The vacant Martin County General Hospital sits abandoned behind a chain since being closed in August of 2023 in Williamston, North Carolina.Karl B DeBlaker/AP
The GOP’s “Big Beautiful Bill,” which cleared the Senate Tuesday afternoon and is returning to the House, is generally terrible for families. But women and babies who live in areas that voted overwhelmingly for Donald Trump are likely to suffer some of its most sweeping and damaging effects.
The historically brutal Medicaid cuts—a staggering $930 billion slashed from the program over the next decade—could force as many as 144 rural hospitals around the US to close their labor-and-delivery units or drastically scale back services, a new analysis by the National Partnership for Women & Families projects. That could have potentially catastrophic consequences for maternal and infant health.
“When somebody is in labor or having a pregnancy-related emergency, every second counts,” says Rolonda Donelson, lead author of the analysis. “And with these hospital closures, people are going to have to travel further and further to get the help that they need.”
Medicaid is one of the most important safety nets for low-income women during pregnancy and the postpartum period, paying for 41 percent of births in the US—about 1.5 million babies a year. The program plays a particularly vital role in rural areas, covering the costs of 47 percent of births in those communities in 2023. Even with Medicaid support, the maternal mortality rate among rural women is almost twice as high as in urban areas; unsurprisingly, infant mortality is significantly higher as well.
Medicaid is likewise a critical safety net for the country’s 1,800 rural hospitals, helping defray the cost of caring for some 16 million rural residents who would otherwise be uninsured. Without Medicaid payments, many rural hospitals—which tend to be smaller and less profitable than their urban counterparts—would be at serious risk of going under. As it is, almost 150 rural hospitals stopped inpatient services or shut down completely from 2005 to 2023, the federal government says. The GOP megabill puts another 338 rural hospitals at risk, University of North Carolina researchers warned in a letter in June.
As rural hospitals have struggled to stay open, labor-and-delivery departments have been among the services at greatest risk of being slashed. That’s because reimbursements by both private insurance and Medicaid are often too low to cover the costs of obstetric services, and rural hospitals don’t make enough money from other types of services to offset those losses. Since 2020, more than 100 rural hospitals have shuttered their maternity units or announced plans to close, according to the Center for Healthcare Quality & Payment Reform, a national think tank; only 42 percent of rural hospitals still offer labor-and-delivery services, while in 11 states, fewer than one-third do.
Thus, vast parts of rural America are already maternity care deserts, forcing pregnant patients to travel further for prenatal care, deterring them from seeking immediate medical treatment when they suffer complications that might be life-threatening, and making them less likely to receive follow-up care after giving birth.
“When somebody is in labor or having a pregnancy-related emergency, every second counts, and with these hospital closures, people are going to have to travel further and further to get the help that they need.”
The GOP cuts and changes to Medicaid and the Affordable Care Act will make that situation much worse, leading to 17 million people becoming uninsured, Donelson estimates. “This will disproportionately impact women because they are more likely to have Medicaid health insurance,” she adds.
More than 60 percent of the rural labor-and-delivery units at risk are in red and purple states that went for Trump in 2024. Trump won rural voters by 40 points last November, a Pew analysis found.
As my Mother Jones colleague, Michael Mechanic has reported, when ordinary Republicans are informed about how the budget megabill—a package of tax and spending cuts that would add an estimated $3.3 trillion to the deficit—would affect the after-tax incomes of American families, they hate it. “Apparently even Trump’s die-hard fans are appalled when they are shown how the bill’s provisions will affect the finances of the nation’s richest and poorest households,” Mechanic wrote, “not that they’d ever hear it on Fox News.”
While the proposed cuts to Medicaid will be devastating for all rural hospitals, those in states that expanded Medicaid under the Affordable Care Act will be hardest hit, Donelson says. The GOP bill “really just shifts a lot of these costs from the federal government onto states that already [are struggling] to afford this,” making it “that much more expensive to cover those in the Medicaid expansion population,” she says.
According to the National Partnership’s analysis, the states facing the greatest threats to rural maternity care are Kentucky and California, each with 13 rural obstetric departments at risk of closure; New Mexico, which has 11; and Louisiana, where ten obstetric units are at risk. Unlike some other conservative holdouts, Kentucky and Louisiana both expanded Medicaid. As Sharona Hoffman, co-director of Case Western Reserve University’s Law-Medicine Center, told my colleague Julia Métraux, Republicans’ new cuts seem intended to undercut Medicaid expansion. “The goal, I think, is to get states to say, ‘Well, we’re not getting the federal money support, and so we’re going to roll back or undo our expansion of Medicaid,’” Hoffman said.
In total, 41 states could lose labor-and-delivery units in their rural hospitals because of GOP Medicaid cuts, Donelson says. The only reason some other states—including Arkansas and Alabama—won’t see cuts is because these states “already have limited maternal health services,” she says.
The cutbacks and closures won’t just affect patients; they will also have a profoundly destructive impact on rural jobs and economies, where hospitals typically serve as one of the biggest employers in their communities. According to the National Partnership analysis, more than 80 percent of people working in hospitals in non-metro areas are women.
The Trump/GOP mega-bill also includes many other provisions that will disproportionately affect women and children, from defunding Planned Parenthood to gutting spending on food stamps.
Reproductive justice groups lost no time in excoriating the Senate after today’s vote. “For the past six months, people in all 50 states have been grappling with the chaos unleashed by the Trump administration’s cuts, freezes, and destruction of critical federal programs—and now Congressional Republicans are pouring gasoline on the fire,” Jennifer Driver, senior director of reproductive rights at State Innovation Exchange, said in a statement. “Instead of helping people make ends meet by lowering costs, Senate Republicans are choosing cruelty over solutions.”
“The Senate’s version of the bill is just as dangerous and devastating as the one passed by the House and attacks our communities’ health, dignity, and futures,” echoed Lupe M. Rodríguez, executive director of the National Latina Institute for Reproductive Justice. “Let it be very clear, instead of helping people stay healthy and safe, it puts our communities at risk only to serve the interests of the billionaires.”
