Health Affairs December 3, 2025
The One Big Beautiful Bill Act (HR 1) is expected to cut more than $1 trillion dollars in funding to hospitals and other providers, primarily through cuts to Medicaid and the Affordable Care Act Marketplaces. As many as 300 rural hospitals face disproportionate risk of closure, service reductions, or conversion, with some already citing HR 1 in decisions to restructure or close essential services. In an attempt to offset the impact, the bill includes a $50 billion Rural Health Transformation Program. However, this funding is a stop-gap measure at best and may not reach the hospitals or health systems most in need.
Meanwhile, many Americans are struggling to afford care and coverage, with high hospital prices contributing to higher premiums...
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