Hospitals go dark in red states that thumbed their noses at Obamacare money: study

Urban hospitals are closing at roughly the same rate as rural ones, and the shuttered hospitals are more likely to have served communities with high poverty rates and fewer transportation options, according to a new study published Thursday in the journal JAMA.

Researchers at the Harvard T.H. Chan School of Public Health analyzed hospital closures and openings that occurred between 2010 and last year. They found that closures increased by 4% year over year, while new hospital openings decreased 3% year over year.

The study comes as health systems across the nation brace for the effects of the broad tax and spending measure passed by congressional Republicans and signed by President Donald Trump in July 2025. The so-called One Big Beautiful Bill Act is projected to cut federal Medicaid spending by an estimated $886.8 billion over the next decade, according to estimates by the Congressional Budget Office.

The law includes $50 billion in rural health grants to be distributed to states over five years, but the funds are for a wide variety of initiatives, with limitations on how much hospitals can benefit.

Public attention has mostly focused on struggling rural hospitals, but the Harvard researchers found that urban hospitals also have been vulnerable: The closure rate was 9.1% for urban hospitals and 8.3% for rural hospitals. Across both rural and urban areas, hospitals that were for-profit, small or safety-net, or served the most vulnerable counties — such as those with higher poverty rates or less access to transportation — were most likely to close.

Overall, 432 hospitals closed between 2010 and 2025 while 216 opened, leading to a net loss of over 24,000 beds. Rural areas were less likely to see a new hospital, as the new facilities were mostly urban, for-profit and small. Rural communities are more likely to have fewer doctors per capita and a lower overall number of patients.

Of the hospitals that closed, about 73% shut down completely, while the remaining retained outpatient care, including rural emergency hospital care.

The Midwest and the South saw the most closures overall, and there were more closures in states that didn’t expand Medicaid eligibility under the Affordable Care Act, according to the study.

Stateline reporter Nada Hassanein can be reached at nhassanein@stateline.org.

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