Republican budget cuts place 446 hospitals at high risk of closure, report warns

A sweeping Republican reconciliation package passed last year threatens to shutter or force service reductions at more than 400 hospitals across the United States due to deep cuts in Medicaid funding, according to new research.

The report, prepared by the consumer advocacy group Public Citizen, identified 446 hospitals at “high risk” of scaling back operations or closing their doors entirely. The figure includes 267 urban and 176 rural facilities.

According to the study, these institutions provided care to approximately 6.6 million patients in 2024 and employed 275,000 individuals in direct patient-care roles.

“The cuts will be devastating for many low-income and disabled individuals who rely on Medicaid,” said Eileen O’Grady, a researcher at Public Citizen, in the report.

O’Grady added that the fallout would create a “ripple effect” on the hospitals that disproportionately serve these communities. She noted that the measures would deepen the financial strain already gripping rural and safety-net hospitals, jeopardizing their capacity to provide care and potentially leading to a wave of closures.

The progressive nonprofit analyzed hospital financing data from 2022 through 2024 to identify the institutions likely to suffer the most severe financial impact from the legislation.

Law narrows health insurance coverage

President Trump signed the controversial and far-reaching “One Big Beautiful Bill Act” into law on July 4, 2025. The legislative package, which faced unanimous opposition from Democrats, introduced new work requirements for Medicaid eligibility and allowed premium tax credits to expire.

Following the bill’s passage last June, the nonpartisan Congressional Budget Office (CBO) projected that the law’s provisions would increase the number of uninsured individuals by 16 million by 2034.

In response to concerns raised by moderate Republicans during negotiations, Senate Republican leaders doubled the allocation for a rural hospital relief fund, increasing it from $25 billion to $50 billion.

Democrats criticized the move, arguing that it “disproportionately favors red states.”

The Public Citizen report found that the majority of at-risk hospitals are concentrated in blue states. California, the most populous US state, leads the nation with 83 hospitals identified as high-risk.

New York followed with 45 at-risk facilities, while Illinois and Washington reported 22 and 28 hospitals at risk, respectively.