Most Americans don’t think about where their nearest hospital is until they need it. Sometimes it’s a car accident. Other times it’s a child with a fever that won’t break at 2 a.m. In those moments, the hospital and its highly trained, competent staff are simply there.

The One Big Beautiful Bill Act, signed into law by President Trump on July 4, 2025, could change that assumption for millions of Americans. A March 2026 analysis by Public Citizen identified 446 hospitals at heightened risk of closure from the law’s Medicaid cuts. Together, the hospitals have 69,000 beds, serve 6.6 million patients annually and employ roughly 275,000 staff.

To be clear, Public Citizen’s list doesn’t predict which of these hospitals will close. What it offers is a map of where the financial pain from Trump’s law will land first.

Why Trump’s Law May Lead To Hospital Closures

When patients with Medicaid go to the hospital, their insurance pays less than 65 cents on the dollar relative to the actual cost of their care. Hospitals that serve low-income communities with a high percentage of Medicaid patients rely on those payments adding up so they can stay afloat.

If a Medicaid patient loses coverage and becomes uninsured, the reimbursement often drops to near zero. Despite that, hospitals are legally required under federal Emergency Medical Treatment and Active Labor Act laws to treat all patients regardless of ability to pay.

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So uninsured patients still get care. The hospital simply isn’t paid. Since many hospitals are already on thin or even negative profit margins, the impact of the Trump’s law could end up putting some hospitals out of business.

The Congressional Budget Office estimates the law will result in 10 million more uninsured Americans by 2034, with 7.5 million of those losses attributable to Medicaid and CHIP cuts. A Commonwealth Fund analysis found that if Medicaid expansion were discontinued, hospital revenues would decline by nearly $20 billion annually.

Public Citizen’s list includes safety-net hospitals with 20% or more revenue from Medicaid. Since many are already losing money, they have little to no capacity to absorb more losses.

Trump’s law cuts dollars to hospitals in five ways. First, work requirements and eligibility checks will disenroll millions of Medicaid beneficiaries. Beginning Jan. 1, 2027, adults in the Medicaid expansion population must document 80 hours per month of work, volunteering or educational activities or prove they qualify for an exemption.

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The administrative burden will cause mass disenrollment. In Arkansas’ 2018 work requirement pilot, 18,000 people lost coverage over several months, the vast majority not because they weren’t working but because they couldn’t navigate the reporting system.

Second, Disproportionate Share Hospital payments, which are federal supplemental payments designed to compensate hospitals for providing care to Medicaid and the uninsured, were cut when the law took effect. The ACA had already reduced DSH payments under the assumption that Medicaid expansion would reduce uncompensated care. This is a double hit that compounds the uncompensated care burden.

Third, State Directed Payments, which are extra dollars states require Medicaid managed care plans to make to hospitals, are now capped at Medicare rates under Trump’s law. These payments are critical for safety-net hospitals.

When Washington State’s SDPs weren’t renewed at the end of 2024, Valley Medical Center in Renton anticipated $80 million to $100 million in state-directed payments. The result were layoffs of more than 100 workers within weeks. RAND projects total SDP reductions will reach $169 billion over the decade, hitting Georgia, Mississippi, South Carolina, Tennessee and Texas the hardest.

Fourth, provider tax restrictions limit states’ ability to generate matching funds they use to supplement Medicaid payments to hospitals. Many states have levied taxes on hospitals and other health care providers. Then, those revenues are used to draw down federal matching dollars, effectively recycling money back into the Medicaid system at a multiplier.

Trump’s law bars new provider taxes and phases down existing ones in expansion states to roughly half their current rates by 2031. States began revising those taxes for some categories starting April 1, 2026. The KFF lists seven states facing immediate impact: California, Illinois, Massachusetts, Michigan, Ohio, New York and West Virginia.

Fifth, because Trump’s law increases the federal deficit, the CBO projects it will trigger roughly $500 billion in mandatory Medicare spending reductions between 2026 and 2034 under existing budget law. This will include a 4% cut in payments to hospitals unless Congress acts to circumvent them. While Congress has historically taken action to block Medicare cuts, there is no guarantee it will do so. For a hospital already running negative margins, a 4% cut in Medicare revenue on top of the Medicaid pressure could accelerate insolvency.

An Injection Of $50 Billion for Rural Health

Trump’s law’s primary mitigation measure for hospitals is the Rural Health Transformation Program, a $50 billion fund available over five years to help rural hospitals adjust. The first $10 billion tranche was distributed across states in 2026.

