The U.S. House made it official Thursday, passing the so-called Big Beautiful Bill in a vote of 218-214. The bill, hailed by President Donald Trump and Speaker Mike Johnson, is projected to strip at least 17 million people of health insurance over the next decade and add $3-4 trillion to the national debt. And while there are plenty of predictions about what the massive cuts to Medicaid will do to hospital systems around the country long term, we won’t have to wait too long to see the impact. Medical providers are already slashing jobs and closing clinics.

The bill will create about $930 billion in cuts to Medicaid, something that President Trump and his Republican cronies insist won’t happen. But health care providers are telling a different story, with one clinic in rural Nebraska blaming its closure on the plans for Medicaid.

Community Hospital in Curtis, Nebraska, is closing its doors according to a new report from local TV station KLKN. “Unfortunately, the current financial environment, driven by anticipated federal budget cuts to Medicaid, has made it impossible for us to continue operating all of our services, many of which have faced significant financial challenges for years,” Community Hospital CEO Troy Bruntz said in a statement to the news outlet.

A study by the University of North Carolina, commissioned by Senate Democrats, found that 338 rural hospitals will be at risk of closing thanks to the GOP bill. But it’s not just rural hospitals already feeling the pinch. Two of San Diego, California’s largest medical providers announced layoffs in the last week. UC San Diego Health is laying off 230 workers and cited “mounting financial pressures” as a result of “federal impacts to health care,” including poor reimbursement rates for Medicare and Medicaid, in a memo seen by the San Diego Union Tribune.

Sharp Healthcare, San Diego County’s biggest provider, also announced it was laying off 315 employees who will work through early September. Executives at Sharp are also taking pay cuts, with CEO Chris Howard asking the board to cut his pay by 25%, according to the San Diego Union Tribune.

Bea Grause, president of the Healthcare Association of New York State told the Times Union that hospitals are going to feel this. “It’s a fiscal pandemic,” Grause said. “Medicaid is an important funder for all hospitals, and so it will financially hurt almost every hospital across the state of New York—and hospitals are central to the economy of each community. That’s what the average New Yorker should be concerned about.”

Many Americans probably don’t even know they’re on Medicaid, given the fact that each state administers its own program and has a different name for it. In California it’s called Medi-Cal, in Massachusetts it’s called MassHealth, and in New Jersey it’s called NJ FamilyCare. But people also don’t seem to understand that Medicaid helps hospitals pay for things that help everyone more broadly and pulling the rug out from under them will have ripple effects.

The Congressional Budget Office estimates 11.8 million people will lose Medicaid coverage between now and 2034, according to the Washington Post, but the bill also abolishes other subsidies for the Affordable Care Act that the CBO estimates will dump another 4.2 million people. Another 1 million on top of that will lose their coverage because of other health provisions in the bill, bringing the grand total to somewhere around 17 million people over the next decade.

When people lose their health insurance it doesn’t mean that they’re not going to need help. As Sen. Catherine Cortez Masto, a Democrat from Nevada, pointed out during a virtual roundtable this week, these cuts will “devastate health care in Nevada,” and people will go to the ER after they get sick enough.

“More people now are going to be showing up in our emergency rooms with acute care because they now have lost the health care that they need to even provide preventative care for them,” Cortez Masto said, according to the Nevada Current.

The Republicans insist that Democrats are just fear-mongering and that nobody is going to lose their Medicaid coverage. Some Republicans will admit that people are going to get stripped of their health insurance, but they insist it’s all about fighting “waste, fraud, and abuse.” We’ll see how many people who lose their health care in the coming years feel when they’re simply dubbed fraudsters.