By Madeline de Figueiredo, The Daily Yonder
September 22, 2025

In the early hours of the morning, Amy Klingler, a primary care physician assistant in Stanley, Idaho, answered a call from a panicked patient. The woman was experiencing severe lower abdominal pain and had been vomiting for hours. She said she feared she might be suffering from an ectopic pregnancy—a serious, potentially fatal condition. But even in that moment of crisis, the patient hesitated to seek emergency care.

“She was calling me at three o’clock in the morning wondering what to do. She didn’t really want to go to the emergency room,” Klingler said. “She’d been sick for several hours and hadn’t gone because she didn’t have insurance. And then, of course, the fears about reproductive health care in Idaho.” 

Klingler said that while treatment of ectopic pregnancies is legal in Idaho, concerns about access to reproductive care often cause patients to delay both preventative and emergency treatment. 

“That was another really heartbreaking thing for me, that this person was in pain, throwing up for several hours, was afraid to go to the ER, was afraid about the bill from the ER.”

Eventually, the patient sought emergency medical attention and was treated for appendicitis. 

Since the Supreme Court overturned Roe v. Wade in 2022, Idaho has enacted one of the strictest abortion bans in the country. Physicians can face felony charges and prison time for providing abortion care. A July study found that, following the implementation of the abortion ban, Idaho lost 35% of its OBGYN providers, worsening the landscape of maternity care deserts and further straining access to care.

Maternity care deserts are counties with no hospital or birth center offering obstetric care and no obstetric clinicians. According to data collected by March of Dimes, 32% of Idaho’s counties are maternity care deserts. 

Now, those pressures are expected to deepen. The federal budget reconciliation bill, passed by Congress in July, significantly tightens Medicaid eligibility and benefits by adding work requirements, more frequent income checks, cost-sharing, and restrictions on non-citizens. Providers said these changes are already creating hurdles and could lead to major coverage losses and reduced access to care.

As providers race to keep pace with increased patient volume, more emergencies, and changing insurance coverage, the new federal policies threaten to exacerbate provider shortages, erode access, and deepen fear around seeking health care. 

Barriers to Access

Idaho expanded Medicaid in 2020 after voters approved a ballot initiative, extending health coverage to an additional 90,000 Idahoans, bringing the total enrollment to around 355,000 adults and children. But now, both state and federal policymakers are rolling back parts of that expansion. 

The budget reconciliation bill introduced major changes to Medicaid, including requiring expansion enrollees to recertify eligibility every six months, a shift that could trigger significant coverage losses due to administrative hurdles. It also imposed work requirements, cost-sharing, limits on non-citizen coverage, and tightened eligibility rules. Preliminary estimates suggest 40,000 Idahoans could lose Medicaid, while another 35,000 could lose marketplace insurance.

Klingler is already seeing the consequences of the recertification process play out with her patients. 

“The administrative burdens and the recertification burdens are what is going…to really impact people,” she said. “I have had patients in the last month try to recertify and run into barriers.” 

Anthony Wright, executive director of Families USA, a nonprofit advocacy group focused on affordable, high-quality health care for all Americans, said that the cuts to Medicaid will affect both patients and health care systems. 

“The cuts to Medicaid and the ACA will have devastating and dramatic impacts on health coverage, care, and costs for American families, and in many ways especially in Idaho. The cuts will not just mean that tens of thousands of Idaho residents lose coverage, but federal cuts will force state budgets into crisis, forcing states to drastically scale back services, leading to closures of rural hospitals and community clinics,” said Wright in a statement.

Clinicians are bracing for these impacts. 

“We anticipate a lot more uninsured people over the next several years because of Medicaid funding loss and Medicaid expansion restrictions,” Klingler said. 

Dr. Brenna McCrummen, an OBGYN in Kootenai County, has already witnessed the impact of worsening maternity care deserts. Bonner General Health, the only hospital with OBGYNs in Bonner County, located directly north of Kootenai County, closed its obstetrics services in 2023.

