Alabama Rural Hospital at Risk

A recent article in AL.com reveals that 3 of Alabama’s rural hospitals are at risk of closing due to Medicaid cuts under Trump’s Big Beautiful bill, according to a national report by Public citizen. The report claims that the Medicaid cuts in the bill, which include $900 billion of cuts over the next decade, are responsible for putting these hospitals at risk. Per the report, a hospital is considered at risk when 20% or more of the patients are insured through Medicaid or the Children’s Health Program (CHIP), and when the hospital operated with negative profit margins from 2022-24. 

The Alabama Hospital Association argues that the hospitals are at risk not because of Trump’s bill as Alabama did not suffer from Medicaid cuts since it never expanded federal healthcare coverage. It argues that the reason the hospitals are in danger of closing is because of decreasing insurance reimbursement. Alabama has some of the lowest rates of insurance reimbursement in the country. Moreover, even before the Big Beautiful Bill passed in the summer of 2026, 27 of Alabama’s rural hospitals, which are over half of the state’s rural hospitals, were at risk of closing in the coming years. 

The different viewpoints in this article highlight the importance of understanding the long-term systemic challenges, particularly with insurance reimbursement, that plague many of Alabama’s rural hospitals, and the impacts of recent national Medicaid cuts. Protecting rural hospitals is critical for the communities they serve, including rural women who rely on hospital services, and teasing out the complex reasons why Alabama’s rural hospitals are failing is key to addressing the root causes to save them.