Tyler Sherman, a nurse at a rural Nebraska hospital, is used to the area’s aging farmers delaying care until they end up in his emergency room.

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.

One analysis reveals that over 300 hospitals may be in danger of closing under the Republican legislation which will slash roughly $1 trillion in Medicaid funding over ten years.