By Senate Democrats are demanding answers over how the Trump administration plans to manage the $50 billion rural health slush fund included in the One Big Beautiful Bill Act (OBBBA) in light of reports that the fund was made to buy Republican votes.
In a letter to Centers for Medicare and Medicaid Services (CMS) Administrator Mehmet Oz, a group of 16 Senate Democrats led by Senate Minority Leader Chuck Schumer (D-N.Y.) blasted the rural health fund as “wholly insufficient to plug the massive hole created by the Big, Ugly Betrayal,” but said it was “critical” that CMS provide clarity and guidance.
“We are alarmed by reports suggesting these taxpayer funds are already promised to Republican members of Congress in exchange for their votes in support of the Big, Ugly Betrayal. In addition, the vague legislative language creating this fund will seemingly function as your personal fund to be distributed according to your political whims,” they wrote.
The Democrats cited additional reporting that some of the rural health fund has been promised to regions in states like Pennsylvania that are not rural. The fund will not make direct payments to rural hospitals, but will first go to states that must file “rural health transformation plans” and receive approval from Oz.
The federal government can take back any unobligated money before the program ends in 2030.
“The Big, Ugly Betrayal makes no meaningful investments in rural hospitals, rural health centers, and other rural health care providers, which have some of the most fragile operating margins in the nation, and often are the largest employers and economic engines of their communities,” their letter read.
The Trump administration defended the rural health fund this week, writing in a memo that the law “contains unprecedented levels of federal assistance to rural and other vulnerable hospitals.”
The Senate Democrats asked to know when CMS would provide states with guidance on what to include in their applications, how much of the money will go to rural health care providers as well as what the administrative process will look like.
They additionally asked to know “what other states or districts have Trump Administration officials already promised funding from the rural health slush fund to?”
Democratic senators who signed the letter include Sens. Ron Wyden (Ore.), Ben Ray Lujan (N.M.), Angela Alsobrooks (Md.), Edward Markey (Mass.), Martin Heinrich (N.M.), Dick Durbin (Ill.), Kirsten Gillibrand (N.Y.), Elizabeth Warren (Mass.), Richard Blumenthal (Conn.) Alex Padilla (Calif.), Tina Smith (Minn.) Andy Kim (N.J.), Chris Van Hollen (Md.), Jeff Merkley (Ore.) and Bernie Sanders (I-Vt.)
The Hill has reached out to HHS for comment.