In the year since President Trump stole $1 trillion out of the American health care system to free up funding for mass deportation, tax breaks for his billionaire friends, and, it turns out, illegal wars of aggression, much of the resulting conversation has focused on how the funding cuts would impact rural hospitals and patients. The idea was that most of the harm would hit there, since rural medical providers were already on the brink of collapse across the country.

But new research from National Nurses United challenges that assumption. Researchers identified 602 financially vulnerable hospitals across 47 states, which together operated with an aggregated deficit of about $10.2 billion. They found that when the full impact of Trump’s One Big Beautiful Bill Act finally hits, the group’s deficit will increase to between $15.4 billion and $17.9 billion. Of this group, 366 are in metropolitan areas, nearly 61 percent, while the rest are in rural or semirural areas.

The finding is important because it illustrates the nationwide damage Trump’s funding cuts are causing, said National Nurses United Director of Research Dan Johnston. The financially vulnerable hospitals in cities tend to be ones that serve communities of poor and working-class people, whether they be Black, brown, or white, no matter where they live.

“It’s not just a rural problem,” Johnston said. “This is going on all over.” His research found that California has 67 financially vulnerable hospitals, the most in the country, followed by New York, with 40, and Texas, with 35.

Trump’s Republican Party also refused to extend Biden-era Affordable Care Act enhanced premium tax credits, which caused enrollment for ACA insurance to drop by about 4.2 million people as of February 2026. Insurers that participate in the program jacked prices so high that enrollees faced an average 114 percent increase just to stay with the same plan as the year before; they have proposed a double-digit increase for next year, too, with a median increase of 14 percent for 2027.