A Republican megabill cuts $1 trillion from Medicaid, risking closures for hospitals that serve some of America’s most vulnerable. Rural hospitals in the U.S. already operate on a razor’s edge, but new cuts to Medicaid in the Republican appropriations bill could tip many of them into failure.

But public outcry over Medicaid cuts led Republicans to include a provision that will provide $10 billion annually to buttress rural hospitals over the next five years, or $50 billion in total. Many rural hospital advocates are wary that it won’t be enough to cover the shortfall.

States and rural health advocacy groups are sounding the alarm that Congress’ slashing of Medicaid will devastate already financially fragile rural hospitals. One analysis estimates more than 300 hospitals could be at risk of closing under the Republican measure to slash about $1 trillion in Medicaid funding over ten years.