All four OBGYNs from Bonner County told NBC that Idaho’s strict abortion laws influenced their decision to leave. As a result, patients now have to travel hours for care, including to see Dr. McCrummen.

“We have patients who drive two to three hours to come see us for prenatal appointments and to deliver in Kootenai County,” Dr. McCrummen said. “It’s quite a lot and some of them don’t have transportation.”

Dr. McCrummen said that many of her patients are covered by Medicaid, including those that travel from Bonner County. 

“The Medicaid population is large, especially in the rural areas that we take care of to the north,” she said. “They have already been kind of displaced in terms of not having providers close to their home. And so in addition now to traveling far to come see us, those who will no longer be on Medicaid find many different barriers to care.”

Spikes in Emergency Care

Dr. McCrummen said that when people lose insurance coverage, it adds to the barriers they already face in accessing care, particularly in rural areas. These compounding obstacles often lead patients to delay treatment, turning manageable health issues into emergencies.

“They’re already traveling, they’re already disadvantaged, and now you’ve just delayed their care even more. And delaying their care, of course, can make problems worse by the time they get to us,” Dr. McCrummen said. “There are more ED visits, their problems are worse because they haven’t been cared for as they should have been, and they have bad outcomes because they’re further disadvantaged from seeking care.” 

These delays, she explained, extend far beyond just obstetrics situations and affect every aspect of women’s health.

“Pap smears, preventative care, birth control, STI testing, all of those things are going to be harder to get,” she said. 

Without access to routine screenings and evaluations, Dr. McCrummen warned, common conditions can escalate into dangerous health crises.

“[For example], women who have abnormal bleeding and can’t be seen or evaluated can then become very anemic and it’s very dangerous,” Dr. McCrummen said. “So it absolutely impacts not just obstetric care, but all of women’s health care across the board.”

In Stanley, Klingler counsels her pregnant patients on acquiring insurance for emergency medical flights. 

“We have a couple pregnant people in the community right now, and one of them is set to deliver in March,” Klingler said. “She saw the OBGYN for her first visit recently, and I was reading the notes, and he was already talking about, okay, you need to have air ambulance insurance.” 

Klingler said two air ambulance services operate in the area, and residents can purchase memberships for coverage.

“We encourage everyone, really, in our community to have that [membership],” Klingler said. “If you do get a helicopter ride out of our community, those helicopter rides are probably anywhere from $25,000 to $50,000 if you were to have to pay out of pocket. Health insurance does cover those emergency flights, but even a 20% copay on that can be really impressive and difficult.”

“It’s all the conversations that we have to have. And then with challenges in health care, with some of the restrictions in Idaho, those things have become even more important,” she said. “So the smaller communities are really being hit the hardest.”

Risks to Providers

The penalties for providing abortion care in Idaho are among the harshest in the country, prompting many physicians to leave the state and deepening an already growing provider shortage. 

Amber Nelson, executive director of the Idaho Coalition for Safe Healthcare, clinician-led group advocating for safe, legal, and evidence-based medical care in Idaho, said the state’s laws are forcing doctors to choose between legal compliance and best medical practices.

“Right now, in this state, our providers have to choose to follow the law or follow medical standards of care,” Nelson said. “And if they choose medical standards of care, they can be threatened with criminal activity. They can be fined, they can be imprisoned. They can have their medical licenses taken away from them, which makes it a less-than- friendly place to practice medicine.” 

Providers say that Idaho’s hostile legal climate is already discouraging new physicians from practicing in the state, and with patient volume on the rise, upcoming Medicaid cuts are expected to make recruitment and retention even more difficult.

“As we see increased volumes, we’re not going to be able to add providers to help take on those volumes,” Dr. McCrummen said. “When you criminalize medicine, people are hesitant to practice in a state like that, and now these Medicaid cuts are going to even worsen that.”

“You’re going to see very severe things and dangerous things,” Dr. McCrummen said. “So all of those things combined to make it very difficult to get providers to come work in Idaho.”

“Who wants to move to a state that doesn’t provide care to their patients?”

This article first appeared on The Daily Yonder and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License