Far-reaching federal health funding cuts under the Trump administration’s One Big Beautiful Bill Act (OBBBA) are exacerbating a maternal health crisis, with rural labor and delivery (L&D) units, free-standing birth centers, and women’s health clinics closing across the country – separate and apart from the implementation of provisions that will cause widespread coverage losses.
Prior to the passage of OBBBA, rural hospitals, safety-net providers, and women’s health clinics were operating under significant financial strain. Since 2020, more than 130 hospitals across rural and urban communities have closed their L&D units, forcing many pregnant patients to travel further for obstetric care.
Today, hospitals and clinics across the country are finding ways to mitigate financial pressures intensified by OBBBA. Many facilities cite staffing shortages, declining margins, or operational challenges as reasons for closure, and these pressures do not exist in isolation. Medicaid is a major payer for hospitals, maternity care, and women’s health services; reductions in coverage and reimbursement have ripple effects across the entire health system.
Medicaid is a lifeline for Women’s Health
Medicaid covers:
- One in five women aged 19-64 nationwide.
- 41 percent of all births and nearly half of rural births.
- 75 percent of family planning services.
The health care system is also facing the combined impact of looming Medicaid cuts and the expiration of Affordable Care Act (ACA) enhanced premium tax credits (ePTCs), which are both expected to increase uncompensated care costs and further destabilize hospitals already operating on thin margins.Reports indicate that ACA Marketplace enrollment is down by three million people this year as of May 2026.
By the Numbers – Maternal Health Closures since OBBBA
OBBBA threatens women’s health across the county, in both rural and non-rural communities. Rural communities remain vulnerable, and urban safety-net providers are also struggling under increasing financial pressures. L&D units are often among the first services cut when hospitals face financial distress because obstetric care is expensive to maintain and requires around-the-clock staffing regardless of patient volume. Freestanding birth centers could help fill critical maternity care gaps, but state laws restrict midwifery practice and established birth centers already struggle to stay afloat. Additionally, Title X and Medicaid funding restrictions and other political attacks on reproductive health care have devastated Planned Parenthood clinics. Overall, these closures are early indicators of broader instability in the health care infrastructure and a reflection of the current threats to women’s health.
What these Closures Mean for Women & Communities
Because of these closures and growing maternity care deserts, pregnant patients are forced to travel farther for prenatal care, childbirth, and emergency obstetrics services. Longer travel times are associated with delayed treatment for emergencies and an increased risk of complications. Along with these geographic barriers, remaining providers face severe capacity strain. NPWF found that one in four women received prenatal care later than desired, with most women noting that their provider did not have any earlier appointments available.
ED closures create additional risks for pregnant patients because EDs often serve as a last or only point of access to care for patients in labor, especially in rural areas and other maternity care deserts. ED closures also compromise emergency abortion access, forcing people to continue with pregnancies that put their health and lives at risk. Furthermore, women’s health clinic closures reduce access to preventive screenings, sexually transmitted infection testing, cancer screenings, contraceptive care, and other reproductive health services, especially for women with low incomes, Medicaid beneficiaries, and other medically underserved communities who rely on these safety net services.
Hospitals and clinics are often among the largest employers in a community. When facilities close or scale back services, communities can experience job losses and reduced economic activity. The providers who remain are under pressure to care for more patients who have no other source of care, which would likely cause quality of care to decline as providers are overburdened.
Looking Ahead
It’s been one year since OBBBA’s passage, and communities are already feeling the devastating impacts on health care access. Across the country, hospitals and clinics are reducing or shutting down essential services that patients rely on for maternity care, emergency care, and preventive women’s health services. These closures exemplify a broader health care crisis. Insufficient, short-term funding, such as the Rural Health Transformation Program, will not offset these structural barriers. Federal and state policymakers must act now to restore Medicaid funding, reject attempts to extend the Medicaid funding ban for Planned Parenthood in OBBBA, protect the ACA, and stabilize hospitals and clinics to preserve access to essential care for women and communities.
Download the full list of women’s health facility closures in Excel spreadsheet format.
