as unwinding — Medicaid enrollees experienced jammed phone lines and hours-long wait times. H.R. 1 effectively makes that crisis permanent.
Communities bear the ripple effects
When hospitals close or cut services — a very real threat under H.R. 1 — communities feel it immediately. Emergency response times lengthen. Care becomes harder to access. Hospital revenue and financial margins fall, creating a cycle that threatens remaining services.
The damage isn’t just medical. Research shows that Medicaid cuts lead to job losses, lower household income, and reduced economic output — impacts that hit low-income and rural communities the hardest.
H.R. 1 threatens the infrastructure that keeps Oklahomans alive
Access to dependable health care is a foundational building block of a stable, thriving life — for families, for workers, and for entire communities. But the federal reconciliation bill doesn’t just cut Medicaid; it destabilizes the entire health care system that Oklahomans rely on. It increases uncompensated care, accelerates provider burnout, raises administrative costs, and pushes rural hospitals even closer to the edge.
Protecting Medicaid now means doing everything possible to keep people covered despite H.R. 1’s new hurdles — simplifying eligibility systems, reducing procedural terminations, strengthening outreach, and ensuring hospitals and clinics aren’t crushed by the financial fallout. Protecting it looks like building a system where Oklahomans don’t lose coverage because of paperwork, missed calls, or inconsistent agency rules.
Even though H.R. 1 has passed, state leaders still have choices. The action is clear: Oklahoma must use every tool available — from administrative flexibility to streamlined renewals and targeted reinvestment — to prevent unnecessary coverage losses and stabilize the health care providers our communities depend on.
