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Congress has adopted and President Trump has signed H.R. 1, known as the One Big Beautiful Bill Act. The law makes significant changes to health care, and — by the end of the decade — could influence Missourian’s health coverage and access to care.  

There’s good news in the short term. Between now and 2030, the law’s $50 billion for a Rural Health Transformation Fund will help support struggling rural hospitals in Missouri and nationwide. In addition, the larger changes to how Missouri finances Medicaid are phased in, with most of the reductions beginning late in the decade.   

In the long-term, the federal spending cuts will begin to affect Medicaid enrollees, individuals that receive subsidized coverage through the marketplace, Missouri’s state government and health care providers. However, the delay in many of the cuts provides an important window of advocacy to reshape the law.   

Every Missourian has a stake in the implementation of this law. Here’s why.  

• One in five adults and two in five Missouri kids presently have Medicaid coverage. This includes seniors in long-term care, expecting mothers and newborns, and children with and without disabilities. 
• The loss of coverage will make access to necessary care more difficult and costly for those who lose coverage, reduce care coordination to manage chronic conditions, and result in higher rates of emergency department care for conditions that don’t require emergency services. This crowds emergency departments and increases wait times. 
• Cuts to Medicaid would jeopardize both the safety-net for low income individuals and the stability of the health care system all Missourians need. Hospitals will be under increasing financial pressure, which could reduce access to specific services or overall. 
• The cuts to Missouri’s financing mechanism could leave the state with more than a $1 billion hole in its budget annually by the end of the decade. This could result in hard choices about how to address shortfalls, including reducing their payments to providers — which are already approximately half of the cost of providing care — to limiting state investments in education, public safety or other priorities.   

We need to work collectively to reduce the potential for long-term harm by continuing to advocate for changes to the law.  

Here's what you can do.

• Contact Missouri's senators and your congressional representatives — and ask your friends and family to reach out as well.
• Help share the message to #ProtectMedicaid on social media with your family and friends.
• If you or a loved one will be directly impacted by these cuts — or you are a health care provider concerned about negative consequences for Missouri patients — share your story below.