In the year since President Trump stole $1 trillion out of the American health care system to free up funding for mass deportation, tax breaks for his billionaire friends, and, it turns out, illegal wars of aggression, much of the resulting conversation has focused on how the funding cuts would impact rural hospitals and patients. The idea was that most of the harm would hit there, since rural medical providers were already on the brink of collapse across the country.
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But from National Nurses United challenges that assumption. Researchers identified 602 financially vulnerable hospitals across 47 states, which together operated with an aggregated deficit of about $10.2 billion. They found that when the full impact of Trump’s One Big Beautiful Bill Act finally hits, the group’s deficit will increase to between $15.4 billion and $17.9 billion. Of this group, 366 are in metropolitan areas, nearly 61 percent, while the rest are in rural or semirural areas.
The finding is important because it illustrates the nationwide damage Trump’s funding cuts are causing, said National Nurses United Director of Research Dan Johnston. The financially vulnerable hospitals in cities tend to be ones that serve communities of poor and working-class people, whether they be Black, brown, or white, no matter where they live.
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“It’s not just a rural problem,” Johnston said. “This is going on all over.” His research found that California has 67 financially vulnerable hospitals, the most in the country, followed by New York, with 40, and Texas, with 35.
Trump’s Republican Party also refused to extend Biden-era Affordable Care Act enhanced premium tax credits, which caused enrollment for ACA insurance to drop by about 4.2 million people as of February 2026. Insurers that participate in the program jacked prices so high that enrollees faced an average 114 percent increase just to stay with the same plan as the year before; they have proposed a double-digit increase for next year, too, with a median increase of 14 percent for 2027.
That means that hospitals are caring for a less-insured population at the same time that the federal government is reducing their funding. By 2034, the expected cost for providing uncompensated care will hit $466 billion, America’s Essential Hospitals estimated last month.
Hospitals, doctors, and other providers are staring down $32.1 billion in lost revenue because of the tax credit expiry, the Robert Wood Johnson Foundation said.
And that means that hospitals are sending patients massive bills just when they can’t afford them and even suing them for payments, Johnston and others said. In one recent example of the punitive lengths hospitals will go to, Kansas health care system Stormont Vail Health garnished patients’ wages to recoup fees, despite the fact that they qualified for free care.
Hospitals are also setting up more barriers for people to get care in the first place, Johnston said. After all, as an FTI Consulting survey found earlier this year, hospital executives no longer list quality of care as the “top clinical concern,” as they once did. Now, their top concerns are workforce shortages and burnout.
“You gotta be really sick to get into a hospital these days,” Johnston said. “They hold off people as long as they can.”
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HOSPITALS PLAN THEIR BUDGETS YEARS IN ADVANCE, so when Trump signed the funding cuts into law on July 4, 2025, hospitals all over began making cuts in anticipation of the shortfall. A new requirement to force Medicaid recipients who aren’t disabled to report 80 hours of work a month hits in 2027. Cuts to state funding to cover Medicaid costs start in 2028. But as the Prospect has been reporting since the beginning, hospitals are already reducing what they offer and patients are suffering as a result.
Five hundred and twenty-two hospitals have now closed certain units or shut down entirely. Another 585 hospitals are at risk of doing so. Those figures, from advocacy group Protect Our Care, are just one aspect of the damage the funding cuts have caused across the country, advocates said.
The services hospitals typically cut first are pediatric, maternity, and psychiatric units as well as home health care, all of which typically do not make hospitals as much money as other divisions, Protect our Care’s Director of Policy Programs Vaishu Jawahar told the Prospect. With more cuts on the way, however, more hospitals are converting to emergency-only service centers.
“Two big things we’re seeing is that a lot of hospitals, especially rural hospitals, are being forced to convert to emergency-only service centers, basically going from full hospitals with inpatients and beds and cancer centers to just being stand-alone emergency rooms,” she said.
The second trend? “We’re seeing this desperate financial situation being a huge boon to private equity companies to come in and take over,” she said. Private equity executives then typically gut the hospital further and increase prices across the board.
Researchers and advocates told the Prospect that the harm Trump has done to the American medical system will take years to repair. It takes a long time to reopen a closed hospital, and if they’re closed long enough, they have to go through the whole lengthy regulation process over again. But given that the Republicans designed the bill in the hopes of evading responsibility, there is still time to undo some of the damage, Johnston said. The first cuts to Medicaid don’t begin until January, so there is time to roll them back, along with the other cuts that haven’t yet come to pass.
“There’s a way around these cuts before we get to the worst,” he said. “We can take care of it now when it’s doable, or we can wait until it’s much worse.”
Johnston noted that the erosion of U.S. health care was already under way when Trump decided to make it much worse. Hospital closures and service cuts were already long-term trends, he said. Reducing services for vulnerable populations has been a 15-year project. He said the fix can’t just be to return to a pre-Trump era, because that would not address the underlying problems preventing people from getting the care they need.
“If we just go back to the way it was, that’s not going to be good enough,” he said. “Obviously, the best thing to do would be to have single-payer.”
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