Maryland Gov. Wes Moore warned last year that everyone except the super-rich was “getting hosed” by President Donald Trump’s signature One Big Beautiful Bill. Yet a year after the legislation became law, the Democratic governor is publicly promoting one of its major provisions.

This month, Moore announced a new Maryland initiative designed to expand health care access for people living in rural communities, saying “Marylanders’ ability to access affordable and quality health care should not depend on their zip code.” The effort is being supported by $168 million in federal funding Maryland received this year through the One Big Beautiful Bill Act, the same legislation Democrats fought to block and that represents Trump’s most significant legislative accomplishment of his second term.

The legislation passed Congress exclusively with Republican support. Among its provisions was the creation of the five-year, $50 billion Rural Health Transformation Program, which provides states with federal funding to strengthen rural health care. Maryland is initially putting $80 million of its allocation toward expanding primary care, mental health and dental services in rural communities.

“This $80 million allocation is another step in our administration’s commitment to investing and expanding innovative initiatives to drive health outcomes for Maryland’s rural communities, leaving no one behind,” Moore said in an Aug. 10 statement. His statement did not identify the One Big Beautiful Bill as the source of the funding.

Democratic governors, much like their counterparts in Congress, mounted strong opposition to Trump’s One Big Beautiful Bill. They criticized provisions extending Trump’s 2017 tax cuts, ending enhanced pandemic-era Obamacare subsidies and imposing new Medicaid work eligibility rules. The Congressional Budget Office estimates those Medicaid changes could result in 7.8 million people losing health coverage by 2034.

The $50 billion rural health program helped win support from some Republican lawmakers who were concerned about the legislation’s Medicaid reductions, which are projected to total $911 billion over a decade, as well as the potential consequences for rural hospitals.

Democratic governors continue to argue that the rural health funding will not make up for the broader effects of the Medicaid changes, especially with the new work requirements scheduled to begin in 2027. Nevertheless, they have eagerly publicized federal rural-health money arriving in their states while generally avoiding any praise for the Trump legislation that created the program.

“This investment allows Hawaii to finally close the distance between rural communities and the care they deserve,” Hawaii Gov. Josh Green, a Democrat, said earlier this year. He was announcing $189 million in federal rural health funding for Hawaii, which will be used to expand access to quality primary care outside Honolulu.

Green had offered a much darker assessment when the legislation passed in July 2025. “These next few years won’t be easy, but we are mobilizing now to respond, protect our people and make sure Hawaii can weather what’s coming,” Green said in a joint statement with Hawaii’s Democratic congressional delegation.

Connecticut Democratic Gov. Ned Lamont similarly praised the $154 million his state is receiving in 2026 through the Rural Health Transformation Program, describing it in March as a “landmark federal grant.” That came after he warned the previous year that the Big Beautiful Bill Act would have “devastating impacts on millions of Americans for years to come.”

“Rural Connecticut has unique challenges, and its residents deserve the same access to high-quality care and support as anyone who lives anywhere else,” Lamont said in March. “This investment allows us to tackle those challenges head-on.”

White House Accuses Democratic Governors of Taking Credit for Trump Program

Every state in the country, regardless of whether it is led by a Democrat or Republican, applied for and received money through the Rural Health Transformation Program. First-year awards ranged from $147 million for New Jersey to $281 million for Texas, with the grants distributed in December 2025.

The White House has accused Democratic governors of attempting to claim credit for a program contained in legislation they repeatedly criticized and sought to defeat.

“Every single Democrat voted against the Rural Health Transformation Fund, and Democrat governors spent months blasting the bill that created it,” White House spokesman Kush Desai said in a statement to USA TODAY. “Democrat governors have no right to now try to take credit for ‘securing’ rural health dollars that they had nothing to do with, these investments are solely thanks to President Trump and Republicans.”

The Republican criticism echoes an argument previously made by President Joe Biden’s administration against GOP lawmakers who voted against Biden’s 2021 infrastructure law but later appeared at ribbon-cuttings for projects financed by the legislation.

To qualify for rural health funding during the program’s five-year lifespan, states were required to submit plans detailing how they would improve rural access to care, modernize hospitals and technology, and introduce new medical innovations in underserved areas.

