The city’s cash-strapped public hospital system is facing dire new financial problems because of sweeping changes planned for Obamacare, according to a report released released Tuesday.

The Independent Budget Office said at a time when more than $1 billion in anticipated federal and state funds have not been secured by NYC Health + Hospitals, the agency’s fiscal future remains “highly dependent on the outcome of the health care debate in Washington.”

“The current House Republican plan, released on March 6, would place a heavy burden on H+H in the coming years,” the IBO said.

“The plan would gradually reduce the federal government’s support by introducing per capita caps to Medicaid and reduce the federal matching rate for … Medicaid expansion starting in 2020.

The IBO also found that the city’s contribution to the hospital system is expected to increase by 4 percent and hit $1.9 billion by 2020 – even as inpatient and outpatient visits drop.

The report cites agency figures for July through November 2016 showing inpatient visits dropping by 3.4 percent and outpatient visits 7.2 percent. H+H blamed the decline in outpatient visits on “undesirable locations of some of its facilities and greater competition for patients in the communities served.”