Healthcare providers across the country have closed clinics and hospital wards in the four months since Donald Trump signed into law the One Big Beautiful Bill Act, the landmark tax-and-spending legislation that will lead an estimated 10 million people to lose their health insurance.The law is expected to slash federal funding by hundreds of billions of dollars over the coming years, as part of Trump’s campaign pledge to shrink government spending.But it will do so in part by paring back eligibility for Medicaid, the US government’s health insurance program for low-income people; raising the cost of healthcare under the Affordable Care Act; and defunding some family planning providers who offer abortions.Rural hospitals and obstetric wards will be disproportionately battered, since they are typically expensive to run and serve high numbers of Medicaid beneficiaries.More than 300 rural hospitals are at risk of closure or cutting services, researchers from the University of North Carolina at Chapel Hill found.

Almost 100 are located in counties that have no other source of obstetric care besides the hospital, according to a forthcoming analysis from the National Partnership for Women and Families, an advocacy group.White, Native American and low-income women are especially likely to lose their sole source of care.“The one big, beautiful bill isn’t the only cause of the closures,” said Michael Shepherd, an assistant professor at the University of Michigan School of Public Health who studies rural healthcare.“But it can be the death knell for hospitals that are already financially struggling – many of which would have survived for years to come without the changes.”A Guardian review found that healthcare provider groups in eight states have announced that the legislation contributed to their decision to shut down hospitals and clinics, end services or lay off employees.

They include:In October, St Mary’s Sacred Heart hospital in rural Lavonia, Georgia, became one of the first hospitals to close its obstetric ward as a result of the One Big Beautiful Bill Act.Mary’s Sacred Heart hospital has long struggled with a physician shortage and what a spokesperson called “changing demographics”, but “the Medicaid cuts solidified our decision”, the spokesperson said in an email.Patients were directed to seek care in a town nearly an hour away.Tammy Frye runs the Hart Life Pregnancy care center, an anti-abortion facility about 20 minutes away from St Mary’s.The center provides women with baby gear and information about motherhood, but does not offer medical care.

Still, after the news of the closure broke, desperate moms-to-be started calling Frye and asking her for help finding a replacement doctor, Frye said.Many do not have access to reliable transportation.“They were all very nervous, very scared and upset because they were connected to their doctor,” Frye said.“What’s going to happen if these moms are in an emergency situation?”In October, Freeman Health System publicly backtracked on plans to open a hospital in a rural corner of south-eastern Kansas.A feasibility study found that the hospital was simply too difficult to open, given “the unpredictable impact of pending legislation such as the One Big Beautiful Bill Act and evolving challenges in rural healthcare”, according to a Freeman Health System press release.

Maine Family Planning, which maintains 18 clinics around Maine, has long provided both primary care and family planning services.Historically, it received about $2m in Medicaid reimbursements each year.But due to a provision in the spending legislation that blocks larger abortion providers from receiving those reimbursements for the next year, the organization was forced to stop offering primary care to patients in October.About 70% of Maine Family Planning patients exclusively rely on it for their healthcare.As a primary care nurse practitioner working in the deeply rural Aroostook county, Heather Curran said she treated patients who had gone without primary care for years.

Now, after 10 years of working for Maine Family Planning, Curran’s job has been eliminated.She expects that many of her former patients will wait months to obtain appointments elsewhere, or simply go without.“I do this is because I want to improve healthcare in Aroostook county and because I love my patients,” she said.“A lot of these people are already barely getting by as it is.”Community hospital, in Nebraska, is closing the only health clinic in a small town called Curtis due to financial difficulties and “anticipated federal budget cuts to Medicaid”.

The Medicaid cuts also prompted Kaleida Health to announce it will be shutting down a family planning clinic in Buffalo, New York, by the end of the year.It has already shut down two therapy clinics in upstate New York, also due to the cuts.Discussions over whether to close the inpatient obstetric and newborn care services at Providence Seaside Hospital, off the coast of Oregon, were already underway by the time Trump signed the big, beautiful bill.But the legislation, a hospital spokesperson said in an email, contributed to a “historic reset” that has led the hospital to shutter its obstetric ward in October.Blue Mountain hospital, near the Idaho border, has also laid off 10 people in anticipation of losing revenue.

Augusta medical group, a hospital in Virginia’s Shenandoah Valley, is closing three primary care clinics.Seattle Children’s hospital, in Washington state, plans to lay off more than 150 staffers, or about 1.5% of its workforce.It will also eliminate another 350 open roles.