Warning as more than 300 US hospitals at risk of closure

More than 300 hospitals across the US are at risk of closure under deep healthcare cuts in President Trump's Big Beautiful Bill. Some 338 facilities in rural areas could be forced to close, convert, or slash services, according to the Cecil G. Sheps Center for Health Services Research. Democratic senators highlighted the findings in a letter to the President last month, urging him to reconsider the legislation.

Congress, however, passed the bill earlier this month despite Republican rebels fighting back against its steep cuts to Medicaid among other issues. The act slashes over $1 trillion in healthcare spending over the next 10 years, mostly from Medicaid, which provides health coverage for millions of low-income Americans.

'A majority of adults living in rural areas are concerned that these health care cuts will "negatively impact hospitals, nursing homes, and other health care providers in [their] community,"' the senators' letter read. 'They are right to be worried, as these cuts will have devastating consequences for health outcomes and costs, jobs, and the economic success of rural communities.' The data found that 46 states had at least one rural hospital at risk, with Kentucky and Louisiana seeing the highest numbers, at 35 and 33, respectively. A rural hospital is labeled 'at risk' when it meets one or both of two criteria.

It needs to either be in the top 10 percent Medicaid payer mix of rural hospitals across the country, or have experienced three consecutive years of negative total margin. 'In Louisiana, 32 rural hospitals — or a majority of rural hospitals in the state — are serving a high concentration of Medicaid patients,' the letter, signed by U.S. Democratic Senators Edward J. Markey, Ron Wyden, Jeffrey A. Merkley, and Charles E. Schumer. 'In Alaska and Kentucky, 44 percent of the rural hospitals with available Medicaid payer mix data serve high concentrations of Medicaid patients.

'In West Virginia, nearly a quarter of rural hospitals are serving high concentrations of Medicaid patients, and 15 percent of rural hospitals are at the highest relative risk of financial distress, per the financial distress index.' The letter pointed out that rural hospitals are already struggling. In 2023, there were 50 fewer rural hospitals than in 2017 — and a lack of healthcare access in rural America is contributing to worse health outcomes for residents.

'Enacting these drastic health care cuts that will kick millions of people off their health insurance coverage, rural hospitals will not get paid for the services they are required by law to provide to patients,' the authors wrote. Alongside Medicaid cuts, the bill will also cut from Affordable Care Act insurance plans and eliminate insurance coverage for 11.8 million people over the next decade, according to the nonpartisan Congressional Budget Office. In response to bipartisan criticism of the impact of the bill on rural hospitals, the Senate added $50 billion in funding for a new rural health fund.

But critics say this will not be enough, as it is about a third of the estimated loss of federal Medicaid funding in rural areas. In response to the claim that the bill will close rural hospitals, the White House said: 'Rural hospitals comprise just 7 percent of all hospital spending on Medicaid, illustrating that they have not benefited from the massive increase in waste, fraud, and abuse under the Biden administration. 'By strengthening Medicaid, we are making more resources available for vulnerable populations and safety net providers, like rural hospitals. We are expanding rural hospital protection, providing targeted funds for rural care, and giving states flexibility to support local providers.'

Following the signing of the bill into law, Senator Markey said rural hospitals are now sorting through 'difficult questions.' 'Will they have to lay off staff? Will they need to stop providing labor and delivery care or mental health care? Will they need to close their doors entirely? 'One hospital in Nebraska already announced it would close because of these cuts. That's a preview of coming atrocities,' he said.

People would have to travel further for chemotherapy sessions and will miss their annual appointments, he added, saying that the consequences could be 'deadly' for communities. It comes as various private hospital chains have filed for bankruptcy in the last several years, with vital local services closing as a result.

Steward Health Care, a major hospital system backed by private equity, filed for bankruptcy in May 2024 . The chain is now suing its 'greedy' former CEO Ralph de la Torre, claiming he plundered the company of hundreds of millions of dollars that directly led to its collapse. Prospect Medical Holdings also devastated communities by closing several hospitals after filing for bankruptcy earlier this year.