Langworthy, Gies Clash Over Rural Hospitals During Debate

During the October 6, 2026, debate between Rep. Nicholas Langworthy and Democratic challenger Dr. Aaron Gies for New York’s 23rd Congressional District, hosted by WETM-TV in Elmira, the candidates exchanged sharply different views about healthcare and hospitals in the district.

The One Big Beautiful Bill Act (OBBBA), which Langworthy voted for, will reduce federal Medicaid spending by more than $900 billion over ten years. These cuts will increase financial pressure on hospitals, many of which already face rising costs, staffing shortages, low reimbursement rates for Medicare and Medicaid, and reduced payments from insurers. In Langworthy’s NY-23 district, the Fiscal Policy Institute lists 8 hospitals in Langworthy's NY23 congressional district as at risk of closing - the most of any congressional district in New York State. See our earlier report on the hospitals at risk.

In the face of Medicaid cuts from the OBBBA, hospitals across the country have closed or reduced services. Just across the border in Pennsylvania, for example, Buffalo-based Kaleida Health submitted a closure notice in 2026 to end inpatient and emergency services at Bradford Regional Medical Center, citing declining patient volumes and financial losses.

Against that background, here is the exchange between Gies and Langworthy, beginning around 18:18 in the debate recording.

Note: The following transcript was prepared by me directly from the audio. The video’s automated captions don't accurately reflect what the candidates said.

Here’s Context for What Gies and Langworthy Said

Dr. Gies said, “…there is disruption in the healthcare markets nationwide.”

• Hospitals already struggle with rising labor and operating costs, healthcare worker shortages, Medicare and Medicaid reimbursement pressures, and payment restrictions imposed by insurers.
• Health insurance premiums continue to rise, while patients struggle to pay for health insurance and medical care. Rural hospitals face particular challenges because of low patient volumes, limited financial reserves, and dependence on government insurance programs.

Dr. Gies said, “Things are not going well and they are about to get dramatically worse.”

• Beginning in January 2027, new Medicaid work requirements and eligibility checks will put millions of Americans at risk of losing their health insurance.
• Additional restrictions on Medicaid financing will reduce federal support to states and hospitals, including financially vulnerable rural hospitals like Arnot Odgen.
• Beginning in October 2028, Medicaid expansion beneficiaries with incomes above the federal poverty level will pay new out-of-pocket charges for medical services.
• The Congressional Budget Office projects that the OBBBA's healthcare provisions will increase the number of uninsured Americans by about 10 million in 2034.
• The Rural Health Transformation Program provides $50 billion over five years. That's much less than the projected $900+ billion cuts in federal Medicaid spending from the OBBBA. The rural transformation program will not replace the Medicaid cuts. They are different programns with different purposes.

Dr. Gies said, “Arnot Ogden, the hospital here in Elmira…is the most threatened hospital [in the NY23 congressional district] by the big, ugly bill.”

• About 42% of Arnot Ogden Medical Center's patient revenue comes from Medicaid and government appropriations. This makes the hospital particularly sensitive to changes in public funding.
• Beginning in 2027, new Medicaid eligibility requirements will increase the number of uninsured patients. Hospitals treating uninsured patients face the prospect of additional uncompensated care.That is, they are required to provide treatment but won't necessarily get paid for it.
• Gies describes Arnot Ogden as the most threatened hospital in NY23 - Langworthy's district. There are 7 other hospitals in NY23 also at risk of closing. "That "Most at tisk" is Dr. Gies assessment, not independently verified. The evidence says Arnot Ogden is at risk of closing but maybe not more or less than the other 7 hospitals on the list.

Earmark, Not Rural Program Money

Rep. Langworthy said, “I think it’s amazing. I have visited Arnot many times. I’ve talked to their executives on a very regular basis, and currently working on getting federal funds for projects within Arnot.”

• Langworthy asked House appropriators for fiscal 2027 Community Project Funding (member earmarks) to modernize Arnot Ogden's interventional radiology suite, with Chemung County as the recipient. The House committee's bill carries $500,000 for Chemung County at his request.
• The proposed earmark is not from the $50 billion Rural Health Transformation Program.
• As of October 26, 2026, Congress has not enacted the funding.
• The money would support facilities and equipment, not replace Medicaid reimbursements for treating patients.
• Modernizing the radiology suite would benefit Arnot Ogden, but it would not address the broader financial pressures created by reductions in Medicaid funding.

Langworthy said, “And they’re going to benefit directly from the Rural Transformation Fund, a fifty billion dollar… the first time of its kind a fund just aimed at rural healthcare all the way across our district and the plans are already in place to bring those funding pots here to our district and the rural hospitals all over America…”

• The Rural Health Transformation Program provides $50 billion over five years, distributed among the 50 states. All states received first-year awards. Washington, D.C., and the five U.S. territories don't get anything.
• States applied for federal funding, and New York distributes portions of its award through competitive applications. No individual hospital is guaranteed funding.
• The program does not replace the OBBBA's projected $900 billion-plus cut in federal Medicaid spending. Medicaid reimburses hospitals and providers for treating patients. The rural program supports investments in technology, workforce development, chronic disease prevention, and improvements in healthcare delivery.
• New York received $212 million in first-year Rural Health Transformation funding. The state has so far made $76.2 million available through its Rural Community Health Integration Initiative.
• Arnot Ogden is not on the list to receive funding in this first round. Other hospitals in NY23 received awards, including Westfield Memorial Hospital ($1.25 million), St. James Hospital ($1.18 million), and the Chautauqua Center ($1 million).

The Numbers Behind the Comparison

Gies said, “…the Rural Healthcare Transformation Fund which is fine, and our share of it is seventy-four million dollars. The big, ugly bill cuts sixty-three billion dollars out of New York States’ Medicare Medicaid budget. It’s almost a thousand times more. So, for Congressman Langworthy to compare the two, they’re just not comparable.”

• Gies put New York's share at $74 million - the number for the first round funding is 76.2 million. The state's first-year award is $212 million.
• The OBBBA is estimated to cut New York's Medicaid budget by about $63 billion through 2034.
• The $63 billion is a cut to Medicaid alone, not both Medicare and Medicaid.
• Dividing $63 billion by $74 million produces a ratio of 851 to one, almost a thousand times. But this compares ten years of Medicaid cuts in NY to the first round rural health funding.
• Gies is correct that the programs - Medicaid and the Rural Health Transformation Program - are different in what they do and how much funding they receive. The rural program does not replace the Medicaid cuts.

Related from WNYP

• After Langworthy and Tenney Voted for Medicaid Cuts, Upstate New York Hospitals Are At Risk: Public Citizen identifies hospitals in Western and Upstate New York as financially vulnerable because of Medicaid cuts in the One Big Beautiful Bill.
• NY-23: Langworthy vs. Gies: A Little Three Rematch, With Higher Stakes Than Basketball: Compares Langworthy's voting record with Gies's platform on Medicaid and SNAP cuts, ACA subsidies, rural hospitals, farm policy and town halls.
• The Real Cost of the "Working Families Tax Cut" Is Already Showing Up in Western New York: The new name for the 2025 law and its Medicaid and SNAP effects in Western New York.