Dr. Mimi Choate is a family doctor treating pregnant women who struggle with drug addiction. She works at the Oasis Center of the Rogue Valley, a clinic in southwestern Oregon that provides integrated mental health care, social services, addiction counseling and prenatal and postpartum care. I asked her to describe what it looks like when a pregnant woman walks into her clinic for the first time.

“Many of my patients are homeless,” she said. “They may be living on someone’s couch. They may bouncing between motels. Many of them are camping or living outside. So this is a person who doesn’t have an address, often does not have a working cellphone or any cellphone.” They tend to be addicted to either fentanyl or methamphetamine, and they often don’t have insurance, but if they do, it’s Medicaid.

Choate works in a semirural region that’s “among the most reliant on Medicaid” of any U.S. congressional district, according to Oregon Public Broadcasting. Oregon also has some of the highest rates of drug addiction and overdoses in the country. Dr. Choate predicts that the Medicaid provisions in the enormous bill that President Trump just signed into law, which cuts more than $1 trillion in health care spending over the next decade, will be devastating for the Oasis Center and its clients.

A lot will depend on how individual states execute the law. Changes to Medicaid financing and programs vary by state and won’t take effect immediately. But considering how drastic the cuts are, it’s possible that even women who have private health insurance will be affected.

Medicaid covers over 40 percent of births in the United States, and an even higher percentage in rural areas. According to an analysis from the National Partnership for Women & Families, a nonprofit advocacy organization, “144 rural hospitals across the country with labor and delivery units are at risk of closure or severe service cutbacks” based on the Medicaid cuts outlined in the bill. That’s in addition to the over 100 rural labor and delivery units that have closed or plan to close since 2020.

For Choate, it is imperative that her patients are seen right away, she told me, because if they aren’t, they might change their minds about getting help. “Even just stepping in the door of a health care facility is a big deal,” she said. “And it’s scary and it feels foreign or it feels like a place where you’ve been judged before or you felt like you didn’t fit in or it wasn’t meant for you.”