For several years, hospitals have been closing maternity units due to financial pressures, particularly in rural areas. Between 2012 and 2022, a quarter of all rural hospitals ceased providing obstetric services, affecting 267 communities, primarily due to financial losses. In 2020, over 8 million women of childbearing age lived in counties without an obstetric hospital. The majority of maternity care deserts are in rural areas, where Medicaid funding is particularly essential. Medicaid plays a critical role in sustaining maternity care access for all women, including those with private insurance. Hospitals in areas with low birth volumes, particularly rural hospitals, struggle to maintain maternity services because revenue from childbirths alone is not enough to cover costs. Without adequate funding, many hospitals will be forced to close their maternity units, leaving entire communities without access to essential perinatal care. Further cuts to Medicaid will accelerate this dangerous trend.

On May 22, the US House passed, 215 to 214, H.R. 1, the “One Big Beautiful Bill Act.” All Republicans except three voted for the bill, and all Democrats voted against it. The bill covers a wide range of topics, including taxes, energy, border security, judicial powers, natural resources, and Medicaid. 

The bill would require Medicaid recipients to provide documentation that they have worked, volunteered, or participated in educational programs. Medicaid is a state-administered, mostly federally funded program. Medicaid enrollees have already shown they meet financial eligibility under their state’s requirements, and many states require them to show they continue to meet financial requirements annually. 

The burden of additional documentation requirements to continue receiving Medicaid would lead to a significant reduction of the number of people enrolled in Medicaid. According to the Commonwealth Fund, the Congressional Budget Office estimates that 4.6 to 5.2 million adults could lose Medicaid in 2026 if work requirements are implemented. 

Now that H.R. 1 has passed the House, it must pass the Senate to become law. As a budget reconciliation bill, it cannot be filibustered. Call your senators' offices to urge them to vote against this bill that would reduce access to maternity care for all women.