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.

Rural hospitals say they’re being forced to consider tough choices after President Trump signed into law a domestic policy bill that includes cuts to Medicaid and Obamacare.