After Rita Buckley slipped on a sidewalk, hitting her jaw so hard she broke four teeth and sustained a traumatic brain injury, she struggled to tell red and green apart. Turning her head could make her lightheaded or, worse, spark a devastating headache. She fought to remember basic daily tasks. Driving became impossible, as did the idea of continuing to work as a nurse.<\/p>\n
But at Buffalo Therapy Services, a clinic near her home in the suburb of East Aurora, New York, Buckley felt hopeful. For more than a year, she worked diligently with the clinic\u2019s cognitive and occupational therapists. They took her into the darkened staff room and flashed red and green lasers so she could relearn the difference. They taught her to write everything down, to help with her lack of short-term memory. They made a list of what she wanted to accomplish, and told her: \u201cWe\u2019re not going to work on what you can\u2019t do any more. We\u2019re going to work on what you can do.\u201d<\/p>\n
\u201cThey made me focus on my strengths,\u201d Buckley said. \u201cI believe my therapists helped me find a different way to bring meaning and purpose to my life.\u201d<\/p>\n
But in August, Buffalo Therapy Services\u2019 parent group \u2013 Kaleida Health, the largest healthcare provider in western New York \u2013 revealed that it would effectively close two of the clinic\u2019s locations, in part due to colossal healthcare funding cuts included in Donald Trump\u2019s sweeping tax-and-spending legislation, the so-called One Big Beautiful Bill Act. Buffalo Therapy Services wasn\u2019t the only casualty: Kaleida also announced plans to shutter a freestanding surgery center and a family planning center.<\/p>\n
Many patients treated at these facilities now say they have nowhere else to go. The two clinics are technically still open, but not offering clinical services to patients.<\/p>\n
Buckley, who is 74, last saw her cognitive and occupational therapists in November. She\u2019s on a waiting list for cognitive therapy; she\u2019s hoping that she\u2019ll be able to see her occupational therapist at a new location in 2026. But nothing is certain. As she waits for care, Buckley worries that her hard-won skills will atrophy.<\/p>\n
Rita Buckley, left, and her daughter Sarah Buckley review notes.<\/p>\n
\u201cI know it was going to come to me,\u201d Buckley said of the One Big Beautiful Bill Act\u2019s cuts. \u201cI just didn\u2019t realize it would be so fast.\u201d<\/p>\n
Signed into law this summer, Trump\u2019s One Big Beautiful Bill Act \u2013 as the legislation known as HR 1 is more colloquially known \u2013 extends tax cuts from Trump\u2019s first term while ripping at the US social safety net. Over the next three years, the US government will slash more than $1tn in federal healthcare funding by making it more difficult for some people to obtain insurance through the Affordable Care Act, Barack Obama\u2019s signature piece of legislation, and shrinking the number of people eligible for Medicaid, the government insurance program for low-income people, among dozens of other changes<\/a>.<\/p>\n Ultimately, the Congressional Budget Office estimates that about 10 million people will lose health insurance due to the One Big Beautiful Bill Act. That dramatic drop, experts say, will not only keep people who rely on Medicaid from accessing care, but also imperil providers\u2019 ability to offer services and stay open. Entire communities could lose access to healthcare.<\/p>\n \u201cHospitals will likely be seeing fewer paying patients, they\u2019ll likely be providing more uncompensated care to patients, and that means their finances could take a hit,\u201d said Zachary Levinson, who studies hospitals and health systems\u2019 financial practices at the health policy organization KFF. \u201cHospitals that treat a large number of Medicaid patients, safety-net hospitals, will take a relatively large hit from the law.\u201d<\/p>\n The One Big Beautiful Bill Act has put more than 300 rural hospitals at risk of closure or cutting services, according to an analysis by the University of North Carolina at Chapel Hill<\/a>. Harvard researchers identified another 90 or so urban hospitals<\/a> whose ability to keep their doors open is also threatened by the bill. Healthcare groups across the US have already started to close locations, cut services and lay off staff<\/a>.<\/p>\n The House speaker, Mike Johnson, has defended the One Big Beautiful Bill Act, whose tax cuts will predominantly benefit the wealthy, by arguing that its changes will prevent waste and fraud. The bill, he told NBC News<\/a>, \u201cstrengthens Medicaid for the people who actually need it and deserve it\u201d.<\/p>\n But Timothy Kennedy, a Democratic congressman and trained occupational therapist whose district includes Buffalo, called the facility closures in his hometown \u201ca warning sign of a broader national pattern\u201d.<\/p>\n \u201cWhen hospitals close, when nursing homes close, when clinics close and people cannot get their healthcare in their communities, they go without it,\u201d Kennedy said. \u201cAnd they die.\u201d<\/p>\n Kaleida Family Planning Center in Buffalo.