Regina Young’s chronic fatigue and anxiety had escalated to debilitating exhaustion, then a panic disorder that had her trapped in her home, unable to care for or even feed herself, when there was a knock on the door.

It was the first visit from paramedic Keith Grayson, part of a Medicaid-funded program that Young believes saved her life. The at-home care from Phelps Health in tiny Rolla, Missouri, about 100 miles southwest of St. Louis, is the kind of program meant to make up for longstanding shortfalls in rural healthcare.

It’s also exactly the kind that residents and caregivers fear will disappear under the $1 trillion in Medicaid cuts at the heart of President Donald Trump’s massive budget bill passed nearly a year ago.

Over its 10-year time frame, the bill could result in 11.8 million people losing Medicaid coverage and an additional 3.1 million losing coverage under marketplace plans, according to the nonpartisan Congressional Budget Office.

Trump carried Missouri with nearly 60% of the vote in November 2024. In Phelps County, where almost 1 in 5 people live below the poverty line, he took more than 70%.

Going on a year after the signing of the bill, however, some Republican voters feel forgotten by a president they see as utterly disconnected from their hardships, even in a place as red as Rolla (pronounced RAH-luh).

“What’s wrong right now is the way Trump is treating us poor people,” said Leslie Luttrell, another client of the Phelps paramedics. The president, she said, was born with a “gold spoon in his mouth.”

Inflation jumped in May to 4.2%, the highest it’s been in three years. There’s been a 21% decline in the number of Medicaid/CHIP enrollees nationwide, with 74.9 million enrolled as of February 2026, down from 94.5 million in March 2023, according to KFF.

“A year ago, it was pretty good. It was better than what it is now,” Luttrell said. “It’s harder to buy shampoo, conditioner, body wash and female items.”

Missouri was awarded more than $216 million from Trump’s spending bill to rebuild rural healthcare hubs and test new ways of delivering care, including paying for most of the paramedicine program. Phelps Health’s ambulance services director, Michael Gruenberg, who created the program, said these home-visit services are not Band-Aids but rather viable long-term solutions to life-or-death healthcare issues plaguing hospitals in rural America.

More than 700 rural hospitals, or one third of all rural hospitals in the country, are at risk of closing in the near future, according to the Center for Healthcare Quality and Payment Reform. In Missouri, 28 rural hospitals — half the state’s total — are at risk of closing.

Fitzgibbon Hospital and The Living Center, a hospital and residential facility serving Missourians for more than a century, filed for bankruptcy in April. The hospital cited rural hospitals operating on the financial edge for years and identified the reduction in Medicaid funding from the “One Big Beautiful Bill Act” as further threatening to “destabilize an already fragile system,” according to the court filing.

The American Hospital Association includes the expected Medicaid cuts among the top national challenges facing rural hospitals, along with “chronic underpayments of government payers such as Medicare and Medicaid, exacerbated by looming Medicaid cuts; workforce shortages in recruiting and retaining physicians and other allied health professionals; and administrative burden and cost imposed by large national insurers to keep up with prior authorization and billing processes that delay necessary care.”

Despite the act’s devastating impact on rural healthcare, U.S. Rep. Jason Smith, whose district includes Rolla and who is running for re-election, has taken credit for the part of the bill that directed $50 billion into rural communities nationwide. “Missouri is the definitive example of the rural setting my Republican colleagues and I had in mind,” Smith wrote in a letter to federal health agency leaders in the fall.

Smith did not respond to MS NOW’s request for comment.

Luttrell lives in extended stay motels and has a lot of health issues, including diabetes. With much care, Marilyn Fuller, the paramedic, checked Luttrell’s blood sugar, weight and lungs. Luttrell said her bedside manner reminded her of her own mother. Fuller helps her secure free, healthy food deliveries that are critical to maintaining her diabetic diet and also helps her keep her prescriptions filled. 

MS NOW met Young and Luttrell during a ride-along with the Phelps Health paramedic team, which brings care directly to patients’ homes to keep them out of crowded ERs.

Gruenberg launched the Community Paramedicine Program a month after Trump’s spending bill was signed into law last July. The timing was coincidental, but as far as Young is concerned, if the service hadn’t existed when she needed it a few months later, she wouldn’t have made it.

“I was dying, and I couldn’t get out of the house,” Young said.

She tried calling doctors, but she couldn’t get beyond the receptionists, who couldn’t understand why she couldn’t do an in-person visit.

“I called so many doctors. I tried to explain, I can’t leave the house, I don’t have family here, I’m all alone, and my life is literally in danger. I tried to explain that, because I was so exhausted that I couldn’t even eat anymore,” Young said.

Enter Grayson, the paramedic she calls her “angel” who now visits her so regularly that they have adopted a tradition: they take a photo together, every time.

The closure of rural hospitals will flood ERs and be deadly for people in remote rural areas, according to Gruenberg. His message to lawmakers is simple: the federal government can either pay to care for people before they face a medical emergency, or pay higher bills when they need to be airlifted to ERs for emergency-level care.

Lutrell, the Republican voter who blames Trump for what she calls the current “Great Depression” in America, said she didn’t vote for him in 2024. She didn’t have transportation to get to the polls.

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