Trump’s Health Care Cuts Are Harming His Supporters and Gutting Rural Maternal Health Care
/The Trump Administration’s Megabill, also known as the One Big Beautiful Bill Act (OBBBA) – signed into law last July – has been anything but beautiful, wreaking havoc on the country’s health care system for the last year. Millions of people have lost coverage as the Affordable Care Act (ACA) Marketplace premiums have skyrocketed. Millions more are expected to lose coverage due to looming Medicaid cuts. Hospitals are shutting down. This cascade of events will lead to reduced access to care while harming local economies. The bill is also putting pregnant women’s health at risk by gutting access to maternity care in rural areas – especially for Trump’s supporters themselves.
Earlier National Partnership analysis identified 131 rural hospitals with labor and delivery (L&D) units that were at risk of closing or reducing services over the next decade, as a result of Trump’s OBBBA. These hospitals are located in 126 counties across 40 states. Three-quarters of these counties (96 counties in total) in 35 states are at risk of losing their only L&D unit, while another 30 counties will see reduced access to care. Nearly 125,000 babies were born in the affected counties in 2024 – including more than 46,000 babies in the counties at risk of losing their only L&D unit.*
New National Partnership Action Fund analysis finds that President Trump won 91 percent of the rural counties that are at risk of losing their only source of hospital-based obstetric care as a result of his OBBBA. Trump won in 80 percent of the 30 counties with reduced access to care.
Trump is Harming Health Care for His Voters: 14 Rural Maternity Wards Have Shut Down Since Last Year
These L&D units from our reporting last year are, in fact, starting to close. National Partnership research shows that as of April 2026, four of these rural L&D units have already shut down, as have another 10 rural L&D units not included in the initial analysis.
“It feels so wrong, like we are just leaving people in the dust.”
— Leah Shilling-Stouffer, patient of Centra Southside Community Hospital in Farmville, VA
The impact of the Trump Administration’s OBBBA on hospital closures will have far reaching consequences, harming rural women, families, communities, and health systems. These painful closures are the real results of Trump’s policies for pregnant women and babies – and they stand in stark contrast to his supposed support for women and families: his new moms.gov website, which is full of misleading information, and his racist, misogynistic, and ableist pronatalist agenda, which fails to support parents.
Nearly 900,000 Rural Women Are at Risk of Losing Their Only Maternity Ward
“My first daughter was a six-hour (precipitous) labor. I barely made it to the hospital in time to have her, and that was here in Delta. I can’t imagine having to drive all the way to Montrose or Grand Junction and make sure that I make it and have a safe baby.”
— Cory Gallegos, patient of Delta Health in Delta, CO
Nearly 2.5 million reproductive-aged women (ages 15–50) live in counties with rural L&D units at risk of closure and close to 875,000 women live in counties that are at risk of losing their only source of hospital-based obstetric care.*
Women will have to travel farther—sometimes more than 60 mins—to reach the closest facility, raising the risk of complications and giving birth in transit.
Longer travel time often means more transportation costs, lost wages due to lack of paid leave, and increased child care costs.
Women will be more likely to schedule c-sections, to avoid going into labor and not being able to get to a hospital quickly. But cesareans come with a higher risk of short term and long term complications for mothers and babies.
Women may delay care altogether, resulting in untreated conditions, which in turn could lead to higher rates of maternal mortality, preterm births, and increased risks to infant health.
Emergency Departments and Neighboring Hospitals Will Suffer
“We’re literally just stuck having to go into a hospital where we have no established care. Where we don’t have anyone that’s familiar with our medical history. We don’t have anyone that’s familiar with any of our past deliveries or any complications that we’ve had. They’re going to be expected to deliver our babies. That’s terrifying when you’re about to give birth.”
— Jordan Hamm patient of Ephraim McDowell Fort Logan Hospital in Stanford, KY
When pregnant women are forced to seek care in emergency departments (EDs) – everyone loses. EDs generally do not have the expertise or equipment to manage pregnancy and labor and delivery emergencies, which may strain their capacity and overextend their staff resources. Worse, the lack of expertise and equipment could leave laboring women without appropriate skilled care, putting their health, and potentially their lives, at risk.
