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Nearly a year has passed since President Trump signed the One Big Beautiful Bill Act, also known as the Big Ugly Bill, into law; a recent report identifies hundreds of hospitals at heightened risk of closure and reduced services due to cuts imposed by the measure. Many of them are hospitals where AFT members show up every day to care for their patients.
The report by Public Citizen, a nonprofit consumer advocacy organization, identifies and analyzes the hospitals most at risk of closing, reducing services, or laying off workers.
Experts warned that the bill would strip affordable healthcare from millions of Americans and put hundreds of rural hospitals at risk of closure. Although Good Shepherd Medical Center in Hermiston, Ore., isn't on Public Citizen's list, the advocacy group Protect Our Care has identified it as one of the top 10 percent of rural hospitals nationwide by Medicaid payer mix—meaning that a disproportionate share of its patients rely on Medicaid, leaving it especially vulnerable to the law's cuts.
Jeff Rost, a registered nurse and Oregon Nurses Association executive committee member at Good Shepherd, says the hospital is preparing for what's ahead. “Our hospital is growing. We're adding more outpatient services to better serve our community and likely prepare for the cuts that are coming,” Rost says. “Our community relies on us for care. If we can safely treat a patient here, we do. We get pushback from patients if we transfer them because they want to stay local,” he adds. “Sometimes, we’ll even transfer patients out for specialty procedures and bring them back here to recover. It’s better for families. They don’t have to worry about driving three to four hours to Portland or Boise to pick up a recovering family member and driving three to four hours back.”
Key findings of the report include:
- 446 hospitals are at heightened risk of closing or reducing services due to Medicaid cuts. Check out the full list of at-risk hospitals.
- These hospitals collectively have approximately 69,000 beds and served approximately 6.6 million patients in 2024. They employ approximately 275,000 direct patient care workers.
- The communities served by these hospitals have a larger share of Black and Hispanic residents, as well as people living below the poverty line, compared with other hospitals. Nearly 20 percent of the at-risk hospitals (85) serve high-poverty areas.
- 267 (60 percent) of the at-risk hospitals serve urban areas, and 176 (39 percent) are rural hospitals.
According to the report, five states now have more than a quarter of all their hospitals at risk: California, Connecticut, Massachusetts, New York and Washington. Almost half of the at-risk hospitals hold special Medicare payment designations typically associated with rural or financially vulnerable facilities that play a critical role in their communities—critical access hospitals (19 percent), rural referral centers (16 percent), sole community hospitals (9 percent) and Medicare dependent hospitals (4 percent). More recently, hospitals have initiated layoffs and reduced services, including obstetrics and maternal care, citing financial strain from Medicaid cuts.
What comes next
For Rost, the fallout is already visible. “With federal and state jobs decreasing, fewer people get health insurance from their employer, and more people have to make their own way. A lot of people in our community are self-employed farmers or small business owners. They have to buy their own insurance. They're worried they can't afford it anymore,” he says. “The other day, several patients in our ICU were uninsured. That's not good. We give them tremendous care in the hospital, but once they leave they don't have the same options for long-term care or home health that someone with private insurance might,” he says. “We spend a lot of time working with our case managers to figure out creative ways to set those patients up for success after they leave, because we don't want them back again for the same problem—but there's a limit to what we can do.”
Public Citizen's report calls on Congress to act—first, by restoring all Medicaid funding cuts enacted by the Big Ugly Bill and extending the enhanced premium tax credits under the Affordable Care Act. For AFT members working in at-risk hospitals, the stakes are high. “These cuts are going to hit Oregonians hard,” Rost says. “The cost of digging out of this hole will be much more expensive than what it would cost us to maintain the care we have and keep improving it.”
[Adrienne Coles]