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61 percent of America’s most financially vulnerable hospitals are in cities. 🏙️
That number stopped me cold when I read it.
Everyone in this space has been told the same story for the past year. The cuts hurt rural hospitals. Rural communities. Rural patients. And yes, that is true and it is devastating.
But new research cited by The American Prospect is cracking that narrative open.
National Nurses United identified 602 financially vulnerable hospitals across 47 states. Together, they are running an aggregated deficit of about $10.2 billion right now. When the full impact of the One Big Beautiful Bill Act hits, researchers project that deficit will balloon to between $15.4 billion and $17.9 billion.
⚠️ And 366 of those 602 hospitals are in metropolitan areas. Nearly 61 percent.
The breakdown by state tells the story:
– California: 67 financially vulnerable hospitals, the most in the country
– New York: 40
– Texas: 35
Dan Johnston, National Nurses United Director of Research, put it simply. “It’s not just a rural problem. This is going on all over.”
He is right. And here is what that means for everyone reading this who works in or around FQHCs.
These are not random hospitals. The financially vulnerable hospitals in cities are the ones serving communities of poor and working-class people, according to The American Prospect. The exact same patients who walk through FQHC doors every single day. These hospitals and community health centers are not competitors. They are ecosystem partners.
💡 When a safety-net hospital in a dense urban neighborhood closes or cuts services, the FQHC three blocks away absorbs that patient volume. With no additional funding. No additional staff. No warning.
On top of this, ACA enrollment has already dropped by about 4.2 million people as of February 2026, after insurers raised prices by an average of 114 percent for enrollees who simply wanted to stay on the same plan.
So the centers we serve are simultaneously facing more uninsured patients showing up at the door, fewer reimbursable encounters, and a hospital partner network under severe financial stress.
This is not a future problem. It is a now problem.
I think the field needs to stop treating urban safety-net collapse as someone else’s issue. Whether your center is in the Bronx, South Side Chicago, or a small Texas town, this erosion is coming for the entire ecosystem we built to serve people who have nowhere else to go.
The number that should scare everyone is not the deficit size. It is the 4.2 million people who already lost coverage and are now navigating a system with fewer doors open to them.
👉 Follow Jonathan Govette, CEO of Oatmeal Health, for daily healthcare insights on LinkedIn. Deeper dives in The Oatmeal Bite on Substack: https://news.oatmealhealth.com
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Author:
CEO/Co-Founder @ Oatmeal Health | AI Lung Cancer Screening | Almost Became a Doctor | Engineer | Follow to Share What I’ve Learned Along the Way
I help patients get the care they need earlier, preventing late-stage cancer.
That’s been the throughline across three companies and almost 20 years in healthcare. At ReferralMD, we fixed broken referral networks so patients didn’t fall through the cracks. At Oatmeal Health, it’s lung cancer: building the diagnostic and screening infrastructure so the 85% of cases caught too late get caught early instead.
Today as CEO of Oatmeal Health, I lead a team embedding AI into radiology workflows to turn routine lung CT scans into reimbursable cancer risk assessments. We partner with FQHCs to reach underserved communities, and with health systems and payers to make early detection economically sustainable. Think HeartFlow or Cleerly, but for lungs.
Between companies, I advised at Techstars and Plug and Play, mentoring founders building in digital health. That experience shaped how I think about what separates companies that ship from companies that stall: distribution, reimbursement, and clinical trust, not just technology.
I’m a CancerX alumnus, a 3x healthcare founder, and someone who believes the biggest problems in cancer aren’t scientific. They’re operational.
We’re hiring mission-driven builders at Oatmeal Health. If you want to work on something that matters, reach out.
When I’m not working, I’m traveling, mentoring, and keeping up with one very energetic husky. 🐾
Substack – The Oatmeal Bite:
Millions of patients get less care because of who they are, where they live, or how they look. I’m fighting to change that. CEO @OatmealHealth, a startup built for the underserved. The Oatmeal Bite: intel for clinicians, investors, and advocates.
Jonathan Govette
CEO of Oatmeal Health
Substack:
https://oatmealhealthjonathangovette.substack.com/
