ISTANBUL

Over 400 hospitals in the US are at risk of closure or service cuts due to Medicaid reductions in President Donald Trump’s “big, beautiful bill,” according to watchdog group Public Citizen.

“We’re seeing hospitals that are already under severe financial strain having to make decisions about how to stay financially solvent,” Eileen O’Grady, a researcher in Public Citizen’s Congress Watch division, told NBC News, adding: “That has pretty clear implications for people who live in that community. It also has ripple effects on other hospitals in those communities.”

The analysis used 2022-2024 financial data from the Centers for Medicare and Medicaid Services covering about 95% of US hospitals and defined at-risk hospitals as those heavily dependent on Medicaid revenue and operating at a loss in recent years.

It further identified 446 at-risk hospitals, with at least one facility affected in 44 states and Washington, DC.

Medicaid cuts, including 2027 work requirements and 2028 funding limits, could reduce federal spending by $1 trillion over 10 years, according to the NBC report on Tuesday.

About 60% of at-risk hospitals, or 267 facilities, are in urban areas, with Black and Latino communities likely to be hardest hit by Medicaid cuts.

According to Zachary Levinson, the project director of the KFF Project on Hospital Costs, the cuts could worsen the crisis, with projected Medicaid losses far exceeding the $50 billion allocated for rural support, while some health system leaders describe the measure as an "existential threat."

Alameda Health System said it will lay off nearly 300 employees and lose more than $100 million annually by 2030, while Trinity Health, a Michigan-based hospital system with branches in other states, projects $1.5 billion in losses, prompting staff cuts and service reductions at some facilities.