Overview:
Healthcare advocates warned that deep Medicaid cuts would leave millions uninsured and destabilize hospitals serving low-income communities. A year later, those predictions are becoming reality. New data show healthcare facilities are closing nationwide, with Black Americans facing heightened risks because of their disproportionate reliance on Medicaid and longstanding barriers to care.
When a hospital closes, it doesn’t just take away healthcare. It takes away time — the minutes between a heart attack and treatment, the miles between a pregnant woman and a delivery room, the difference between life and death.
That reality is becoming increasingly common in Black communities across America. One year after President Donald Trump and congressional Republicans enacted more than $1 trillion in cuts to Medicaid and the Affordable Care Act, more than 1,000 hospitals, clinics, nursing homes, maternity wards, and healthcare providers have closed, reduced services, or face imminent risk of doing so, according to a new report from Protect Our Care.
The report traces the fallout from congressional Republicans’ decision to make the largest cuts ever seen to the healthcare safety net that almost 80 million people enrolled in Medicaid/CHIP and 25 million ACA enrollees rely on.
Before President Donald Trump signed the legislation, Congress’ own experts had predicted the damage would be widespread, with millions of Americans losing health coverage; experts warn the worst is still to come, with Black communities disproportionately harmed.
“The only reason they [cut healthcare funding] was to pass along tax cuts for their billionaire and corporate friends,” Sen. Chris Murphy, Democrat of Connecticut, said during a press conference introducing the Protect Our Care report. “And the first impact of that is that people lose coverage,”
The Protect Our Care report, which includes an interactive website, tells a disturbing story.
Ninety-two percent of hospital executives expect Medicaid cuts to significantly affect their financial operations, according to the report. At least 14 hospitals have closed across 13 states and more than 400 hospitals are at risk of closing or cutting staff. Over 360 clinics have closed and more than 30 nursing homes have shut their doors.
Facilities close “when fewer people have insurance, and when [payments] are lowered,” Murphy said. Community hospitals, nursing homes and maternity wards, he said, “are closing at an alarming rate, and that’s the consequence of the decision that Republicans made.”
When the bill was up for debate last year, it was estimated that 15 million Americans — including seniors, children, and people with disabilities — could lose healthcare coverage. Just a year later nearly four million individuals have already lost it.
A Crisis for Black Americans
The vulnerable care facilities tend to disproportionately serve Black and low-income residents than other hospitals. Nearly 20% of the at-risk hospitals identified in a report from Public Citizen serve high-poverty areas and 60% of them serve urban areas. Another 176 (39%) are rural hospitals.
Black Americans already face higher uninsured rates, with around 9% lacking coverage compared to roughly 5% of whites, according to the research firm KFF. They also make up about 21% of Medicaid and CHIP enrollment and are far more likely than their white counterparts to rely on government-subsidized healthcare.
In April, civil rights and health equity advocates declared a “Health Equity Emergency” warning that the law is actively stripping health coverage from low-income Black communities at an alarming rate.
Dr. Oni Blackstock, a prominent health equity physician, noted that the new policies increase the amount of red tape, such as work and reapplication requirements, making the system difficult to navigate.
The Economic Policy Institute, a Washington, D.C., think tank, estimated that the end of ACA tax credits alone would cause more than 170,000 Black adults in just 10 major metropolitan areas to lose health insurance, with the largest losses concentrated in Atlanta, Houston, Dallas, and Miami.
The organization predicts ending the credits could lead to more than 200 preventable Black deaths each year.
Meanwhile, the closure of maternity wards comes at a time when the Black community is already grappling with a maternal health crisis.
Multiple studies have shown Black mothers die from pregnancy-related complications at three times the rate of white mothers — and Medicaid is the largest single payer of maternal health care in the country. The GOP’s bill has already shuttered nearly 40 maternity wards and put more than 140 additional units at risk.
In Lavonia, Georgia, a maternity ward closed in October, forcing expectant mothers to travel as long as 90 minutes to reach the nearest labor and delivery unit. In Fort Smith, Arkansas, Zoe Thompson, 20 weeks pregnant, was forced to find a new provider midway through her pregnancy after Baptist Health shut down its labor and delivery unit.
“Having a baby is scary,” she said. “I’m kind of freaking out, to be honest.”
Timing Is Everything
When emergency departments shut down, ambulance times increase. Studies find that, after a rural hospital closes, transport times climb 11 to 16 minutes after a rural hospital closure, adding precious minutes in emergency situations, such as a stroke or heart attack.
“When we talk about time and emergency medicine, time is everything,” Dr. Chris Ford, an emergency medicine physician in Milwaukee, said at the press conference. “When a hospital closes, these emergencies don’t stop; the heart attacks don’t stop; the strokes don’t stop. The patients are still there, but they have to travel farther, and they have fewer places to go.”
If the cuts aren’t reversed, Ford said, patients and their families will have to deal with ”delayed care, preventable suffering, and lives lost.”
Devastation Stretches Nationwide
Mental health and substance use treatment has been especially hard hit, according to the Protect Our Care report.
Medicaid covers nearly a third of adults living with a serious mental illness and half of all adults with opioid use disorder, and the GOP bill gutted the program’s ability to fund those services. More than 70 mental health clinics, behavioral health facilities, and inpatient psychiatric units have shuttered since the bill’s passage.
Researchers estimate that 156,000 Americans will be cut off from opioid use disorder treatment, and that overdose rates among them could double, leading to an estimated 1,000 additional fatal overdoses per year.
RELATED: Black OD Death Rates Are High. They Just Might Get Worse
Only the Beginning
The bill’s lesser-known provisions aren’t scheduled to take effect until 2027 and 2028. The law also eliminated financial incentives for the 10 states that have yet to fully expand Medicaid, including Texas, Florida, Georgia, Mississippi, and Alabama, leaving 69 hospitals in those states at grave risk and now further than ever from financial relief.
The 1,000-facility mark, Protect Our Care and others warn, is just a preview of the next onslaught as congress considers the 2027 budget.
