While the cost of health care continues to rise in America, many hospitals are working to find ways to remain open or maintain their staffing.
When the One Big Beautiful Bill Act was signed, billions in Medicaid spending were cut from the federal budget over the next 10 years, leaving millions of citizens without Medicaid coverage, according to The Public Citizen.
Iowa’s U.S. representatives and senators all voted in favor of The Big Beautiful Bill Act.
The spending cuts also put 446 hospitals at risk of closing or reducing services, according to the consumer advocacy organization. Among those hospitals, 176 are in rural areas.
Among the hospitals the report said were at risk of closing, three are located in Iowa.
They are:
How did The Public Citizen determine which hospitals are at risk of closing?
The federal spending cuts would impact low-income families and disabled individuals who rely on Medicaid coverage, according to the report. Some hospitals may have even been forced to lay off workers due to the spending cuts.
The report considered hospitals at-risk if they met both of these benchmarks:
MercyOne announced layoffs, closing after Big Beautiful Bill was signed
About six months after the Big Beautiful Bill was signed by President Donald Trump, MercyOne announced 67 layoffs in January as it outsourced some services. That month, it also closed a family medicine clinic in Ottumwa.
The job cuts, according to the company, came as the company faced a reduction of $1.5 billion in recent and upcoming federal funding along with reductions to coverage, payment, and access to Medicaid and Medicare.
About three months later, MercyOne announced it was closing a family practice and an urgent care location in south Des Moines.
The company cited staff shortages and federal reimbursements that only cover a portion of the cost of care among its reasons for closing the location on Southwest Ninth Street.
UnityPoint also announces layoffs
West Des Moines-based UnityPoint Health announced in April that it would cut more than 200 jobs as it outsources information technology and revenue jobs.
“Like many health systems across the country, we are navigating a period of sustained financial pressure that requires us to make difficult but necessary decisions,” Scott Kizer, president and CEO of UnityPoint Health, said at the time.
Federal grant aims to expand health care in rural Iowa
The One Big Beautiful Bill Act also created the Rural Health Transformation Program, a $50 billion, five-year initiative designed to offset some losses from Medicaid cuts.
Iowa received $209 million from the program in December 2025, and hopes to see up to $1 billion over five years.
Iowa’s program, called Healthy Hometowns, will try to expand rural health care access; improve cancer prevention, treatment and outcomes; and increase telehealth access, among other efforts.
Emery Glover is an audience engagement specialist for the Des Moines Register. Reach him at eglover@usatodayco.com.
This article originally appeared on Des Moines Register: Medicaid cuts could close 400 rural hospitals. 3 in Iowa are at risk.
Reporting by Emery Glover, Des Moines Register / Des Moines Register
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