*Alexis Berry
I. Introduction
Cuts to Medicaid following the passage of the One Big Beautiful Bill Act (OBBBA) in July 2025[1] are expected to result in the closure of many rural hospitals, leading to higher healthcare costs and limited access to essential medical care.[2] With “almost 60% of people in prisons and 25% of those in local jails [being held] in rural counties,” rural hospital closures will likely present a public health care crisis for incarcerated individuals.[3] Incarcerated women requiring reproductive health services may encounter additional difficulties due to rural hospital closures, which may implicate their constitutional Eighth Amendment rights to adequate medical care.[4]
II. What the One Big Beautiful Bill Act Could Mean for Rural Hospitals
The operating margins of rural hospitals are some of the lowest in the nation.[5] Prior to the passage of the OBBBA, almost half of rural hospitals operated at a financial loss, underscoring the importance of Medicaid funding for rural hospitals.[6] The financial challenges faced by rural hospitals are exacerbated when reproductive health care is considered.[7] In 2024, “Medicaid paid rural hospitals approximately [sixty-three] cents on the dollar for inpatient obstetrics care.”[8] Over the last decade, “[t]here has been a 16% decline in rural counties with hospital-based obstetric care services.”[9] Even before the estimated cuts to Medicaid funding,[10] rural hospitals were already financially struggling to provide comprehensive reproductive care for those who rely on them.[11]
While “[t]he [OBBBA] includes $50 billion in relief funding for rural hospitals [spread] over . . . five [y]ear[s,]” that funding would disappear altogether following that period.[12] Therefore, this relief funding is likely inadequate to meet the needs of rural hospitals, especially given the Act’s projected $1.02 trillion in Medicaid spending cuts.[13] The current financial circumstances of rural hospitals put more than 300 hospitals at risk of closure, a risk that will likely increase due to the continued reductions in Medicaid funding.[14]
III. The Reality of Reproductive Healthcare for Incarcerated Women
The combination of the inherent risks of pregnancy,[15] strained obstetrics resources in rural hospitals,[16] and the public health problems in prisons[17] puts incarcerated women in a precarious position. A 2025 Bureau of Justice Statistics report, using 2023 data, states that 2%—about 1,157—of individuals tested for pregnancy at admission to state and federal prisons tested positive for pregnancy.[18] Moreover, there are already existing issues with a lack of adequate reproductive care for incarcerated women, as compared with the general population; incarcerated women have higher rates of miscarriages and premature births.[19]
Losing access to rural hospitals will only reinforce discrepancies in a situation where those in need of reproductive care already face inadequate care due to incarceration.[20] Pregnant “women [who live] in maternity care deserts face a 13% higher risk of preterm birth.”[21] About “[six] in [ten] maternity care deserts are [in] rural, less populated areas.”[22] Furthermore, reports show that almost “half of maternal deaths . . . are preventable if women [have timely] access [to] emergency care.”[23] Thus, the inherent risks of pregnancy are heightened for those living in areas with decreased access to emergency reproductive care.[24] The challenges of maternal healthcare in rural areas are magnified when combined with the reality of prison healthcare, where “limited resources . . . [lead to incarcerated] women . . . receiv[ing] . . . inappropriate and inadequate [care], [resulting in] undetected illnes[s], [mis]treatment, and potentially worsen[ed] overall health.”[25] Reduced access to rural hospitals may heighten the risk of adverse or even fatal consequences for those requiring reproductive healthcare.[26]
Using the framework of the Eighth Amendment’s protection against cruel and unusual punishment, the Supreme Court has recognized that “the governmen[t] [has an] obligation to provide medical care for those [that are] incarcerat[ed].”[27] Prior to Dobbs v. Jackson Women’s Health Organization, courts recognized that this fundamental right to adequate healthcare also extends to reproductive care for incarcerated women to receive access to abortions.[28] However, in the aftermath of Dobbs, incarcerated women have likely faced even more obstacles in receiving adequate reproductive care, and with increased anti-abortion legislation, incarcerated women have felt the effects even harder.[29] Eighth Amendment rights of incarcerated women are thus further implicated where the closures of rural hospitals without sufficient alternatives strain the state’s ability to provide adequate medical care to women who are incarcerated in these areas.[30] The challenges faced by incarcerated women post-Dobbs, combined with limited access to comprehensive reproductive care,[31] strained resources of prisons in rural areas,[32] and the heightened risk posed by closures of medical facilities in these regions[33] suggests a potential constitutional issue concerning the Eighth Amendment rights of incarcerated women.[34]
IV. Conclusion
Cuts in funding for rural hospitals not only present a public health crisis but also present both prisoners’ rights and reproductive rights problems.[35] Occurring at the intersection of issues of public health, prisoners’ rights, and reproductive rights, the threatened closures of rural hospitals implicate a health care crisis complicated by the inherent problems with obtaining reproductive care both in prisons and in rural areas.[36] When factoring in the impact that the closure of rural areas could have on incarcerated women specifically, the crisis begins to show at an even greater magnitude.[37] In the wake of increased abortion bans,[38] the loss of access to comprehensive reproductive care presents an even more cruel reality for women in general, and especially for those who may be more susceptible to pregnancy complications resulting from being incarcerated in rural areas.[39]
*Alexis Berry is a second-year student at the University of Baltimore School of Law where she is a Staff Editor for Law Review, the 2L Representative for the Criminal Law Association, and a Scholar of the Royal Graham Shannonhouse III Honor Society. Her primary interest in law involves exploring the intersections between criminal law, women’s rights issues, and reproductive justice.
[1] See One Big Beautiful Bill Act, H.R. 1, 119th Cong. (2025).