“Rural Arizonans have waited too long for healthcare that meets them where they are, and we’re changing that,” Democratic Arizona Gov. Katie Hobbs said in March when she unveiled her state’s rural health program and website. Arizona received $167 million under the federal initiative. Hobbs described the effort as “a signal that help is on the way.”

Arizona Governor Katie Hobbs greets supporters during the opening of Copper State Victory’s first coordinated Democratic campaign office in Tucson, Arizona, U.S., July 12, 2026.

Pennsylvania Gov. Josh Shapiro, another Democrat, said the $193 million his state received in federal funding during 2026 is enabling Pennsylvania to move ahead with its “plan to improve rural health care, attract and retain a skilled workforce, promote long-term, sustainable access, support the growth of innovative care, and foster technological innovation.”

At the same time, Democratic governors maintain that the new rural-health funding will not compensate for expected Medicaid losses in the years ahead. They also point to reductions in food stamp funding and other changes to the social safety net contained in the Big Beautiful Bill Act.

“Governor Hobbs has been clear that the partisan Washington budget will have devastating impacts on the people of Arizona and that the RHTP is a bandaid on a gaping wound created by the federal government,” said Christian Slater, a spokesman for Hobbs. “But the governor will unapologetically fight for every dollar she can to protect Arizonans from the federal government’s attacks on affordable and accessible healthcare.”

Cathryn Vaulman, Lamont’s communications director, said the Rural Health Transformation Program “cannot come close to offsetting the harm caused by Congressional Republicans’ cuts to healthcare, food assistance, and other benefits in H.R. 1.” She added that the federal money “nevertheless provide important resources to strengthen rural health care in those communities.”

Democratic Michigan Gov. Gretchen Whitmer made a similar argument last December when she said her state’s $173 million 2026 allocation “will support access to health care for rural communities across Michigan as we deal with funding shortfalls caused by federal Medicaid cuts.”

Even as Maryland accepts the federal rural health money, Moore’s spokesman Ammar Moussa emphasized that the governor remains opposed to Trump’s broader legislation.

“Taking advantage of one worthwhile provision does not change the governor’s view of a law that makes deep cuts to Medicaid and will cause close to 200,000 Marylanders to lose health coverage,” Moussa said. “But once Congress passed the law, Governor Moore was never going to leave federal resources on the table that can help Marylanders.”

RN Michelle McVey demonstrates infant care in the emergency room at Coffey County Hospital in Burlington, Kansas, U.S., February 19, 2026.

Will Medicaid Cuts Outweigh the Rural Health Funding?

Medicaid provides coverage to 16.1 million people living in rural areas, representing roughly one in four rural adults, according to KFF, an independent health care research organization.

A KFF analysis estimates that Medicaid spending in rural communities will fall by approximately $137 billion as a result of Trump’s legislation. That means the $50 billion rural health program would cover only about one-third of the projected reduction. States with significant rural populations that expanded Medicaid through the Affordable Care Act are expected to experience some of the largest decreases in federal Medicaid spending.

The White House disputes those calculations, arguing that rural hospitals receive only about 7% of Medicaid funding. Administration officials say reductions tied to the legislation stem from work requirements that they argue are broadly popular and intended to ensure Medicaid primarily serves people who qualify for the program.

White House officials also argue that the $50 billion rural health initiative was created to address long-standing problems in rural health care caused by decades of population decline, rather than to replace Medicaid funding reduced by Trump’s legislation.

Colorado, under Democratic Gov. Jared Polis, is another example of a Democratic administration moving forward with money created by the law it opposed. In June, the state began accepting applications from organizations seeking to help implement its rural health strategy after Colorado received $200 million in first-year funding.

The state is focusing its efforts on 29 rural counties with high rates of chronic illness and 23 frontier counties where residents have limited access to specialized services, including behavioral health, obstetrics and gynecology.

“By taking advantage of every opportunity to reduce healthcare costs and support rural communities Colorado can increase access to the care we need to thrive, in urban and rural communities,” Polis said.

Eric Maruyama, a spokesman for Polis, nevertheless reaffirmed the governor’s opposition to the One Big Beautiful Bill Act. He said the legislation “does significant harm” through reductions in food assistance and Medicaid and by allowing enhanced ACA subsidies to expire.

“It also ripped an immediate billion dollar hole in our state budget,” Maruyama said. “Congress nevertheless passed the law, and Colorado will not leave federal funding on the table, especially given the enormity of the cuts to services the law creates.