After Langworthy and Tenney Voted for Medicaid Cuts, Upstate New York Hospitals Are At Risk

Hospitals in the congressional districts represented by Rep. Nicholas Langworthy (R-NY23) and Rep. Claudia Tenney (R-NY24) have been identified as financially vulnerable following Medicaid cuts in the One Big Beautiful Bill they voted for, according to a new report from Public Citizen.

The report does not predict that these hospitals will necessarily close. Instead, it identifies facilities that rely heavily on Medicaid funding and that have operated at a financial loss, a combination that places them at heightened risk of service reductions or closure if federal Medicaid funding declines.

Public Citizen’s report, Big Ugly Threat: Medicaid Cuts Put Hospitals at Risk, identifies 446 hospitals nationwide as financially vulnerable. These hospitals served approximately 6.6 million patients in 2024 and employ roughly 275,000 healthcare workers. The report also found that 45 of these hospitals are in New York State. New York is one of five states where more than one-quarter of hospitals are considered financially vulnerable.

Hospitals Already Facing Financial Pressure

These at-risk hospitals serve communities in Buffalo, Cuba, Elmira, Hornell, Montour Falls, Newark, Niagara Falls, Rochester, and Springville, along with surrounding rural areas where access to healthcare is already limited. If services are reduced or hospitals close, patients in rural communities could face longer travel times, fewer maternity services, and fewer local healthcare jobs.

Some hospitals are already making cuts. Erie County Medical Center in Buffalo, one of the hospitals identified in the Public Citizen report, announced layoffs and unpaid furloughs earlier this year, citing financial pressures, including concerns about Medicaid funding. Public Citizen also noted that hospitals in several states have already reduced services, including obstetrics and maternal care, in anticipation of declining Medicaid revenue.

Although many Medicaid reductions in the One Big Beautiful Bill do not take full effect until 2027, hospitals plan years in advance. Financial pressure from anticipated funding losses is already shaping staffing, services, and long-term planning decisions.

Hospitals often operate on thin margins, particularly in rural areas. Even modest funding reductions can force difficult decisions.

Langworthy and Tenney Voted for the Bill

The One Big Beautiful Bill passed the House narrowly in July 2025, with Republicans Nicholas Langworthy and Claudia Tenney voting in favor. President Trump signed the legislation into law on July 4, 2025. According to estimates from the Congressional Budget Office, the law reduces federal Medicaid and CHIP spending by approximately $911 billion over ten years and increases the number of uninsured people by 10 million. Additional analysis is available from the Kaiser Family Foundation.

Langworthy and Tenney both issued public statements last summer justifying their votes for the One Big Beautiful Bill. They portrayed the legislation as providing needed fiscal reform.

At-Risk Hospitals in NY-23 and NY-24

Public Citizen identified six hospitals in the congressional districts represented by Nick Langworthy (NY-23) and Claudia Tenney (NY-24) as financially vulnerable. These hospitals serve largely rural areas or small cities where healthcare options ar already imited.

Additional At-Risk Hospitals in Western and Upstate New York

How Public Citizen Identified At-Risk Hospitals

Public Citizen classified hospitals as at risk if they met two criteria:

• At least 20 percent of revenue came from Medicaid
• The hospital recorded negative operating margins

Hospitals meeting both criteria were identified as financially vulnerable if Medicaid coverage declines or funding is reduced.

Public Citizen used relatively conservative screening criteria. Other analyses using broader financial indicators identify even more hospitals at risk, suggesting that the Public Citizen list may represent a lower-bound estimate. One example is the Center for Healthcare Quality and Payment Reform’s rural hospital analysis, which uses broader indicators of financial distress.

Work Requirements

The One Big Beautiful Bill also introduces Medicaid work requirements for many adults. Adults ages 19 to 64 must generally document 80 hours per month of work, school, job training, or volunteering to maintain coverage, unless they qualify for an exemption. Supporters argue the requirement promotes employment. Critics say work requirements often reduce coverage because of paperwork barriers rather than changes in employment.

Arkansas implemented Medicaid work requirements in 2018. Within months, more than 18,000 people lost Medicaid. Later research found that most of the people who lost Medicaid were already working or qualified for exemptions. Employment rates in Arkansas did not significantly increase, but Medicaid enrollment declined. The work requirement program was halted by a federal court. See the New England Journal of Medicine study here.

Consequences for Rural Communities

If hospitals reduce services or close, the effects extend far beyond the loss of a building. In rural areas, hospital closures are associated with:

• Longer travel times for emergency care
• Increased mortality for heart attacks and strokes
• Loss of maternity services
• Increased strain on emergency medical services

When hospitals close in rural communities, ambulances must travel farther and remain tied up longer, reducing emergency response capacity across entire regions.

Maternity care is particularly vulnerable. When rural hospitals close labor and delivery units, pregnant patients often must travel an hour or more for care. Studies link these changes to increased emergency deliveries and worse infant outcomes. Research on rural hospital closures is available through Health Affairs.

Hospitals also play a major economic role in rural communities. Healthcare facilities are often among the largest employers in smaller towns. In some rural areas, healthcare accounts for up to 10% of local employment.

Impact in Upstate New York

Nick Langworthy and Claudia Tenney voted for the One Big Beautiful Bill. Public Citizen now identifies multiple hospitals across Western and Upstate New York as financially vulnerable following Medicaid cuts in the One Big Beautiful Bill. The consequences would not be felt in Washington. They would be felt in Buffalo, Cuba, Elmira, Hornell, Montour Falls, Newark, Niagara Falls, Rochester, and Springville — and in rural communities across Western and Upstate New York, where hospitals are not just healthcare providers, but lifelines for entire regions.