FREDONIA, N.Y. — As New York puts millions of dollars toward a new rural hospital in Western New York, Gov. Kathy Hochul is warning that federal healthcare changes could create even greater financial pressure for hospitals across the state.
Hochul was in Fredonia Thursday to highlight $124 million in state funding for the new Northern Chautauqua Hospital, which is expected to open in 2029. The state investment represents more than half of the project’s total cost.
But Hochul used the construction site to make a broader argument about the future of healthcare in New York.
“The state has had to step in after literally one year ago when the big, ugly, horrible bill was passed and withheld $10 billion in health care money from the state of New York,” Hochul said. “That is a big hit.”
Hochul said rural hospitals are already facing lower reimbursements, rising costs, staffing shortages and difficulties recruiting doctors, nurses and other healthcare professionals.
She argues changes to Medicaid and health coverage included in the federal law commonly referred to by President Donald Trump and supporters as the “One Big Beautiful Bill” will add to those pressures.
But Republicans point to another provision of the same law: the $50 billion Rural Health Transformation Program, which provides funding to states over five years to strengthen rural health systems.
New York received more than $212 million from that program for its first year.
State Sen. George Borrello, a Republican whose district includes Fredonia, said that federal investment also needs to be considered when discussing the law’s impact on rural hospitals.
“There is $50 billion for rural hospitals in the bill that she was bashing,” Borrello said.
The two figures, however, are not a direct dollar-for-dollar comparison.
The new federal rural health funding is not primarily designed to replace Medicaid reimbursements or other health coverage dollars New York says could be lost under separate provisions of the law.
Instead, the Centers for Medicare and Medicaid Services says the Rural Health Transformation Program is intended to help states modernize how care is delivered in rural communities, including efforts involving primary care, technology, workforce development and new models of care.
That distinction is at the center of the debate over what the federal changes will ultimately mean for rural hospitals.
While Hochul is warning about billions of dollars in broader Medicaid and health coverage losses, the federal government is simultaneously directing new money toward transforming rural health systems.
Borrello argues New York also needs to address problems within its own Medicaid program, particularly reimbursement rates for providers.
“They all talk about one main thing: Medicaid,” Borrello said of hospitals and other providers in his district. “They all say the same thing, ‘Our Medicaid rates are below the cost of care.’”
The debate raises a broader question for rural communities across New York: how much can the new federal transformation funding help hospitals withstand the other financial pressures state leaders say are coming?
In Fredonia, the new hospital will provide one test of how New York approaches rural healthcare going forward.
The planned 133,000-square-foot facility will include 20 private medical, surgical and observation beds, a 17-bay emergency department, three operating rooms, three procedure rooms and 47 exam rooms for primary and specialty care.
Hochul has said the hospital’s partnership with Kaleida Health gives her confidence the facility will remain financially viable after it opens.
The Northern Chautauqua Hospital is expected to open in 2029.