its hard to say for sure. I haven't played Sardinia-Piedmont much, and not since I got ahd. I highly doubt its from the health care reforms. All that effectively does is raise your population growth which is good.
Have you checked the prices of the goods you mainly produce? Are your factories struggling? Are you subsidizing the factories?
Also what is your administration efficiency like? First step for most countries is NFing bureaucrats in the most populated states and then moving on down the list until your admin efficiency is 100%. It makes tariffs more efficient, it makes all your government cost cheaper, and it also makes NFing more efficient, so when you try to NF other Pops in the future everything happens faster.
If you are really struggling to make a profit, research technologies that boost your farm and mine production, or increase tax efficiency. When you have enough colonies or prestige to get the goods it requires to run a successful industry, then start focusing on capitalist, clerks, craftsmen, and commerce techs, specifically the ones that increase input or output efficiency. Having a high level of railroads and good natural pop growth is important as well, so don't skimp on those technologies.
Even being sphered, you should be able to stay afloat if you lower your national stockpile spending, and education spending. See what is costing you so much, and/or where all your income disappeared from and try and remedy it.
