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Billing envelopes litter the floor of the shuttered Southeast Health Center in Ellington, Missouri. The rural hospital closed in March 2016 after accumulating $17 million in debt.

“The impact on rural health and rural hospitals will be devastating.”

That was the clear message we heard after three days of in-depth conversations with rural hospital CEOs, health providers and researchers. The stories we heard were both sobering and inspiring – tales of resilience from community health care leaders who stretch every dollar and work long hours in service to the people and places they call home.

These stories emerged in recent days during a meeting of the Aspen Health Strategy Group. This diverse group of health leaders quickly reached a clear, bipartisan agreement: The proposed $793 billion in Medicaid cuts over 10 years in the One Big Beautiful Bill Act, as calculated by the nonpartisan Congressional Budget Office, would be catastrophic for the people of rural America and their health systems, many of which are already hanging by a thread.

The Senate narrowly passed the bill Tuesday, adding in new reductions that now cut Medicaid by a total of $930 billion. It now heads back to the House for final consideration. As co-chairs of the Aspen Health Strategy Group – one Republican, one Democrat – who have also served in Washington, we cannot stay silent.

Of the 7.8 million Americans projected to lose Medicaid coverage under the bill, an estimated 1.8 million live in rural America. In these areas, Medicaid covers nearly half of all births, 65% of nursing home residents and 40% of children. It is also the nation’s largest funder of mental health care.

The rural hospitals and clinics we examined are not places of supposed waste, fraud and abuse – contrary to the........

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