Senate Democrats are demanding answers over what they call a “slush fund” created to mask the effects of sweeping health care cuts passed by Republicans earlier this month.
In a letter led by Senate Minority Leader Chuck Schumer and Senator Ron Wyden, lawmakers questioned the $50 billion rural health fund’s legality, transparency, and purpose. They argue the fund was crafted behind closed doors to secure votes for a reconciliation bill that slashed over $1 trillion from the U.S. health care system—the largest single reduction in federal health funding in history.
“The rural health slush fund appears to be nothing more than a political parachute to pay off members of Congress for their unpopular votes,” the letter stated, calling the legislative language “vague and open-ended” with no guarantees that funds will even support rural health care.
Democrats pointed to social media posts from Republican senators celebrating specific dollar amounts already promised to their states, raising concerns about political favoritism. Lawmakers cited examples from Alabama, Ohio, Missouri, and Louisiana, and noted reports of promised funding in non-rural districts.
According to the letter, the fund has no formal criteria for how the Centers for Medicare & Medicaid Services (CMS) should allocate the money, no accountability framework, and no restrictions requiring the funds to support rural hospitals or providers. States could, under the bill’s wording, use the funds for unrelated projects such as wearable health devices or experimental care models.
The Senators requested CMS clarify how it will define eligible uses of funds, what share will go directly to rural providers, how oversight will be handled, and which districts have already been promised money. They also raised concerns about CMS’s capacity to administer the fund amid an ongoing hiring freeze, and whether a third-party vendor has already been selected.
At stake, they argue, is the survival of rural health care providers. One-third of rural hospitals are already at risk of closure, and over 330 may be forced to reduce services or shut down entirely under the new law.
While calling the rural fund “wholly insufficient,” the Senators emphasized the urgency of implementing safeguards. They urged CMS to commit to a transparent application and distribution process before the December 31 deadline to approve state proposals.
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