CHILLICOTHE, Ohio — Southern Ohio Medical Center in Portsmouth, along with hospitals in Fayette County, Jackson County, and Adams County are among 11 Ohio facilities at risk of closure if President Donald Trump’s proposed “Big, Beautiful Bill” becomes law. The reconciliation package, passed by House Republicans in May 2025, imposes over $1 trillion in cuts to Medicaid and the Affordable Care Act, plus $500 billion in Medicare reductions, jeopardizing the financial stability of rural hospitals across Ohio.
A new version of the bill, which was passed by the Senate on Tuesday still leaves the hospitals at the same level of risk as the bill heads back to the House.
The bill, a flagship of Trump’s second-term agenda, seeks to overhaul federal health care spending while providing tax breaks for high-income earners. Proponents claim it will streamline programs and spur economic growth, but critics warn it could devastate rural health care, leaving millions uninsured and forcing hospitals to reduce services or close entirely.
Ohio Hospitals on the Brink
Data from the Cecil G. Sheps Center for Health Services Research at the University of North Carolina identifies 11 Ohio hospitals as vulnerable due to their reliance on Medicaid patients or sustained financial losses. These hospitals, flagged for serving high Medicaid populations or enduring three consecutive years of negative total margins, are:
- Southern Ohio Medical Center (Scioto County, Portsmouth)
- Adams County Regional Medical Center (Adams County)
- Mercy Health – Clermont Hospital (Clermont County)
- Fayette County Memorial Hospital (Fayette County)
- Holzer Medical Center – Gallipolis (Gallia County)
- Mercy Health – Urbana Hospital (Champaign County)
- Holzer Medical Center – Jackson (Jackson County)
- Mercy Health – Tiffin Hospital (Seneca County)
- Blanchard Valley Hospital (Hancock County)
- Mercy Health – Willard Hospital (Huron County)
- Morrow County Hospital (Morrow County)
Southern Ohio Medical Center, a major employer in Portsmouth, anchors Scioto County’s health care and economy. Fayette County Memorial Hospital in Washington Court House serves a high-poverty region, while Holzer Medical Centers in Jackson and Gallipolis are critical for Appalachian communities, offering emergency and obstetric care, along with Adams County.
The ‘Big, Beautiful Bill’ Explained
Introduced in early 2025, the “Big, Beautiful Bill” is a reconciliation package aimed at reducing federal spending and cutting taxes for corporations and wealthy individuals. It slashes Medicaid and Affordable Care Act funding by over $1 trillion over a decade and cuts Medicare by $500 billion. The Kaiser Family Foundation estimates these reductions could strip health insurance from 16 million Americans.
Rural hospitals, already grappling with low reimbursement rates and declining patient volumes, face acute risks. The Sheps Center reports that 338 rural hospitals nationwide, including Ohio’s 11, are vulnerable due to Medicaid dependence or persistent unprofitability. In Ohio, reduced Medicaid revenue could force hospitals to cut services like emergency care or obstetrics, convert to clinics, or close entirely.
Voices from Ohio and Beyond
Governor Mike DeWine has not made a definitive public statement fully endorsing or opposing the “Big Beautiful Bill.” His comments reflect a nuanced position: support for certain Medicaid reforms like work requirements, but significant concern about the bill’s impact on rural hospitals and vulnerable populations. His actions, such as vetoing state budget provisions to protect Medicaid access for children, suggest he may resist aspects of the bill that threaten Ohio’s health care infrastructure.
Ohio lawmakers from both parties have voiced concerns about the bill’s impact. However, the representatives who represent Adams, Fayette, Jackson, and Scioto county hospitals voted in favor of the bill; they included Congressmen David Taylor and Mike Carey.
“The Senate’s Big Beautiful Bill still doesn’t cut spending—promising future cuts isn’t enough. This runaway spending train is headed for a crash. I can’t support it,” Republican Congressman Warren Davidson of Ohio expressed.
“Cutting Medicaid and Medicare isn’t just about budgets—it’s about denying care to our most vulnerable,” Jason Smith, a nurse said. “Hospitals in Portsmouth, Fayette, Jackson, and Adams are on the edge, and this bill could push them over, costing us jobs and access to care.”
Community Impact and Uncertain Future
In Portsmouth, the potential loss of Southern Ohio Medical Center has alarmed residents. “If our hospital closes, we’re looking at longer drives for emergencies, which could be deadly,” said Tammy Evans, a local teacher. The facility employs hundreds and provides specialized care critical to Scioto County.
Fayette County Memorial Hospital’s closure would leave residents like Lisa Carter, a nurse, facing a 30-mile trip to the nearest emergency room. “For heart attacks or strokes, that’s a death sentence,” Carter said. In Jackson County, Holzer Medical Center support local economies and provide care unavailable elsewhere in the region.
Nationwide, 83 rural hospitals are at the highest risk of financial distress, according to the Sheps Center’s financial distress index. Ohio’s 11 at-risk facilities show the state’s exposure. If the “Big, Beautiful Bill” becomes law, experts predict a surge in closures, worsening health disparities and economic challenges in rural areas.
The bill passed the Senate this week with Vice President J.D. Vance casting the tie-breaking vote. It now heads back to the House for reconsideration with amendments.