Health care executives in Cleveland and across the country are grappling with lingering questions about the long-term impact of the recently enacted America the Beautiful Act.
The 10-year, nearly $1 trillion plan, passed by Congress in July and signed by President Donald Trump, slashes funding for Medicaid.
Analysts at the University of California, Berkeley, warn that the measure could strip approximately 11.8 million Americans of their health insurance, forcing hospitals to shoulder the costs they once covered.
Supporters argue that the cuts will curb fraud and ensure only eligible beneficiaries receive benefits, while critics warn that they will lead to mounting unpaid bills and a decline in hospital service quality.
The financial impact on hospitals will depend on factors such as federal policies, insurance partnerships, and local market conditions. Some health care systems may use the legislation as an opportunity to cut underperforming departments, increase their reliance on artificial intelligence, or streamline administrative staff.
However, declining insurance coverage and rising medical costs could cause more patients to delay or avoid care, forcing them to visit emergency departments where they may be more seriously ill and require more expensive treatment.
MetroHealth Clinic Closures
On Monday, MetroHealth announced plans to close six outpatient clinics in the Cleveland area, effective October 3rd, to stabilize its finances. The closures include:
Broadview Heights Sports Medicine and Physical Therapy Clinic
Old Brooklyn Health Center Dental Clinic
Medina Health Center
Rocky River Medical Office
State Road Family Practice in North Royalton
Westlake Physical Therapy at the West Shore YMCA
MetroHealth leadership said years of expansion have led to overlapping services and inefficiencies. Consolidating operations will allow the system to expand hours and redeploy staff across larger clinics.
The decision comes as charity care costs have doubled since 2022, currently exceeding $1 million per day. Combined with rising expenses and uncertainty about government funding, the system faces increasing financial pressure.
Earlier this year, MetroHealth eliminated approximately 125 positions, primarily administrative staff, and has been notifying patients of changes in their healthcare providers and appointments.
Despite the closures, MetroHealth will continue to operate more than 20 outpatient locations. Looking ahead, the system plans to open a new outpatient health center on its main campus in 2026 and a drive-through pharmacy in 2027. These projects, which include parking and campus renovations, are expected to cost $168.2 million.
Regional Healthcare Under Pressure
MetroHealth reported an operating loss of $50 million in 2024 and projects a larger loss in 2025. Other major healthcare providers in Cleveland are also cutting costs: Cleveland Clinic eliminated 114 administrative positions earlier this year, while University Hospitals eliminated more than 300 leadership positions after closing two hospitals in 2022.
As a safety-net hospital in Cuyahoga County, MetroHealth receives only partial funding from the county. Trustees approved a $2 billion operating budget for 2025, up from $1.9 billion in 2024, but challenges remain because of looming Medicaid cuts.