In northeast Georgia, a hospital closed its maternity ward. In rural New Hampshire, a neighborhood well being middle shuttered. And in Iowa, a Des Moines hospital system laid off dozens of staff and closed a clinic.
All these suppliers cited President Donald Trump’s sweeping domestic policy agenda package, which slashed greater than $1 trillion in federal assist for well being care, as an element of their choices.
The laws, often known as the “One, Big, Beautiful Bill Act,” is predicted to depart thousands and thousands extra Americans with out protection and to chop very important monetary assist for hospitals – a mix that would pressure already cash-strapped suppliers to tug again on providers and staffing, leaving sufferers with fewer locations and longer waits for care, significantly in emergency rooms.
At the laws’s signing, President Donald Trump touted its tax and border safety provisions, downplaying the impression of the well being care cuts. The administration and GOP lawmakers typically seek advice from the bundle because the “Working Families Tax Cut Act.”
But Republicans hoping to tout the laws as a degree of their favor in November are confronting an escalating political backlash to the rising penalties of these cuts, as lawmakers who supported it take the blame.
Many hospitals, significantly these in rural areas or who deal with a whole lot of underserved sufferers, have been struggling financially for years, contending with rising bills, workforce shortages, an growing older inhabitants and federal reimbursement charges that don’t cowl the price of care. Nearly 200 rural hospitals have closed or stopped offering inpatient care since 2005, in line with the Sheps Center for Health Services Research.
The “big, beautiful bill” will improve that fiscal pressure, consultants say. Its historic cuts to Medicaid, which embrace including the first-ever work requirement to the protection internet program, are anticipated to depart 7.5 million extra folks uninsured over the subsequent decade, in line with the Congressional Budget Office. Other provisions push up that figure to a complete of 10 million.
But when a lot of these people get sick, they may nonetheless present up at hospitals, who should present emergency care even when they gained’t get reimbursed.
Compounding the issue is the expiration of the Affordable Care Act’s enhanced premium subsidies, which Republicans in Congress opted to not prolong regardless of heavy strain from Democrats. Some 2 million fewer folks are anticipated to be insured this yr, in line with the CBO.
In addition, the “big, beautiful bill” curtailed states’ means to levy taxes on well being care suppliers, which assist states fund their share of Medicaid, and to supply particular funds to beef up the reimbursement charges for hospitals and different suppliers, amongst different makes use of. These supplier taxes and state-directed funds additionally increase federal Medicaid funding that states obtain.
“Our health care system was already fragile and now the largest cuts in health care history are going to disintegrate it further,” mentioned Vaishu Jawahar, director of coverage packages at Protect Our Care, a left-leaning advocacy group.
Douglas Holtz-Eakin, president of the conservative-leaning American Action Forum, argued that “there’s nothing that says Medicaid always has to look like the original program,” and mentioned Republicans need much less systemic dependence on it.
“Republicans have always viewed Medicaid as a targeted, low-income safety net program for health insurance for those who cannot get it on their own,” he mentioned. “Democrats have taken the view that Medicaid is just another program, another way to get to universal coverage. Expand wherever you can, do what you have to. And so this just represents the collision of those views.”
The bundle additionally created a $50 billion Rural Health Transformation Program, which is meant to immediate states and their rural suppliers to enact lasting adjustments that may put them on a extra sustainable monetary path. While some suppliers say this system can be helpful, others say it gained’t do a lot to assist them cope with the most important funding holes the invoice will create.
And the agricultural fund doesn’t do something to assist city hospitals. Nearly 100 of those hospitals that are financially distressed and disproportionately present care to Medicaid enrollees are most vulnerable to shutting down or limiting providers due to the invoice, in line with a November evaluation by Harvard’s TH Chan School of Public Health.
Although most of the invoice’s principal Medicaid provisions don’t begin kicking in till the subsequent yr or two, some hospitals and different suppliers are starting to take steps now to blunt the impression of the approaching cuts.
St. Mary’s Sacred Heart Hospital in rural Lavonia, Georgia, closed its labor and supply unit, in addition to its obstetrics and gynecology middle, final fall. Expectant moms now should drive about half-hour to the closest hospital with labor and supply providers or about an hour to St. Mary’s hospital in Athens, which nonetheless operates a maternity ward.
St. Mary’s mentioned in an announcement that it spent 18 months attempting to recruit extra medical doctors, create partnerships and pursue different funding because it contended with an growing older inhabitants and a declining variety of births. But the invoice performed a job.
“Recent Congressional cuts to Medicaid solidified this decision,” the hospital mentioned.
