These Are the Communities Most Likely to be Hurt By Hospital Closures and Medicaid Cuts

While the Congress has negotiated the details of the “One Big Beautiful Bill”, a parade of independent analyzes warned the impact that this would have on millions of American health care. Noting these conclusions, a handful of republican legislators expressed the alarm that the Medicaid and Medicare cuts contained in the bill would directly harm their voters, decimating the funding of rural hospitals. The majorities of the two chambers voted the bill anyway.

What has been warned of the members is now happening.

The hospitals most at risk of closing due to the massive cuts of the bill on federal spending for Medicaid and Medicare are located in communities which are mainly white and poorer on average than the rest of the nation. They are also more likely to have supported President Donald Trump and are mainly represented by Republicans at the Congress, according to an analysis of the memo discussion note of a new report on rural hospitals of the University of North Carolina.

The National Democratic Committee is launching a messaging campaign “to show how Trump’s policies harm people who voted the most for him”, setting up display signs outside of rural hospitals who had to close or reduce services. According to the DNC, at least 10 rural hospitals have announced a complete or partial closure since Trump took office. Among these hospitals, there were at least three which explicitly cited uncertainty around the future of federal funding to announce their imminent closure. While some facilities have decided to close before the Federal Expenses bill was adopted, the experts said that hospitals – who plan their budget for several years, are counting on Medicaid accounts for one fifth of hospital care spending – have probably seen writing on the wall.

“I am deeply concerned about my rural voters, the people of Georgia in a small town,” Senator Raphael Warnock told TPM.

“Even in cases where the hospital does not close,” he continued, “many of them will have to cut the services-the workforce and childbirth, for example, which is dangerous and potentially deadly for women who try to bring a child to the world.”

The legislation, which President Trump signed on July 4, should reduce $ 1 billion of Medicaid funding over the next 10 years and drive 10 million people to lose their health insurance.

“In a large part of these rural communities, in the mine, it is true that 70% of these people voted for the Republicans, voted for Trump,” said Rob Davidson, an emergency doctor in the rural West of Michigan who is executive director of the Committee to protect health care. Its organization offers doctors tools to explain to communities that their GOP legislators are responsible for the Medicaid and Medicare cuts.

“I think it is important that they at least understand that this is why this hospital disappears. Because of these cuts,” he said. Davidson said that his organization “floods the area with the realities of this type of legislation … and ensuring [community members] Understand who did this.

Even before Trump’s bill was promulgated, many rural hospitals suffered intense financial pressure. In the state of the Missouri of Senator Josh Hawley, the complete closure of a hospital, announced in June, cost the community more than 300 jobs. Hawley voted in favor of the bill and its MEDICAID support exhaustion before introducing its own legislation trying to reverse the cuts. (His new bill is unlikely to pass.)

The Arkansas Valley regional medical center in a deep red Otero county, Colorado – represented in the congress, until recently, by Trump Ally Lauren Boebert’s (R -CO) – announced its intention to dismiss 5% of its staff in June. A senior hospital official told Colorado Public Radio that the Republican budget bill “would injure” the hospital and other rural facilities. “The reduction in funding from Medicaid would have dangerous and real consequences,” said the official.

Davidson said he was happy that some impacted hospitals point to politics and, by extension, politicians.

“In some respects, it is refreshing to see that they are ready to put a name for the reason they do,” he said.

Although the budget bill includes $ 50 billion specifically for a rural hospital fund, this sum is only a drop in the bucket compared to what these hospitals lose, said Zachary Levinson, director of hospitals cost at KFF, a health policy organization.

“Overall, the $ 50 billion fund will cover just over a third of the estimated discounts of Fed Medicaid expenses according to KFF estimates,” said Levinson.

Robinson said it more frankly.

“I think we – probably all – should stop saying that it is a rural health fund,” he said.

“This represents $ 1 billion of dollars over a decade and $ 50 billion to help try to strengthen it,” said Davidson later. “This represents 5% of the problem in a period of 5 years. These mathematics do not work.”

More than 330 hospitals were highlighted in the report of the University of North Carolina, which was commissioned by four Democratic senators and published by the Scecil G. Sheps Center for Health Services Research. Senators Edward J. Markey (D-MA), Ron Wyden (D-OR), Jeffrey Merkley (D-OR) and Chuck Schumer (D-NY) sent a letter to Trump and other members of his administration detailing the conclusions of the study.

The report has reported hospitals that are among the highest 10% in terms of patients on Medicaid, or who reported negative margins for at least three consecutive years, or both, for their vulnerability to changes in federal health care expenses.

Only eight hospitals were both the best MEDICAIDE suppliers and had longer -term negative margins. Six of them are in the States that Trump won in the 2024 elections. All except one have higher poverty rates than the national average of 11.1%, and all except one were in the majority districts of the White Congress. This trend continues when you zoom. Six of the 10 best states with the greatest number of risky hospitals elected Trump in 2024. The list is led by Kentucky, which has 35 vulnerable rural hospitals, and Louisiana, which has 33. Strongly democratic California ranks third, with 28.

Leadership in the eight hospitals most at risk mentioned by the Sheps Center did not respond to requests for TPM comments.

Congress districts with rural hospitals are even more republican. Every first 10 except one are represented by a member of the Congress of the GOP, and each of the Republican representatives supported and even celebrated the Trump spending bill. One of these representatives was the president of the Mike Johnson room (R-La).

None of the Republican Congress members who represented the most vulnerable rural communities responded to requests for TPM comments.

MEDICAIDI’s individual cuts should start to start immediately after the mid-term elections in 2026.

Emine Yücel contributed the reports.