In Washington's marble halls, senators and representatives speak passionately about rural healthcare. They cite statistics about hospital closures, describe constituents driving 100 miles to deliver babies, and secure promises to address these "critical" issues. The concern seems genuine, the rhetoric moving.

Then they vote.

The recent congressional approval of legislation that healthcare experts warn will accelerate rural hospital closures reveals a troubling truth: while politicians perform concern, real communities face extinction. The very representatives who champion rural healthcare in hearings turn around and vote for bills that push these hospitals closer to the edge.

While Congress was deliberating legislation that would make their survival even harder, the people of Anson, Texas were fighting to keep their hospital doors open. Their story, captured in the video below, shows what the political rhetoric obscures: real people making extraordinary sacrifices to save the institutions their communities depend on.

Vice President JD Vance cast the tie-breaking vote as the Senate passed the “One Big Beautiful Bill” (or substitute your own descriptor) 50-50 after a 27-hour marathon of voting. While the most extreme Scott amendment was ultimately defeated, the base bill’s devastating wealth transfer from healthcare to tax cuts for the wealthy now moves to the House, where the real fight begins.

In the pre-dawn hours of Tuesday morning, the U.S. Senate completed one of the most consequential votes in recent American history—not just for what it passed, but for what it revealed about who matters in American democracy. After 27 hours of marathon voting that forced senators to cancel July 4th vacation plans, Republicans achieved their goal of the largest wealth redistribution in recent memory: cutting more than $793 billion from Medicaid to fund tax cuts for the wealthy.

The vote came down to a 50-50 tie broken by Vice President Vance, with only three Republicans joining all Democrats in opposition: Susan Collins of Maine, Thom Tillis of North Carolina, and Rand Paul of Kentucky. The absence of the ultra-extreme Scott amendment—which would have completely eliminated Medicaid expansion funding starting in 2031—represents the only silver lining in an otherwise devastating outcome for American healthcare.

As a leader in rural healthcare, I can attest firsthand to the indispensable role the 340B Drug Pricing Program plays in maintaining healthcare access for our most vulnerable communities. For over 30 years, this program has served as a lifeline for rural and safety-net hospitals across America, allowing us to stretch limited resources and continue serving patients regardless of their ability to pay.

The 340B program represents a rare policy success: it costs taxpayers nothing while delivering tremendous value to communities in need. By requiring pharmaceutical manufacturers to provide discounts to qualifying hospitals in exchange for Medicaid and Medicare participation, the program helps offset the rising costs of medications that threaten to overwhelm our healthcare systems.

Rural hospitals operate on razor-thin margins. They serve communities with higher percentages of elderly, low-income, and uninsured patients, while facing all the challenges of attracting healthcare professionals to non-urban settings. The harsh reality is that without programs like 340B, many rural hospitals cannot survive.