Trump’s “Big Beautiful Bill”: What Healthcare Professionals in Idaho Need to Know

May 28

Former President Donald Trump’s recently proposed “big beautiful bill” may carry a familiar slogan, but the potential harm for healthcare access in Idaho is far from cursory. If enacted, the proposal threatens Medicaid eligibility, rural infrastructure, and maternal care, all with outsized consequences for our state.

Idaho’s Medicaid Under Threat

Early modeling suggests the bill could slash $4.3 billion in federal Medicaid funding over the next decade and lead to 40,000 fewer Idahoans enrolled, something healthcare and advocacy groups are already tracking.
Since Idaho expanded Medicaid via a 2018 ballot initiative, any rollbacks could erode the program’s gains, especially among low-income and medically vulnerable populations.

Rural Hospitals: Financially Fragile and Increasingly Vulnerable

Nearly 50% of rural hospitals in Idaho are operating on extremely thin margins, or even in the red. One local expert notes many are working at 1% margin or less, a hair’s breadth from insolvency.
National benchmarking confirms this is no anomaly: across the U.S., 46% of rural hospitals are running deficits, with 432 facilities classified as vulnerable to closure.

A study from the Sheps Center flags three rural hospitals in Idaho—Power County Hospital, St. Luke’s Jerome, and Cassia Regional Hospital—as high‑risk due to sustained financial distress.

Maternal Care Deserts: A Growing Emergency

Since 2020, three rural labor and delivery departments have shuttered in Idaho, representing 16% of the state’s rural hospitals.
In 2025, 14 rural hospitals lack OB services, while those that do, only 53% of rural hospitals, can be a median 39-minute drive away. Four of those still‑operating units are also considered at risk.
Since an abortion ban became effective in August 2022, Idaho has lost 51 obstetricians, dropping from 227 to around 176 by 2023. Two hospital OB programs have closed; a third is in “serious jeopardy.” Only 22 of Idaho’s 44 counties now have any practicing OB‑GYN, and 85% of these specialists are concentrated in the seven largest counties.
These trends coincide with Idaho ranking in the 10th percentile nationally for maternal outcomes, meaning 90% of states fare better.

Idaho’s Healthcare Infrastructure: A Snapshot

Idaho is home to numerous Critical Access Hospitals (CAHs) across the state, such as those in Soda Springs, Grangeville, and Arco, vital for remote communities but especially vulnerable to Medicaid cutbacks.
The Idaho Department of Health and Welfare offers loan repayment programs, telehealth support, and value‑based care initiatives to bolster access in underserved areas—but these supports may be overwhelmed if funding declines.

What Idaho Healthcare Leaders Need to Do Now

Strategy | Action Step

Scenario Planning | Model disruption scenarios assuming $4.3B in Medicaid funding cuts, major rural hospital loss, and OB unit closures.

Advocacy & Messaging | Leverage clear, local data, like three OB closures, 51 fewer obstetricians, and facilities at risk, to mobilize support across legislators and communities.

Operational Resilience | Expand telehealth, deploy mobile clinics, and partner with Federally Qualified Health Centers to sustain care in "maternity deserts."

Workforce Investment | Highlight gaps to advocate for targeted loan repayment, recruitment, and retention programs, especially in rural and maternal health.

Policy Alliances | Connect with state coalitions (hospital associations, rural health networks) to push against damaging federal rollbacks, especially given Idaho’s hard-won Medicaid expansion.

Final Thoughts

For Idaho, the “big beautiful bill” is more than rhetoric, it risks unraveling critical healthcare access, especially for the most vulnerable. With half of rural hospitals financially strained, multiple OB units shuttered or threatened, and communities already designated as care deserts, the proposed legislation could tip systems into crisis.

Healthcare professionals must move preemptively: model outcomes, voice local realities, fortify services, and rally for policy protections. Patients in rural counties are counting on it.