Major Medicaid cuts in Trump’s tax bill could hit rural voters especially hard -- giving organizers hope the party can make improvements in these areas in the midterms.

It comes as rural hospitals – defined as any hospital outside a metro – are already struggling. Twenty hospitals in Iowa were at immediate risk of closing before the bill was passed, according to the Center for Healthcare Quality and Payment Reform. It was 17 in Illinois.

Rural hospitals across the U.S. say they’re being forced to consider tough choices — like cutting services for children or cancer patients — after President Donald Trump signed into law a sprawling domestic policy bill that includes sweeping cuts to not only Medicaid but the Affordable Care Act,