The road to four struggling rural hospitals now hosts a political message: “If this hospital closes, blame Trump.” In a series of black-and-yellow billboards erected near the facilities, the Democratic National Committee (DNC) seeks to tell voters in deep red states “who is responsible for gutting rural healthcare”.

“UNDER TRUMP’S WATCH, STILWELL GENERAL HOSPITAL IS CLOSING ITS DOORS,” one sign screams. The billboards are outside hospitals in Silex, Missouri; Columbus, Indiana; Stilwell, Oklahoma; and Missoula, Montana.

The fate of rural hospitals has become a politically contentious issue for Republicans, as historic cuts pushed through by the GOP are expected to come into effect over the next decade. Trump’s enormous One Big Beautiful Bill Act (OBBBA) cut more than $1tn from Medicaid, the public health insurance program for low-income and disabled Americans, insuring more than 71 million adults.

“Where the real impact is going to be is on the people who just won’t get care,” said Dave Kendall, senior fellow for health and fiscal policy at Third Way, a center-left advocacy organization. “That’s what used to happen before we had rural hospitals – they just don’t get the care because they can’t afford it, and they can’t get to the hospital.”