As the Trump administration bombs hospitals across the Middle East, it’s blowing them up throughout the United States, too. Since the passage of the One Big Beautiful Bill Act, more than 800 hospitals, nursing homes, maternal wards, psychiatric centers, and other health care facilities across the country have either closed entirely, cut services, or are at risk of doing so, according to a Protect Our Care report released last week. 

That is the early consequence of the law’s more than $1 trillion in health care cuts, money that has been reallocated to pay for tax breaks for billionaires, disastrous and deadly immigration raids in Minnesota and across the country, a coup in Venezuela, and the even more disastrous war on Iran and its neighbors, conducted jointly with Israel. The biggest reductions are yet to come, timed to hit after the midterm elections. A new work requirement that forces Medicaid recipients who aren’t disabled to report 80 hours a month of work will begin in 2027, for example. Cuts to funding that states use to cover the cost of their Medicaid programs will begin in 2028. 

“We’re going to see the whole situation amplified on an exponential basis,” Protect Our Care’s director of policy programs, Vaishu Jawahar, said in an interview. 

The most harmed are people in rural areas, mothers, and seniors, she said, though the cuts will affect everyone, regardless of what type of insurance they have or whether their nearest hospital is open. 

“If you’re a patient in an emergency room, or a parent taking care of a loved one, or you’re taking care of a sick parent yourself, all of that is ten times harder and it is going to get worse,” Jawahar said. 

The expectation of future cuts is driving the early damage, as hospitals must plan for a future with fewer insured patients and a loss of revenue. They’ve also been battered by the expiration of enhanced insurance subsidies under the Affordable Care Act (ACA) last December, which has led to a dramatic drop in insured patients. And the carnage isn’t over, if Republicans have their way, with more cuts imagined in the next Trump budget and a possible second party-line funding bill that would provide money for the war in Iran.

“If you’re a patient in an emergency room … that is ten times harder and it is going to get worse.” –Protect Our Care’s Vaishu Jawahar

Even if a local hospital does manage to absorb all of these body blows and stay open, it will likely be overcrowded with patients who would otherwise have gone elsewhere, and understaffed as hospital executives cut workers to save money. Twenty-eight thousand nurses, doctors, and therapists have already lost their jobs nationwide, and another 150,000 jobs are at risk, Protect Our Care found.

A University of Minnesota School of Public Health study found last summer that when a hospital closes, the price of inpatient stays at nearby surviving hospitals increases an average of about $500 per stay. 

“It will literally make an impact in terms of lives,” Jawahar added. “You’re going to find yourself waiting longer for care, paying more for care. Wen people get sick and aren’t insured they still have to go to the hospital, so they will come in worse condition and the burden of uncompensated care gets passed on in higher bills and premiums.” 

Trump himself described the tradeoff of health care for imperialism directly in remarks last week, when he said, “it’s not possible for us to take care of daycare, Medicaid, Medicare, all these individual things. They can do it on a state basis. You can’t do it on a federal. We have to take care of one thing: military protection. We have to guard the country.” 

He reiterated that priority in his 2027 budget proposal, which seeks a 10 percent reduction in nondefense spending. It proposes cutting $73 billion from federal programs outside the military; among other cuts, it would reduce funding to the National Institutes of Health by $5 billion. In all, the Department of Health and Human Services would see a $15.8 billion reduction under the proposed budget. Just like last year, the money would be reallocated to the military, this time in service of the historically enormous $1.5 trillion defense budget.

“Trump’s budget vows to make deeper cuts to health care to pay for a war he started—this is a trade-off no American wants to make,” said 314 Action spokesperson Grace Silva in a statement that urges Congress to “ignore Trump’s proposal and preserve funding for NIH once again.”  

Beyond the regular budget, Republicans are preparing to complete appropriations for immigration enforcement and the war in Iran through another party-line reconciliation bill. The emerging plan is to offset that spending by targeting cost-sharing reductions, which make health insurance more affordable for low-income populations. This would reduce insurance rolls by another 300,000, according to some estimates.

Obamacare is already impossibly expensive for one in ten people, health care researcher KFF found in a survey last month. That’s how many had Obamacare coverage in 2025 but dropped it this year. Another three in ten people told surveyors they had to change plans this year. In all, the ACA has seen a 5 percent drop in enrollment this year, which translates to well over one million patients. 

Some Democratic lawmakers have highlighted specific impacts on their states from the cuts already being implemented. Sen. Ron Wyden (D-OR) said late last month that 15 hospitals, clinics, and other medical service providers have closed in his state, with more planned this spring, while 727 health care workers have been laid off because of Republican cuts. Six urgent care clinics in Portland and Clark County are among the closures; 310 of the job cuts are related to specialized care at long-term hospitals for patients with medically complex needs. 

Next door in California, even more health professionals have been laid off, according to a recent report by the Orange County Register. As of mid-March, more than 400 hospitals across the state have laid off over 3,400 of their employees, and more are expected. Trump’s cuts will reduce funding in California by up to $30 billion over the next two years, “forcing hospitals to make difficult decisions about staffing, services, and patient care,” the Service Employees International Union–United Healthcare Workers West said in an announcement. 

The union, which is attempting to qualify a ballot measure in November that will impose a one-time 5 percent tax on billionaire wealth to offset the federal cuts, expects dozens of hospitals and emergency rooms in California will close as a result of the GOP policy and that 3.4 million Californians will lose Medicaid, “including many seniors, children, veterans, and people with disabilities.” 

“Every day I come to work thinking about my patients, making sure they get the care they need, that they feel safe, that they’re not alone. Now, I’m also thinking about whether I’ll still have a job next month,” Mayra Castaneda, an ultrasound technologist at a hospital in Lynwood, California, said in the announcement. “We’re already stretched thin, and the idea that more staff could be cut is terrifying. It doesn’t just impact us as staff. It impacts every patient who walks through our doors. You can’t keep taking resources out of health care and expect people not to suffer.”

GOP lawmakers also shouldn’t expect people to sit back and take it, advocates say. “Americans have made it very clear that they want health care, not warfare,” Jawahar said, noting that health care is at the top of voters’ affordability and issue concerns going into the midterms. 

Wanting to fund a war no one wants for $200 billion, when it would take less than a third of that to give 20 million people affordable health care for a year, “is just nonsensical, and it’s irresponsible, and it’s reckless,” Jawahar added. “The Trump administration is really going to pay a price” at the polls, she warned. 

In the meantime, practitioners and researchers said Americans should hope that there isn’t another pandemic or related public health emergency. It’s impossible to imagine how the U.S. would confront that, Jawahar said, other than resulting in a lot of death. 

“We see how easy it is for a system to be on the brink of collapse,” Jawahar said. When the larger cuts ripple through and decimate what’s left of America’s health care system, it “is really going to have a shocking effect and I can’t imagine what’s going to happen if we have another crisis.” 

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Whitney Curry Wimbish is a staff writer at The American Prospect. She previously worked in the Financial Times newsletters division, The Cambodia Daily in Phnom Penh, and the Herald News in New Jersey. Her work has been published in multiple outlets, including The New York Times, The Baffler, Los Angeles Review of Books, Music & Literature, North American Review, Sentient, Semafor, and elsewhere. She is a coauthor of The Majority Report’s daily newsletter and publishes short fiction in a range of literary magazines.