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For subscribers	July 9, 2025

Eleanor Davis

Hundreds of labor and delivery units are at risk of closing

	By Jessica Grose

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."

If you don't have a fixed address or a phone, keeping up with paperwork to prove that you are eligible, which the bill requires, is nearly impossible.

The reimbursement rates for providers who accept Medicaid, as Choate does, are already low and are likely to get lower. "Our ability to keep our doors open relies on reasonable reimbursement," Choate told me, adding, "At least some of our ancillary services are covered by federal grants which have been at risk since Inauguration Day."

Cuts to Medicaid will have an impact on women across the country regardless of which community they live in. City maternity wards have also been closing, because labor, delivery and infant care are expensive. "Urban hospitals had the highest number of labor and delivery unit closures — 299 — between 2010 and 2022," my newsroom colleague Sarah Kliff wrote in December.

The United States already has some of the worst health outcomes for mothers and infants in the developed world; it's only going to get worse as fewer women are able to receive adequate prenatal and postpartum care in a timely fashion.

Sarah Gordon, who is a co-director of the Boston University Medicaid Policy Lab, said that one of her biggest worries is that a lot of lower-income pregnant women will fall through the cracks. "Medicaid programs do not know who is pregnant," she told me, and often contacting your Medicaid office is "the last thing on most people's minds."

If these women are uninsured to begin with, they may not be aware that they're eligible for Medicaid, and even if they do try to get coverage, "with the punishing amount of administrative burden that's on state Medicaid agencies, it could take three, four months to sort that out," Gordon said. With such a short window of time to get prenatal coverage, it could be too late for women to even receive the services they're entitled to.

Dr. Katharine White, the chief of obstetrics and gynecology at Boston Medical Center, told me she's also worried that even if her patients remain covered by Medicaid, the increased copays for some of them may keep them from getting that care. "A $35 copay may not sound like a lot to many people, but for the patients I care for, that co-payment could represent half of their utility bill. And a mother is always going to put the needs of their children before their own," White said.

And these cuts come just as Medicaid was serving more women. Until 2021, Medicaid covered women only until 60 days postpartum. Since then, 48 states and Washington, D.C., have adopted a Medicaid expansion that covers women up until a year after giving birth. According to the Commonwealth Fund, around 30 percent of maternal deaths happen between 43 and 365 days postpartum. If postpartum coverage is dropped — which Gordon thinks is likely — I don't think it's a leap to say that more women will die from a lack of preventative care.

Which brings me back to the patients Choate works with. Part of the Trump administration's health care promise has been that it will "focus on reversing chronic disease." An executive order issued in February maintains that chronic disease in childhood, specifically, is a "crisis."

But the planned gutting of Medicaid will imperil the long-term prospects of clinics like the Oasis Center, which offer mental health and substance abuse treatment to pregnant women. This will make babies less healthy from the very beginning. Even some of the people who ended up voting for this bill know how devastating it is going to be. What a preventable tragedy. What a pathetic shame.

End Notes

Abortion crackdown: I didn't even get into the 200 Planned Parenthood clinics that might close because the bill bans Medicaid payments to big nonprofits that offer abortion services. But you should know about that, too!
Mamala vs. the Mountainhead: I subscribe to more newsletters than any human has time to read, but I always make time for Tina Brown's Fresh Hell — it's gossipy and smart, and Tina's always a good time. She is at her best when she analyzes power, and I agreed with her take on the disappearance of so many prominent women from the public square since November. "Blown away by the massive ordnance penetrators that have phallicized our world, female political stars seem to have disappeared off the map. We were promised Mamala and instead we got Mountainhead. And a cadre of influential women, perhaps beaten down by the tyranny of testosterone, seem OK with going along." Sigh.
Feel free to drop me a line about anything here.

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