# Government Hospital A **government hospital** (or public hospital) is owned and operated by a government — state, county, or municipal ("County General"), or federal ([[Department of Veterans Affairs]]). Public hospitals are about **18% of U.S. hospitals** and include many urban [[Safety-Net Hospital]] facilities that carry a disproportionate share of uncompensated and emergency care. ## Why It Matters This is the layer most exposed to **budget politics**. Public hospitals depend on [[Medicaid]] reimbursement and direct appropriations, which makes them the first casualty of [[Medicaid Work Requirements]], rate cuts, and the spending fights tracked in [[Budget Hub]]. A third of rural hospitals are government-owned, versus about 10% of urban hospitals — so contraction at this layer maps directly onto [[Rural Hospital Closures]]. Unlike the privately owned models, the federal government's role in the broader system is overwhelmingly as **payer** ([[Medicare]], [[Medicaid]], [[CMS]]) rather than owner — the U.S. exception explored in [[Healthcare Industry Ecosystem]].