Maternal care is already strained in Georgia, mentioned Whitney Griggs, director of well being coverage at Georgians for a Healthy Future, an advocacy group. The state has maternal and toddler mortality charges that are a lot increased than the nationwide common, and solely 36% of counties had a labor and supply unit in 2022.
Losing a labor and supply unit is a “huge loss” to the ladies within the space, she mentioned
Sen. Jon Ossoff, the lone Democrat operating for reelection this yr in a state Trump gained in 2024, has pointed to St. Mary’s choice on the marketing campaign trial.
“In Lavonia, St. Mary’s Hospital, they’ve announced they will no longer provide obstetric services to delivering mothers because of decisions made by politicians,” Ossoff mentioned in Atlanta final September.
In Georgia selling the “One Big Beautiful Bill Act” final August, Vice President JD Vance slammed Ossoff’s opposition to the laws, saying he was “allegedly worried about people getting kicked off their health care.”
“Well, you know what? The President of the United States made a promise, a sacred promise that the only people who are going to lose access to health care are illegal aliens who shouldn’t be in this country to begin with,” Vance mentioned.
The GOP bundle additionally contributed to MercyOne, which has 21 medical facilities and a number of clinics throughout city and rural Iowa, deciding to shut its clinic in Ottumwa and lay off dozens of staffers.
MercyOne is a part of Trinity Health, which mentioned in an announcement to NCS that “the recent and future government funding policy changes” are anticipated to cut back its annual income by $1.5 billion.
That is forcing it to make adjustments “to ensure long-term sustainability and future growth,” together with reducing positions in its billing and collections division by 10.5% throughout Trinity Health.
Retired Dr. Peter Reiter, who spent 4 a long time serving sufferers in Ottumwa, reacted to the closure of the MercyOne clinic there, saying that “this is not the way that’s best for patients and not the best for providers.”
“The number of people who were former patients or just acquaintances who said, I go to MercyOne. What am I supposed to do? Where do I go? How do I get a doctor? And I don’t have an answer,” he mentioned.
Julie Lawrence, an Ottumwa resident and a affected person impacted by the MercyOne closure, shared her frustration with the disruptions.
“You know, I’m in the elderly category,” she mentioned. “I’m 68, and I would just like to stay in my hometown. So, you know, if you don’t feel good, you don’t want to have to drive half an hour. I mean, I can, but I don’t really want to.”
Like St. Mary’s in Georgia, the MercyOne closures in Iowa are enjoying out in aggressive midterms contests, with affected places within the battleground third district.
GOP Rep. Zach Nunn is in search of reelection there after profitable in 2024 by slightly below 4 factors, and his main Democratic challenger, Sarah Trone Garriott, has centered her criticism on his vote for the “One, Big Beautiful Bill Act” and its adjustments to Medicaid.
“It’s a bad time for health care here in Iowa’s 3rd congressional district, and it’s Zach Nunn’s fault,” Trone Garriott said in a social media video. “First MercyOne announced they were closing their Ottumwa clinic because of federal Medicaid cuts. Now MercyOne Des Moines is announcing layoffs this March, because again, federal Medicaid cuts.”
This month, Nunn wrote on his House blog that he met with sufferers and suppliers at Ottumwa Regional Health Center “to hear directly from those on the front lines,” touting $209 million allotted to his state by the OBBBA’s $50 billion “Rural Health Transformation Fund.”
“The message was clear and consistent: workforce shortages are stretching staff thin, operating costs continue to climb, and rural hospitals can’t keep carrying the burden alone,” he mentioned.
And amid the backlash to his vote for the One Big Beautiful Bill Act, Nunn broke along with his social gathering final month on a vote to increase subsidies for the Affordable Care Act regardless of his vocal criticism of this system.
Ed Shanshala, CEO of Ammonoosuc Community Health Services in New Hampshire, needed to make the painful choice to close down its location in Franconia, which served almost 1,600 sufferers within the rural White Mountains, final fall.
Ammonoosuc, which has 4 remaining facilities that present main care, behavioral well being and different medical providers to 26 cities, is going through a $500,000 annual loss in income from the invoice, primarily as a result of fewer of its sufferers are anticipated to have Medicaid protection because of the new work necessities. As a federally certified well being middle, it should proceed to offer care, but it surely gained’t know the way a lot the sufferers will be capable of pay.
The closing of the Franconia website is just step one to coping with the consequences of the laws, Shanshala mentioned. The transfer offers about $250,000 in one-time financial savings since Ammonoosuc shifted the eight staffers to different places.
