Editor's note: This story has been updated with additional analyses quantifying the current funding bill's financial impacts on hospitals.

Hundreds of rural hospitals teetering on the edge of financial collapse could be pushed over the edge by healthcare funding cuts and other changes to coverage eligibility included the reconciliation package passed last month in the House of Representatives, according to a trio of recent analyses.

On Thursday, Senate Democrats cited data from the Cecil G. Sheps Center for Health Services Research at the University of North Carolina outlining at least 338 rural hospitals in red and blue states alike considered to be “at risk,” which the senators defined as having either three straight years of negative total margins or being in the top 10% of Medicaid payer mix.

Eighty-three rural hospitals were deemed by the Sheps Center’s researchers to be at the “highest relative risk of financial distress” based on a predictive model developed by the researchers combining financial performance and multiple hospital characteristics.

Other analyses released in subsequent days outlined the hit hospitals could expect with the bill's current language: a $50.4 billion reduction in federal Medicaid spending on rural hospitals over the next decade, per the American Hospital Association and Manatt Health Strategies, and a $63 billion increase in uncompensated care costs for hospitals nationwide, according to the Urban Institute and the Robert Wood Johnson Foundation. 

“It isn't just 16 million people who will lose care,” Sen. Ed. Markey, D-Mass., ranking member of the Subcommittee on Primary Health and Retirement Security, said Thursday. “The ripple effect of these healthcare cuts will drown hospitals, community health centers and nursing homes across the country. For those living in rural areas, these cuts will have devastating consequences for health outcomes and costs—and it costs jobs and economic success in rural communities.”

The Democratic senators had requested the numbers last week and shared them during a Thursday morning press conference and in a letter (PDF) to Republican leaders including President Donald Trump.

In a letter responding to specific questions from the lawmakers that accompanied the data, Sheps Center researchers affirmed that hospitals with a larger share of revenue stemming from Medicaid tend to be less profitable and at greater financial risk.

“Medicaid cuts are likely to have a proportionate impact—meaning that hospitals most reliant on Medicaid are both more financially fragile and more vulnerable to revenue reductions,” the researchers wrote. “Substantial cuts to Medicaid or Medicare payments could increase the number of unprofitable rural hospitals and elevate their risk of financial distress. In response, hospitals may be forced to reduce service lines, convert to a different type of healthcare facility, or close altogether.”

Markey and Senate Minority Leader Chuck Schumer, D-N.Y., noted during the press conference that the country lost 50 rural hospitals between 2017 and 2023. Prior research has also outlined service line reductions among the rural hospitals that have remained open.

The pair of senators said the bill’s fallout that would affect constituents across the country and made the point by listing the number of at-risk hospitals within each state. Their letter to Republican colleagues highlighted Louisiana, where more than half of rural hospitals (33) serve a high concentration that met their criteria, as well as Kentucky (35), Alaska (5), West Virginia (7), Alabama (5) and Tennessee (9).

Though their warnings of rural hospital closures spanned the political divide, the Democrats drew a clear line in the sand on support for the bill and its projected healthcare funding cuts, for which they blamed Republican leaders’ “mania to give tax breaks to the rich.”

“We say to our Republican colleagues: when these hospitals close next year … don’t come to us, don’t try to shrug your shoulders and say ‘I don’t know why this happened,’” Schumer said. “It happened, but you voted for this plan.”

The version of the so-called "big beautiful bill" passed last month in the House is currently undergoing review in the Senate and will likely face edits during deliberations. Republicans, partially at the urging of the president, have said they don’t want to cut Medicaid funding but rather weed out “fraud, waste and abuse” within the safety-net healthcare program. A short-lived bid to extend that effort into Medicare this past week was quickly snuffed out amid pushback.

As it stands, the version of the bill that’s on the table is projected to leave 10.9 million people without health insurance in 2034 due to provisions such as Medicaid work requirements, according to the Congressional Budget Office. Other sections would limit or freeze states’ ability to draw federal funds for supplementary hospital payments via provider taxes, which conservative groups and more recently the Centers for Medicare & Medicaid Services have described as states “gaming the system.”

Democrats’ warnings fall in line with those coming from healthcare provider organizations. 

A data brief released last week by America’s Essential Hospitals estimated hospitals would be on the hook for $42.4 billion of additional uncompensated care costs—$21.7 billion from Medicaid payment shortfalls and $20.6 billion from caring for the uninsured.

Urban Institute, on Friday, outlined a $797 billion decline in national healthcare spending over the next decade, with $321 billion of that related to hospitals. Uncompensated care would increase by $204 billion during the same period, $63 billion of which would be faced by hospitals and $24 billion by physicians.)

The American Hospital Association, in its recently released report, estimated 1.8 million individuals in rural communities losing coverage under Medicaid by 2034, with Kentucky (142,300 people),  California (134,900 people), and Ohio (86,000 people) most heavily affected. 

During a June 11 press event held by the Infectious Diseases Society of America, specialists who are fellows with the organization spoke against the bill’s “catastrophic” cuts to Medicaid. Invoking Atlas, the mythological titan who holds the world on his shoulders, they said the Medicaid program provides insurance coverage for roughly half of all children and sustains healthcare nationwide, including for those on private insurance or living in rural areas.

“Medicaid really is essential for, I would say, everywhere in America—but for rural America, it is probably even more important,” Kathleen McManus, M.D., an infectious disease physician with UVA Health, said.