The vacant Martin County General Hospital sits abandoned behind a chain since being closed in August of 2023 in Williamston, North Carolina.Karl B DeBlaker/AP

The GOP’s “Big Beautiful Bill,” which cleared the Senate Tuesday afternoon and is returning to the House, is generally terrible for families. But women and babies who live in areas that voted overwhelmingly for Donald Trump are likely to suffer some of its most sweeping and damaging effects.

The historically brutal Medicaid cuts—a staggering $930 billion slashed from the program over the next decade—could force as many as 144 rural hospitals around the US to close their labor-and-delivery units or drastically scale back services, a new analysis by the National Partnership for Women & Families projects. That could have potentially catastrophic consequences for maternal and infant health.

“When somebody is in labor or having a pregnancy-related emergency, every second counts,” says Rolonda Donelson, lead author of the analysis. “And with these hospital closures, people are going to have to travel further and further to get the help that they need.”

Medicaid is one of the most important safety nets for low-income women during pregnancy and the postpartum period, paying for 41 percent of births in the US—about 1.5 million babies a year. The program plays a particularly vital role in rural areas, covering the costs of 47 percent of births in those communities in 2023. Even with Medicaid support, the maternal mortality rate among rural women is

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