It’s been nearly a year since the federal Medicaid cuts took effect, and rural hospitals are feeling the strain.
Almost one-third of rural hospitals in the United States are considered financially vulnerable. Today, roughly 720 rural hospitals across the country are at risk of closure, including 294 that face an immediate threat.
The source of many of these challenges is H.R. 1, also known as the “One Big Beautiful Bill Act,” which was signed into law on July 4, 2025. The law reduced federal Medicaid spending, added new eligibility and reporting requirements, and increased administrative barriers for recipients. Federal Medicaid spending is projected to decline by $911 billion over the next decade, while more than 10 million people could lose health insurance by 2034. Medicaid serves approximately 80 million low-income Americans and accounts for about one-fifth of personal health care spending nationwide.
The effects are already visible across the country. In February 2026, a health clinic in Ottumwa, Iowa, closed after receiving a month’s notice. The clinic had served the community for generations. A health care company in Des Moines also closed several clinics and laid off 67 employees due to expected revenue losses linked to Medicaid cuts.
For rural communities, hospitals are often much more than health care facilities. They provide emergency services, jobs, and critical infrastructure. Without a nearby hospital, patients experiencing heart attacks, stroke, pregnancy complications, or serious injuries may need to travel much significantly farther for treatment. In emergencies, those delays can be life-threatening.
The closure of the labor and delivery unit at Winner Regional Health in South Dakota illustrates the challenge. Pregnant women like Sophie Hofeldt now travel more than three hours round-trip for prenatal appointments and must deliver at a hospital 90 miles away. In other rural areas, patients travel as far as 170 miles to access maternity care.
A Public News Service report on the closure of MercyOne’s clinic in Ottumwa found widespread concern about access to care. One retired teacher, Mary Stewart, summarized the situation bluntly: “There simply aren’t doctors here anymore.” Elderly residents and those with limited transportation face particularly difficult barriers to receiving routing and emergency care.
As hospitals lose funding and face closure, women are often among the first to experience the effects. Medicaid is the largest provider of maternity care in the United States, covering about 40% of births nationwide and nearly half of births in rural areas. The program funds prenatal care, labor and delivery services, postpartum care, and maternal mental health support.
Reducing Medicaid funding threatens access to these essential services and can worsen maternal health outcomes. Research has shown that Medicaid expansion improved women’s health, reduced maternal mortality and helped narrow racial disparities in care. Yet current federal policy moves in the opposite direction by reducing resources for health systems that millions of Americans rely on.
Long after the political debates fade from the headlines, communities will continue to live with the consequences. Women travel farther for reproductive care; families postpone medical appointments; refugees struggle to find stable healthcare; rural hospitals struggle to keep their doors open.
As Medicaid funding shrinks, Americans are left wondering what kind of future lies ahead in a country where healthcare is viewed as a privilege for some rather than a promise for all.