I run rural Missouri health clinics. Trump’s Big Beautiful Bill will cut deep | Opinion

At a Fourth of July celebration full of fireworks and fanfare, President Donald Trump signed the One Big Beautiful Bill into law — a sweeping package of tax breaks and spending cuts. Supporters hailed it as historic, a win for American families and small businesses. But from where I sit — inside a rural health clinic at the Lake of the Ozarks — the view is far more sobering.

Because buried beneath those headline-grabbing tax cuts are deep structural changes to health care funding that threaten the very survival of rural clinics like mine.

I’m not writing this as a partisan. I’m writing as a family doctor and as chief medical officer at Central Ozarks Medical Center which serves more than 20,000 patients across five counties in central Missouri. We care for veterans, farmers, children, older adults and people recovering from addiction. We keep our doors open because of federal programs such as Medicaid and the 340B drug pricing program. This new law puts all of that at risk.

Let’s start with Medicaid. Missouri voters expanded it in 2020, and more than 300,000 residents have gained coverage since then. But the new law imposes work requirements for adults age 19 to 64 — mandating at least 80 hours of employment per month to keep coverage, with only narrow exemptions.

On paper, that may sound fair. In practice, it means patients with chronic illness, caregiving duties or no transportation may lose access to care. The Congressional Budget Office estimates that 16 million Americans could lose coverage by 2034 as a result of these changes.

We’ve seen this before. In Arkansas, similar rules led to 18,000 people losing coverage in a matter of months — many because they couldn’t navigate the online reporting system. Now imagine applying that policy in rural Missouri, where broadband is spotty and digital literacy is limited.

And Medicaid isn’t the only target. The law also changes SNAP — the program formerly known as food stamps — raising the work requirement age from 54 to 64. Only parents of kids under 14 are exempt. As a physician, I see what hunger does to health: unstable blood sugar, malnourished children, older adults skipping meals to afford prescriptions. These cuts won’t make people more self-sufficient. They’ll make them sicker.

Then there’s 340B — a lifeline for clinics such as ours. This program allows us to purchase medications at steep discounts and reinvest the savings into behavioral health services, addiction treatment, and our pharmacy in Camdenton. That pharmacy provides low-cost insulin, antibiotics, and mental health medications to patients who often drive 30 to 60 minutes to reach us. If Medicaid coverage drops, so does our 340B eligibility. And with it, those services disappear.

One of my patients, a woman in her 50s, came in recently with shortness of breath. She’d lost her Medicaid coverage and was terrified to be seen without insurance. We treated her anyway. Labs, imaging, consults — absorbed into our already thin budget. She was diagnosed with early chronic obstructive pulmonary disease. But under this law, we may not be able to keep doing that.

Uninsured rates will rise. Clinics will close. Access will shrink. And people will wonder: How did we let this happen?

Missouri lawmakers who voted for this bill — Sens. Josh Hawley and Eric Schmitt, Reps. Ann Wagner, Bob Onder, Sam Graves and others — celebrated it as a win for the “America first” agenda. But to those of us delivering care in the Ozarks, it feels like being left behind.

Yes, the bill includes new tax cuts: a bump in the child tax credit, a $6,000 senior deduction and limited deductions for tips and overtime pay. But these changes won’t help if you’ve lost your coverage, your pharmacy or your local clinic.

This isn’t just about money. It’s about dignity. About whether a single mom in Richland or a veteran in Iberia will be able to see a doctor or afford medicine.

The One Big Beautiful Bill may have passed in Washington. But the real story is unfolding in exam rooms like mine — quietly, urgently and out of view.

We’ll keep showing up. We’ll keep fighting for access. Because rural lives matter. And we are not disposable.