By Savannah Tryens-Fernandes
al.com
More rural hospitals are at risk of closure in the South, according to a new report examining the impacts of President Trump’s Big Beautiful Bill.
The Southern Poverty Law Center reports that 99 rural hospitals in Alabama, Florida, Georgia, Louisiana and Mississippi could now be at risk of closing.
“For people living in the rural South, hospital closures aren’t just an inconvenience,” said Gina Azito Thompson, policy analyst at SPLC, in a press release. “They can be the difference between whether a person survives a trip in an ambulance or doesn’t make it in time to receive lifesaving care.”
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Rural hospitals were already struggling financially before Congress last year passed the Big Beautiful Bill. And in rural communities, which face higher rates of chronic conditions, patients already have to travel much farther for care than people who live in the suburbs or urban areas.
But the situation will worsen, according to the report, due to the nearly $1 trillion in cuts to federal health programs and because Congress failed to renew enhanced tax credits that were part of the Affordable Care Act.
At least 34 rural hospitals closed in the Deep South between 2005 and 2023. Ten of those hospitals were in Alabama.
“Unfortunately, these critical lifelines are under threat thanks to devastating cuts to programs that ensure Americans in these areas have health insurance,” Azito Thompson said in the SPLC release. “In a region with alarming rates of chronic illness, diabetes and high blood pressure, making healthcare more expensive will result in people forgoing necessary visits to the doctor, causing treatable problems to turn deadly.”
More people will ultimately become uninsured, forcing hospitals to take on more care without getting paid.
The enhanced tax credits alone insured nearly 7 million people across Alabama and four other Deep South states in 2025, according to the report. They expired in December when Congress rejected legislation to extend them — the central focus of the longest federal government shutdown in U. S. history.
The credits were used most in states that haven’t expanded Medicaid, including Alabama. Louisiana is the only Deep South state that expanded Medicaid.
Almost immediately after the enhanced credits expired in January, more than 22,000 Alabamians dropped from coverage on the Affordable Care Act marketplace.
“When we talk about making America healthy, one of the fundamental ways to do that is to ensure everyone can see a doctor or health professional without the fear of taking on tremendous medical debt,” added Azito Thompson. “By kicking people off of their insurance, this administration’s signature piece of legislation will only worsen so many of the health disparities that already exist across the Deep South.”
The Big Beautiful Bill contained “some of the largest program cuts to healthcare in U.S. history,” the SPLC report said, but it also provided a Rural Health Transformation Fund allocating $50 billion in grants over the next five years to states to improve healthcare.
Alabama was awarded $203 million for 2026.
That money, however, is not enough, the SPLC found, pointing to Lawrence Medical Center in Moulton, which closed its Emergency Department last year.
“The hospital blamed the number of uninsured patients as one of the reasons for its emergency room closure. According to the Alabama Hospital Association, 82% of the state’s rural hospitals are operating in the red,” the report said.
“The appropriated $50 billion will do little to insulate rural communities and hospitals from the imminent damage,” it added.
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