The road to four struggling rural hospitals now hosts a political message: “If this hospital closes, blame Trump.”
In a series of black-and-yellow billboards erected near the facilities, the Democratic National Committee (DNC) seeks to tell voters in deep red states “who is responsible for gutting rural healthcare”.
“UNDER TRUMP’S WATCH, STILWELL GENERAL HOSPITAL IS CLOSING ITS DOORS,” one sign screams. The billboards are outside hospitals in Silex, Missouri; Columbus, Indiana; Stilwell, Oklahoma; and Missoula, Montana.
The fate of rural hospitals has become a politically contentious issue for Republicans, as historic cuts pushed through by the GOP are expected to come into effect over the next decade. Trump’s enormous One Big Beautiful Bill Act (OBBBA) cut more than $1tn from Medicaid, the public health insurance program for low-income and disabled Americans, insuring more than 71 million adults.
“Where the real impact is going to be is on the people who just won’t get care,” said Dave Kendall, senior fellow for health and fiscal policy at Third Way, a center-left advocacy organization.
“That’s what used to happen before we had rural hospitals – they just don’t get the care because they can’t afford it, and they can’t get to the hospital.”
In response to criticism, Republicans added a $50bn “rural health transformation fund” just before passage of the OBBBA. The fund is expected to cover about one-third of the losses rural areas will face, and about 70% of the losses for the four hospitals where Democrats now have nearby billboards. The rural health fund provides money through 2030, while the Medicaid cuts are not time-bound.
That is already becoming a political football, as Democrats argued in a letter that the money is a “slush fund” already promised to key Republican Congress members.
“We are alarmed by reports suggesting these taxpayer funds are already promised to Republican members of Congress in exchange for their votes in support of the Big, Ugly Betrayal,” wrote 16 Democratic senators in a letter to Dr Mehmet Oz, Trump’s head of Medicare and Medicaid.
A billboard in Missoula, Montana. Photograph: DNC
“In addition, the vague legislative language creating this fund will seemingly function as your personal fund to be distributed according to your political whims.”
Rural hospitals have been under financial strain for more than a decade. Since 2010, 153 rural hospitals have closed or lost the inpatient services which partly define a hospital, according to the University of North Carolina Sheps Center for Health Services Research.
“In states across the country, hospitals are either closing their doors or cutting critical services, and it’s Trump’s own voters who will suffer the most,” said the DNC chair, Ken Martin, in a statement announcing the billboards.
The OBBBA is expected to further exacerbate those financial strains. A recent analysis by the Urban Institute found rural hospitals are likely to see an $87bn loss in the next 10 years.
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“We’re expecting rural hospitals to close as a result – we’ve already started to see some hospitals like, ‘OK, how are we going to survive?’” said Third Way’s Kendall.
A June analysis by the Sheps Center found that 338 rural hospitals, including dozens in states such as Louisiana, Kentucky and Oklahoma, could close as a result of the OBBBA. There are nearly 1,800 rural hospitals nationally, according to the Kaiser Family Foundation (KFF), a healthcare research non-profit.
That perspective was buttressed by the CEO of the National Rural Health Association, Alan Morgan, who in a recent newsletter said 45% of rural hospitals are already operating at a loss.
“When you remove $155bn over the next 10 years, it’s going to have an impact,” he said.
In the fragmented US healthcare ecosystem, Medicaid is both the largest and poorest payer of healthcare providers. Patients benefit from largely no-cost care, but hospitals complain that Medicaid rates don’t pay for the cost of service, making institutions that disproportionately rely on Medicaid less financially stable. In rural areas, benefit-rich employer health insurance is harder to come by; therefore, more hospitals depend on Medicaid.
But even though Medicaid pays less than other insurance programs, some payment is still better than none. Trump’s OBBBA cut of more than $1tn from the program over the coming decade is expected to result in nearly 12 million people losing coverage.
When uninsured people get sick, they are more likely to delay care, more likely to use hospital emergency rooms and more likely to struggle to pay their bills. In turn, the institutions that serve them also suffer.
“This is what Donald Trump does – screw over the people who are counting on him,” said Martin, the DNC chair. “These new DNC billboards plainly state exactly what is happening to rural hospitals under Donald Trump’s watch.”