“It buys time for us to look at other revenue opportunities consistent with our mission, but it won’t come close to addressing the impact of the bill’s disinvestment in our friends, family and neighbors through Medicaid,” he mentioned.
After states started increasing Medicaid to extra low-income adults underneath the Affordable Care Act in 2014, the uninsured price fell, which led to a decline in hospitals’ uncompensated care prices in these states, mentioned Cindy Mann, a accomplice at Manatt Health and former Obama administration official.
“When the uninsured rate goes up, you’ll have more uncompensated care and you’ll see it pretty quickly,” she mentioned. “If you have a patient base which is mostly Medicaid, Medicare and the uninsured — which is really a lot of the safety net hospitals — there’s nowhere to go to, there’s no cushion, there’s no cost shift that can make that up.”
In Maine, Northern Light Health’s executives knew they needed to issue into their multi-year plan the elevated monetary pressures that the “big, beautiful bill” would carry. The well being system, which operates 9 hospitals, a medical group, nursing houses and a number of other dozen main care places within the state, is projecting a $27 million annual drop in income from the bundle, mentioned chief monetary officer James Rohrbaugh. That’s largely as a result of 34,000 Mainers are anticipated to lose Medicaid protection later this yr and subsequent.
The looming income decline led Northern Light Health to make some main strikes final yr, together with considerably reducing workers, enhancing its cost assortment and consolidating medical doctors’ workplaces. It additionally closed certainly one of its money-losing hospitals, although Rohrbaugh mentioned that call predated the laws.
Now, the well being system is in search of different methods to develop into extra fiscally sound – and it hopes to make use of among the $190 million that Maine is receiving from the Rural Transformation Health Program this yr to assist it accomplish that. Among its plans are to extend its use of telehealth to increase its means to look after rural residents and to rent extra monetary counselors to extra proactively assist sufferers with making use of for protection – together with navigating Medicaid’s new work necessities — or discovering different cost help, Rohrbaugh mentioned.
“I see that as a big opportunity,” he mentioned of this system. “The plan for the rural transformation funds is to help figure out how to make sure health care is sustainable in rural areas.”
Going ahead, extra hospitals and suppliers should cope with shrinking reimbursements and better uncompensated care prices because the provisions of the “big, beautiful bill” begin to take impact.
“They will have to determine whether they can continue offering all their current services or have to shutter some or shift them to other providers,” mentioned Lucas Swanepoel, vice chairman for public coverage on the Catholic Health Association, which represents Catholic hospitals, long-term care amenities and different suppliers.
“The coming year or two will be really telling,” he mentioned.
Jennifer Mendrzycki is the CEO of TMC Health, which primarily based out of Tucson oversees 4 hospitals situated all through southern Arizona, along with dozens of different smaller places protecting the state’s giant rural expanse.
“This is a time like we have not seen in health care before, where we’ve got competing pressures,” she mentioned, discussing the impacts of the sweeping laws. “We’ve always had competing pressures, but this is more acute than I have seen it in my career.”
Mendrzycki emphasised the problem of concurrently contending with Medicaid cuts and reductions in supplier taxes. “It’s totally untenable, and it’s – we’ve never, I don’t think, had a time like this, in at least the time that I have been in healthcare, where both of those things are coming. It’s like the perfect storm,” she mentioned.
It’s a difficulty for a sequence of high-stakes races throughout all these states that would assist determine management of Congress this fall.
In New Hampshire, the events are vying for the open seat left by retiring Sen. Jeanne Shaheen in a state that Democratic presidential nominee Kamala Harris carried by lower than 3 full factors in 2024. And in Maine, Republican Sen. Susan Collins is in search of a sixth time period in what’s anticipated to be some of the aggressive 2026 races, already drawing tens of thousands and thousands of {dollars} in advert spending reservations.
Both states have older, rural populations disproportionately uncovered to the adjustments to Medicaid and the strain on native suppliers. Holtz-Eakin mentioned Republicans, and Collins particularly, ought to level to the Rural Transformation Fund, although he acknowledged its limitations.
“The Rural Health Transformation Fund is there because of her,” he mentioned, touting her legislative efforts. “So certainly she’s going to talk about that.”
“There’s an enormous amount of discretion by (Centers for Medicare & Medicaid Services Administrator Mehmet Oz) in allocating – so there’s like $10 billion you have that goes out from the total of $50 billion. And about $5 billion of that is greatly at the discretion of the CMS administrator. One would hope that that might be showing up in Maine and she could point to it and say, this is what I did for you,” he mentioned.