A Republican megabill cuts $1 trillion from Medicaid, risking closures for hospitals that serve some of America’s most vulnerable. Rural hospitals in the U.S. already operate on a razor’s edge, but new cuts to Medicaid in the Republican appropriations bill could tip many of them into failure.

States and rural health advocacy groups are sounding the alarm that Congress’ slashing of Medicaid will devastate already financially fragile rural hospitals. One analysis estimates more than 300 hospitals could be at risk of closing under the Republican measure to slash about $1 trillion in Medicaid funding over ten years.