Experts across the political spectrum have described this as insufficient. Public Citizen calculates that $50 billion represents just 37% of the estimated loss in federal Medicaid funding to rural areas over 10 years. Rich Rasmussen, president of the Oklahoma Hospital Association, called it “a drop in the bucket.” Importantly, federal guidance for the fund emphasizes investment in new technology and activities, not backfilling revenue losses. It also caps provider payments at 15% of each state’s allocation. It is also partly competitive, meaning hospitals that most need relief must apply and compete for it.

What Leads To Actual Hospital Closure

Hospital closure is rarely an immediate shutdown. The more common trajectory: service elimination, then staffing reductions, then eventual closure or conversion. Obstetrics often emerges as the first service line to go.

Take St. Mary’s Sacred Heart Hospital in Lavonia, Georgia. In November 2025, it closed its maternity unit (Note that St. Mary’s is not on the Public Citizen list because it only has 15% Medicaid). A month later, Centra Southside Community Hospital in Farmville, Virginia, closed its labor and delivery unit and OB surgical services, noting it “like other rural health care providers, must adapt to significant financial and operational challenges, including recently enacted reductions in federal health care funding.” In January 2026, Greene County General Hospital in Linton, Indiana ended obstetric services.

A 2025 GAO study found that closures of urban hospitals outpaced new openings from 2019 to 2023. The Steward Health system collapse in 2024 eliminated six Massachusetts hospitals before Trump’s Law took effect. Alameda Health System in Oakland announced nearly 300 layoffs in December 2025 and projects losses exceeding $100 million annually by 2030.

For patients, the clinical effects of closure are well-documented. Studies of rural hospital closures find increased pre-hospital transport times, higher out-of-hospital cardiac arrest mortality and delayed diagnosis of serious illness. Counterintuitively, prices tend to rise at surviving nearby hospitals, which lose a competitor and face less pressure to keep costs down.

Here’s What Comes Next With Trump’s Law and Hospital Closures

Ultimately, what is coming may be a slow-motion contraction of the healthcare infrastructure that low-income communities, rural regions and underserved urban neighborhoods depend on.

How many hospitals close in the end depends heavily on how states implement work requirements: how broadly they define “medically frail,” how much automated data-matching they deploy and how accessible their reporting portals are. States that build administrative barriers will see more disenrollment, more uncompensated care and more hospitals pushed to the brink.

State-by-State: The Complete At-Risk Hospital List

Note: The table below uses exact figures from Public Citizen’s appendix (March 2026), which drew on CMS cost report data from 2022–2024 covering 4,241 hospitals. This is approximately 95% of U.S. acute care facilities.

A hospital is designated at-risk if (1) Medicaid, SCHIP and other low-income government programs constitute 20% or more of its payer mix, and (2) it posted negative net profit margins on average from 2022–2024.

CMS payment designations: CAH = Critical Access Hospital; SCH = Sole Community Hospital; RRC = Rural Referral Center; MDH = Medicare Dependent Hospital; PPS = Prospective Payment System (standard payment)

California — 83 of 269 hospitals (30.9%) at risk

PIH Health Good Samaritan Hospital (Los Angeles) — RRC, 308 beds, Rural

Coalinga Regional Medical Center (Coalinga) — CAH, 24 beds, Rural

Martin Luther King Community Hospital (Los Angeles) — PPS, 152 beds, Rural

Pioneers Memorial Hospital (Brawley) — PPS, 107 beds, Rural

Mad River Community Hospital (Arcata) — PPS, 49 beds, Rural

Hollywood Presbyterian Medical Cntr (Los Angeles) — RRC, 317 beds, Rural

Sierra View Medical Center (Porterville) — PPS, 128 beds, Rural

El Centro Regional Medical Center (El Centro) — PPS, 161 beds, Rural

Adventist Health Bakersfield (Bakersfield) — PPS, 254 beds, Rural

East Los Angeles Doctors Hospital (Los Angeles) — PPS, 102 beds, Rural

St. Agnes Medical Center (Fresno) — PPS, 384 beds, Rural

St. Joseph Hospital - Eureka (Eureka) — RRC, 131 beds, Rural

Delano Regional Medical Center (Delano) — PPS, 105 beds, Rural

Adventist Health Tulare (Tulare) — PPS, 73 beds, Rural

St. Bernardine Medical Center (San Bernardino) — RRC, 318 beds, Rural

Valley Presbyterian Hospital (Van Nuys) — PPS, 333 beds, Rural

Greater El Monte Community Hospital (South El Monte) — PPS, 104 beds, Rural

Dameron Hospital (Stockton) — PPS, 170 beds, Rural

Mark Twain Medical Center (San Andreas) — CAH, 25........

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