The “One Big Beautiful Bill Act” which includes tax breaks and spending cuts that slashed nearly $1 trillion from Medicaid, is threatening rural Minnesota economies. The funding for Astera Health in Wadena, Minn., has disappeared, leaving the nonprofit hospital with a deficit of funding. Astera officials are scrambling to maintain the hospital, which accounts for over a fifth of Astera’s payer mix. The reliance on federal dollars is most pronounced in rural communities, which tend to be older and poorer than metro areas. Over the past 50 years, money from Medicaid and other federal programs has become a larger share of American incomes. In Minnesota, 18% of total nonfarm income came from these transfer receipts in 2023, compared to 11% in 1973. The federal cuts will result in an estimated 21,400 job losses by 2029, and an estimated 1.65 million jobs nationwide.