Cuts to federal spending on Medicaid could affect hundreds of rural hospitals in many states that have elected Republican senators and voted for President Trump, Senate Democrats warned Thursday, citing a list they commissioned of rural hospitals in financial distress.

“If Republicans plan to pass drastic cuts to Medicaid and Medicare and effectively repeal the Affordable Care Act, communities should know exactly what they stand to lose,” Sen. Ed Markey, the top Democrat in the Senate’s health committee, said in a statement.

The warning from Senate Democrats, outlined in a letter sent to President Trump and Republican congressional leaders, comes as senators are now wrestling with the budget package that Mr. Trump dubbed the “big, beautiful bill,” which narrowly passed the House last month. 

Budget analysts say a slew of changes that the House bill made to Medicaid provisions — which backers argue would target “excesses and abuses” in the program — could add up to reduced federal Medicaid spending by more than $800 billion over the next decade, resulting in 7.8 million more uninsured people.

The American Hospital Association has warned Medicaid cuts being considered by Congress “could have a devastating impact on rural hospitals,” which often face larger shares of patients without health insurance.

“Rural hospitals serve as critical — and sometimes the sole — source of care for rural communities,” the hospital lobbying group says.

Democrats cited a list of at-risk rural hospitals that the University of North Carolina’s Cecil G. Sheps Center for Health Services Research compiled at their request.

“If your party moves ahead with these drastic health care cuts that will cut millions of people off their health insurance coverage, rural hospitals will not get paid for the services they are required by law to provide to patients. In turn, rural hospitals will face deeper financial strain,” the Democrats’ letter states.

The center analyzed data from the Centers for Medicare and Medicaid Services to compile a list of rural hospitals at the highest risk of financial distress, broken down by state and congressional district.

“Republican health care cuts would be felt by rural hospitals across the country. In Louisiana, 32 rural hospitals — or a majority of rural hospitals in the state — are serving a high concentration of Medicaid patients. A total of 33 hospitals are at risk based on serving a high share of Medicaid patients, experiencing negative total margins, or both,” Democrats wrote.

Louisiana is the home state of Sen. Bill Cassidy, the top Republican on the Senate health panel.

The letter also itemized rural hospitals at risk in Alaska, Kentucky, West Virginia, Alabama and Tennessee.

“Substantial cuts to Medicaid or Medicare payments could increase the number of unprofitable rural hospitals and elevate their risk of financial distress. In response, hospitals may be forced to reduce service lines, convert to a different type of healthcare facility, or close altogether,” wrote University of North Carolina researchers Mark Holmes, George Pink and Tyler Malone in their responses to the Democrats.