An L&D unit closure in one community could mean nearby hospitals in other communities that offer obstetric care will face increased patient volume, which can lead to understaffing, strained resources, lower quality of care, and longer wait times.
The Health and Economy of Rural Communities Will Decline
“We have many longstanding nurses who have worked in our maternity department for many years…They are beloved to us; they're amazing nurses, so this is a very sad and difficult decision.”
— Rebecca Coplin, Chief Administrative Officer at Providence Seaside Hospital in Seaside, OR
Hospitals serve as a critical source of employment for rural residents, supporting one in 12 rural jobs. When an L&D unit closes, it causes immediate job losses.
L&D unit closures impact women's employment and economic security in rural communities. Women make up nearly 80 percent of people working in hospitals in rural areas,* in roles including health care professionals, social service workers, medical technicians, health aides and assistants, food service workers, and cleaning service workers.
Rural hospitals serve as economic drivers for rural communities. In 2020, rural hospitals contributed to $220 billion in economic activity. L&D unit closures may make attracting and retaining younger workers and families more difficult, potentially harming the economy of rural communities.
Loss of L&D units is associated with an overall decline of other hospital services, increasing health risks for the entire community.
Trump Failed Rural Voters Who Elected Him: Voters and Policymakers Must Take Action
One year later, it’s evident that OBBBA is failing rural women, families, and communities. While the Trump administration touts the $50 billion Rural Health Transformation program as “the largest ever investment in rural health care” he’s simultaneously planning to cut $137 billion in Medicaid funding from rural communities. Rural communities deserve elected leaders who will preserve a strong Medicaid program. After all, three in four rural residents say Medicaid is very important for people in their local community – including 66 percent of those who voted for President Trump in 2024. And the majority (over 75 percent) rural residents do not support Medicaid cuts. Rural voters matter and their voices should be heard.
To improve access to rural maternal health, state and federal policymakers should:
Protect postpartum care coverage for up to 12 months along with other critical, optional maternal health benefits.
Provide adequate Medicaid reimbursement for all maternity care services.
Invest in team-based models of care that integrate midwives, doulas, and community health workers.
Champion targeted federal maternal health legislation specifically designed to preserve and expand rural obstetric care like the Keep Obstetrics Local Act (KOLA), Midwives for MOMS Act, and BABIES Act.
Expand Medicaid for 1.6 million adults who fall into a coverage gap.
Protect and expand access to affordable health coverage for everyone in their communities.
Advance robust social support infrastructure like paid leave and paid sick days.
The health and economic effects of rural hospital closures and L&D units are devastating. Rural communities are foundational to this nation and they deserve better.
*Methods note:
This analysis relies on The National Partnership for Women & Families earlier analysis of at-risk labor and delivery units. March of Dimes analysis determined that these 131 units are located in 126 counties across the U.S. and calculated that, should these 131 labor and delivery units close, 96 counties would lose their only hospital-based source of obstetric care, while the remaining counties would see a reduction in the number of labor and delivery units and analyzed the number of babies born in these counties based on National Center for Health Statistics 2024 Natality data (March of Dimes analysis on file with authors) as well as the number of women living in these counties based on American Community Survey 2019-2023 five-year estimates. The authors compared these counties with county-level 2024 Presidential vote data from Dave Leip’s Atlas of U.S. Presidential Elections to determine what number of these counties President Trump won. Alaska does not report presidential vote returns by county, but rather by Election District, thus we used these results when possible. Specifically, in this analysis we used Alaska District 1 results as a proxy for Ketchikan Gateway Borough and Alaska District 5 results as a proxy for Kodiak Island Borough. Anchorage has too many election districts for an appropriate proxy so we conservatively assumed it did not vote for President Trump. Authors’ analysis of rural hospital workers uses American Community Survey 2024 one-year data via IPUMS.