SINCE IT WAS founded in 1866, St Barnabas Hospital in the Bronx has “changed millions of times”, says David Perlstein, its president and a former paediatrician. “It used to be a rich person’s hospital. We used to make money!” he exclaims. Those days seem far off. The former Home for Incurables, now more optimistically known as SBH Health System, is a safety-net hospital. Two-thirds of local residents are on Medicaid, the health programme for the hard-up. In the hospital’s congressional district, 100,000 are expected to lose their insurance in the wake of the One Big Beautiful Bill. Dr Perlstein predicts that the hospital will lose $75m, 12% of its budget. “We don’t have that kind of fat in our system. We just don’t,” he says. “If I lay folks off, I’m going to be closing services.”