Federal funding through Medicare and Medicaid is the foundation that allows hospitals, clinics, and nursing homes to keep their doors open. With Medicaid cuts on the table, that foundation is at risk and could change how and where nurses do their work.
Medicaid and Medicare are deeply embedded in Oregon’s healthcare delivery system. In Oregon, low-income residents receive health coverage through the Oregon Health Plan (OHP), which is funded jointly through state taxes and Medicaid. It’s a widely used program with 1 in 3 Oregonians using OHP to pay for their healthcare. This includes working families, children, pregnant adults, single adults, and seniors. Medicare is a federal health insurance program that covers people over the age of 65 and some younger people with serious disabilities. As of 2023, more than 21 percent of the state’s population pays for their care using Medicare.
OHP is a major source of revenue for hospitals, community health centers, nursing homes, and other providers. While state and federal reimbursement rates are often lower than private insurance, the volume of Medicaid patients provides essential cash flow. For some Oregon hospitals, more than 75 percent of patients use OHP or Medicare to pay for their care.
Right now, Medicaid is on the line. The 2025 federal budget proposal, also called the One Big Beautiful Bill Act, includes several changes to Medicaid that, if approved, could mean about $880 billion reduction in spending over the next 10 years, along with other restrictions for immigrants and work requirements. The Oregon Health Authority estimates that the state could lose $1 billion in the 2027-2029 biennium alone.
How will Medicaid cuts impact Oregon’s nursing workforce?
It is estimated that the proposed cuts will have the greatest impact on long-term care and nursing homes, behavioral health providers, community health centers, and hospitals in rural communities. As of 2023, approximately 14 percent of Oregon's nurse workforce practice in settings primarily funded by Medicaid, including about 2000 nurses at rural hospitals and 4300 nurses in long-term care settings. If major Medicaid cuts happen:
- Hospitals and clinics could close or downsize, especially in rural communities, reducing available services and nursing jobs.
- Nurses still working could face higher patient loads, more stress, and less time for each patient as positions that support nurses are reduced or eliminated.
- In facilities where nurse staffing ratios are mandated, fewer available resources could mean closing beds or limiting admissions, ultimately restricting patient access to care.
- Without insurance, patients may delay or skip care, meaning that they are likely to be sicker and harder to treat when they eventually seek out care.
The vote on the federal budget bill is anticipated to take place on or before July 4. It’s easy to feel disconnected from budget debates in Washington, D.C. But what happens there could hit nurses directly at the bedside.
What Nurses Can Do to Prepare:
- Understand the connection: Learn how your workplace uses OHP funding and what services are most at risk if funding drops.
- Use your voice: Nurses are consistently voted the most trusted profession. Get involved in a professional association. Share your story of how OHP makes it possible for your patients and families to get care.
- Connect with each other: Stay alert for signs that your employer may need to reduce services and be ready to support your colleagues.
- Stay flexible and informed: Check in with OCN, your employer or your professional organizations so you’re not caught off guard.
- Prioritize your own well-being: Uncertainty and systemic change can create emotional strain. Explore Moral Resilience in Nursing, a resource for navigating ethical stress and preserving your sense of purpose.
What Nurse Leaders Can Do:
- Assess funding risks: Understand how changes to OHP and Medicare might affect your operations, staffing, and service delivery.
- Communicate transparently: Keep your teams informed about potential impacts and planning steps.
- Support your workforce: Proactively address stress and moral distress. Use the Moral and Ethical Misalignment Toolkit to build structures that support team resilience.
- Engage in advocacy: Use your platform to share workforce impact data and real-world implications with policymakers. Collaborate with professional associations and coalitions to amplify your message.
- Stay connected with OCN: Leverage our data, policy insights, and workforce briefs to inform internal and external decision-making.
Medicaid is a vital link to care for many Oregonians, and its future directly impacts the work nurses do and the patients they serve. Federal budget decisions have real and far-reaching consequences. Cuts to Medicaid will ripple outward—threatening the financial stability of hospitals and clinics, limiting care access for Oregonians, and placing nurses in untenable positions where they’re unable to provide the care they are trained to give.
While policymakers and healthcare leaders hold the levers of change, nurses bear witness to the human cost. The Oregon Center for Nursing is committed to providing the data, insight, and frontline voices needed to inform decisions that protect both care access and workforce integrity.
We are monitoring these developments and preparing resources to support healthcare leaders, policymakers, and the nursing workforce through this period of uncertainty.
Stay informed. Sign up for updates at https://oregoncenterfornursing.org, join us for a Friday Huddle, or follow us on LinkedIn or Facebook. Together, we can work to ensure that Oregon’s nursing workforce remains strong for all Oregonians.
