OMAHA, Neb. (AP) — Tyler Sherman, a nurse at a rural Nebraska hospital, is used to the area’s aging farmers delaying care until they end up in his emergency room.

Now, with Congress planning around $1 trillion in Medicaid cuts over 10 years, he fears those farmers and the more than 3,000 residents of Webster County could lose not just the ER, but also the clinic and nursing home tied to the hospital.

“Our budget is pretty heavily reliant on the Medicaid reimbursement, so if we do see a cut of that, it’ll be difficult to keep the doors open,” said Sherman, who works at Webster County Community Hospital in the small Nebraska town of Red Cloud just north of the Kansas border.

If those facilities close, many locals would see their five-minute trip to Webster County hospital turn into a nearly hour-long ride to the nearest hospital offering the same services.

“That’s a long way for an emergency,” Sherman said. “Some won’t make it.”

Already struggling hospitals would be hit particularly hard

States and rural health advocacy groups warn that cutting Medicaid — a program serving millions of low-income and disabled Americans — would hit already fragile rural hospitals hard and could force hundreds to close, stranding some people in remote areas without nearby emergency care.

More than 300 hospitals could be at risk for closure under the Republican bill, according to an analysis by the Cecil G. Sheps Center at the University of North Carolina at Chapel Hill, which tracks rural hospital closures. Even as Congress haggled over the controversial bill, a health clinic in the southwest Nebraska town of Curtis announced Wednesday it will close in the coming months, in part blaming the anticipated Medicaid cuts.

Bruce Shay, of Pomfret, Connecticut, fears he and his wife could be among those left in the lurch. At 70, they’re both in good health, he said. But that likely means that if either needs to go to a hospital, “it’s going to be an emergency.”

Day Kimball Hospital is nearby in Putnam, but it has faced recent financial challenges. Day Kimball’s CEO R. Kyle Kramer acknowledged that a Senate bill passed Tuesday — estimated to cut federal Medicaid spending in rural areas by $155 billion over 10 years — would further hurt his rural hospital’s bottom line. Roughly 30% of Day Kimball’s current patients receive Medicaid benefits, a figure that’s even higher for specific, critical services like obstetrics and behavioral health.

“An emergency means I’m 45 minutes to an hour away from the nearest hospital, and that’s a problem,” Shay said. And he and his wife wouldn’t be the only ones having to make that trip.