<\/p>\n With one in four US hospitals<\/a> characterized as in \u201cfinancial distress\u201d, much of the US healthcare system was stretched to its breaking point long before Trump took his Sharpie to the One Big Beautiful Bill. One 2022 report by the Healthcare Association of New York<\/a> found that 64% of New York state hospitals were operating in the red, in part due to the rising cost of labor, drugs and equipment. Medicaid and Medicare \u2013 the government insurance program for people over 65 \u2013 also don\u2019t pay hospitals enough money to adequately reimburse them for the cost of care.<\/p>\n Kaleida Health had already planned to launch a $200m \u201cstrategic plan\u201d to address some of those challenges, a spokesperson said in an email. \u201cWhat the federal bill did was accelerate the implementation of that plan,\u201d the spokesperson said. \u201cIt\u2019s added to the size of the challenge and the pace at which we need to implement and execute.\u201d<\/p>\n Kaleida estimates that it will lose up to $125m a year due to the One Big Beautiful Bill Act.<\/p>\n When news of the Kaleida closures broke, patients and providers rallied. Sarah Buckley, Rita Buckley\u2019s daughter, works both as a nurse at a Kaleida hospital and as the political and legislative director for Communication Workers of America Local 1168 (CWA 1168), which represents several Buffalo Therapy Services employees. To raise awareness of the closures, Sarah Buckley organized a small meeting at her union\u2019s office with elected officials. She expected about 12 people to attend.<\/p>\n About 75 showed up.<\/p>\n Rita Buckley, left, and her daughter Sarah.<\/p>\n \u201cIt was standing room only,\u201d Sarah Buckley recalled.<\/p>\n Gina Passantino took to regularly calling her state representative, her congressman \u2013 Kennedy \u2013 and officials at Kaleida. Passantino had spent a decade undergoing physical therapy at Buffalo Therapy Services, where her therapist helped ease overwhelming pain in her shoulder and neck. Without that therapy, Passantino said she\u2019s started to fear going to sleep, because she can only sleep two, maybe three hours at a time before she wakes up in pain.<\/p>\n \u201cIt makes me depressed. I\u2019m anxious because I don\u2019t know how I\u2019m going to be fixed,\u201d Passantino said. \u201cI take Advil. I take a muscle relaxer at night. I try to stretch. I try to stay as active as I can be. And sometimes I cry a lot, even though that doesn\u2019t really get me anywhere.\u201d<\/p>\n Her voice ragged with tears, Passantino continued: \u201cMy therapist \u2013 I will tell you, he has literally saved my life. That is not hyperbole.\u201d<\/p>\n New York department of health regulations require that healthcare facilities obtain permission to close, which the department has not granted Kaleida. A Kaleida spokesperson said that the two Buffalo Therapy Services locations slated for closure are still staffed, to assist walk-in patients and callers, but they are no longer providing clinical care. The family planning center is still seeing patients and will remain open until the health department authorizes its closure, but the surgery center has not seen patients since October.<\/p>\n New York health regulations also require that, before closing, facilities identify other places where patients can obtain care. Passantino said that although Kaleida recommended that she seek services at two other local clinics, neither clinic offers the therapy she needs. According to Passantino, the clinics also told her that, even if they had offered the right therapy, their providers didn\u2019t have the capacity to take on all of Buffalo Therapy Services\u2019 former patients.<\/p>\n \u201cThere\u2019s a huge void in this area now for care,\u201d Passantino said.<\/p>\n A Kaleida spokesperson said that the organization sent letters to all patients who are being affected by the closures with information about obtaining care elsewhere. It is also willing to work with patients one-on-one.<\/p>\n Buffalo Therapy Services in Williamsville, New York.<\/p>\n \u201cKaleida Health has been very transparent with the Department of Health about the challenge of the Department of Health requirement to notify all impacted stakeholders prior to submitting our closure plans,\u201d the spokesperson wrote in an email. \u201cWhen we do that, naturally providers, staff and patients begin seeking other options for employment and care. As that occurs, it increases the challenge of continuing operations, staffing and care at the site[s].\u201d<\/p>\n In a statement this month, CWA 1168 deemed the Buffalo Therapy Services facilities closed. Between the changes at Buffalo Therapy Services, the family planning center and the surgery center, at least 50 positions have been eliminated, according to the union.<\/p>\n As more and more of the One Big Beautiful Bill Act\u2019s cuts take effect, Sarah Buckley worries that hospitals will become less safe for patients. In the days before Trump signed the One Big Beautiful Bill, New York hospital trade groups estimated<\/a> that its passage would lead hospitals to cut 34,000 jobs.<\/p>\n \u201cAs a nurse, you always have to tell people: \u2018You gotta have a loved one there. You can\u2019t leave them there by themselves.\u2019 You assume that that kind of care is available, but it\u2019s not. Especially at times like these,\u201d Sarah Buckley said. \u201cYour loved one is gonna have to be in their bed soiled if they can\u2019t look after themselves.\u201d<\/p>\n She added: \u201cEven small cuts have such a terrible impact on our patients, but a cut that is as big as this, in terms of the human suffering that will create \u2013 it\u2019s actually immeasurable.\u201d<\/p>\n