[2] Marc Blatstein, Nearly 1M Are Incarcerated in Rural America: 60% in Prisons and 25% in Local Jails – Soon Without Medical Care, PHYSICIAN PRESENTENCE REP. SERV. LLC: Physician Prison Consultants (Oct. 28, 2025), https://pprsus.com/nearly-1m-are-incarcerated-in-rural-america-60-in-prisons-and-25-in-local-jails-soon-without-medical-care/.
[3] Emily Widra, Almost Half of All Incarcerated People Are in Rural Jails and Prisons and at Risk of Losing Access to Hospitals, PRISON POL’Y INITIATIVE (Oct. 28, 2025), https://www.prisonpolicy.org/blog/2025/10/28/rural-prisons-jails-hospitals/.
[4] See discussion infra Part III.
[5] Mia Ives-Rublee & Kim Musheno, The Truth About the One Big Beautiful Bill Act’s Cuts to Medicaid and Medicare, Ctr. for Am. Progress (July 3, 2025), https://www.americanprogress.org/article/the-truth-about-the-one-big-beautiful-bill-acts-cuts-to-medicaid-and-medicare/.
[6] Rural Hospitals at Risk: Cuts to Medicaid Would Further Threaten Access, Am. Hosp. Ass’n (June 13, 2025), https://www.aha.org/fact-sheets/2025-06-13-rural-hospitals-risk-cuts-medicaid-would-further-threaten-access (“48% of rural hospitals operated at a financial loss in 2023.”).
[7] See infra notes 8–11 and accompanying text.
[8] Id.
[9] Id.
[10] See Ives-Rublee & Musheno, supra note 5 (“[T]he OBBBA will cut federal spending on Medicaid and Children’s Health Insurance Program (CHIP) benefits by $1.02 trillion[.]”).
[11] See supra note 9 and accompanying text.
[12] Ives-Rublee & Musheno, supra note 5.
[13] Id.
[14] See supra note 6 and accompanying text.
[15] See infra notes 21–26 and accompanying text.
[16] See discussion supra Part II.
[17] Widra, supra note 3.
[18] Laura M. Maruschak, Maternal Healthcare and Pregnancy Prevalence and Outcomes in Prisons, 2023, U.S. Dep’t of Just.: Bureau of Justice Statistics (Apr. 2025), https://bjs.ojp.gov/document/mhppop23.pdf.
[19] Leah Wang, Unsupportive Environments and Limited Policies: Pregnancy, Postpartum, and Birth During Incarceration, PRISON POL’Y INITIATIVE (Aug. 19, 2021), https://www.prisonpolicy.org/blog/2021/08/19/pregnancy_studies/.
[20] Blatstein, supra note 2.
[21] Maternity Care Desert Report Reveals Millions Unable to Access Care, MARCH OF DIMES (Sep. 10, 2024), https://www.marchofdimes.org/about/news/maternity-care-desert-report-reveals-millions-unable-to-access-care (“More than one-third of US counties are now classified as maternity care deserts, which is a county with no birthing facilities or obstetric clinicians.”).
[22] March of Dimes, Nowhere to Go: Maternity Care Deserts Across the US 8 (2024), https://www.marchofdimes.org/sites/default/files/2024-09/2024_MoD_MCD_Report.pdf.
[23] Aduragbemi Banke-Thomas et al., Inequalities in Geographical Access to Emergency Obstetric and Newborn Care, Bull. of the World Health Org., Oct. 2024, at 837, 837.
[24] See supra notes 21–23 and accompanying text.
[25] Elizabeth Swavola, Kristine Riley & Ram Subramanian, Overlooked: Women and Jails in an Era of Reform 15 (2016), https://vera-institute.files.svdcdn.com/production/downloads/publications/overlooked-women-and-jails-report-updated.pdf?dm=1568746265.
[26] See supra note 20 and accompanying text.
[27] Estelle v. Gamble, 429 U.S. 97, 102–03 (1976).
[28] E.g., Monmouth Cnty. Corr. Institutional Inmates v. Lanzaro, 834 F.2d 326, 349 (3d. Cir. 1987).
[29] See Kate Bock, Abortion Access for Incarcerated People Post-Dobbs, 30 Mich. J. Gender & L. 277, 296 (2024)
(“Because everything moves more slowly through jail bureaucracy, and because pregnant folks depend on prison staff to get the care they need, burdensome requirements placed on abortion access—including limitations on providers, shortened timeframes, and restrictions on the kinds of abortifacients—pose that much more of an obstacle for incarcerated people. . . . Incarceration does not mean people will be insulated from the restrictions being passed; rather, jails and prisons are where the effects will be felt the hardest.”).
[30] See supra notes 22–25 and accompanying text.
[31] See supra note 29 and accompanying text.
[32] See supra notes 8–11 and accompanying text.
[33] See discussion supra Parts II–III.
[34] See Estelle v. Gamble, 429 U.S. 97, 103 (1976); see also Monmouth Cnty. Corr. Inst. Inmates v. Lanzaro, 834 F.2d 326, 349 (3d. Cir. 1987) (finding that incarcerated women are entitled to abortion access under the Eighth Amendment).
[35] See discussion supra Part III.
[36] See discussion supra Parts II–III.
[37] See supra note 20 and accompanying text.
[38] See generally Dobbs v. Jackson Women’s Health Org., 597 U.S. 215 (2022) (finding that the U.S. Constitution does not provide a right to abortion and that abortion regulation must be returned to the states); see also Talia Curhan, State Bans on Abortion Throughout Pregnancy, guttmacher Inst. (Jan. 30, 2026), https://www.guttmacher.org/state-policy/explore/state-policies-abortion-bans (“41 states have abortion bans in effect[.]”).
[39] See discussion supra Part III.
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