A new analysis from Public Citizen warns that Medicaid cuts in the Trump administration’s bill could put more than 400 U.S. hospitals at high risk of closure or service reductions, threatening access to care and jobs.

Urban hospitals—about 267 facilities, roughly 60% of at‑risk hospitals—are disproportionately affected, and Black and Latino communities are expected to bear the heaviest impact.

Several major systems have already reported adverse financial effects, including Alameda Health System with layoffs and losses, Trinity Health facing an estimated $1.5 billion impact and staff reductions, and reductions in maternity and mental health services across various facilities.

Rural hospitals are a particular concern, as Medicaid spending reductions could exceed the roughly $50 billion rural support in the plan, potentially totaling about $137 billion over ten years.

Experts warn that even without full closures, hospitals may scale back essential services, worsening access to care and straining remaining facilities.

At‑risk hospitals are defined as those with Medicaid and other low‑income government program revenue making up at least 20% and operating at a loss in recent years, covering about 95% of U.S. hospitals based on 2022–2024 CMS data, with 446 hospitals identified across 44 states and D.C.

The analysis relies on CMS financial data from 2022–2024 and does not predict exact closure dates, noting closure as a worst‑case scenario but emphasizing significant reductions in services as the likely outcome.

The largest concentrations of at‑risk hospitals are in California, New York, Illinois, and Washington, with sizeable counts in congressional districts represented by Republicans.

Potential closures or reduced services could force patients to travel farther, wait longer, and face overcrowded alternative facilities, increasing risk to time‑sensitive and life‑saving care.

Medicaid accounts for about a fifth of hospital spending, and the cuts are phased with more drastic changes in 2027 and 2028, collectively reducing federal Medicaid funding by roughly $1 trillion over ten years.