In the rolling, mountainous terrain of northern Idaho, a crisis in maternal and reproductive health care is quietly but dramatically unfolding. The state, already grappling with the aftermath of a near-total abortion ban, now faces the additional threat of deep Medicaid cuts that could further erode access to essential services for women and families. The situation in Idaho offers a stark illustration of how legal, political, and economic forces can collide, leaving vulnerable populations at risk and entire communities scrambling to adapt.
It was just over six months after Idaho’s abortion ban took effect in 2022 when Bonner General Health, the only hospital in the small city of Sandpoint, announced it would no longer provide obstetrical care. The hospital’s decision, made public in March 2023, cited the state’s “legal and political climate” as a significant factor. Bonner General was not alone; it became one of three Idaho health systems to shutter their labor and delivery services in recent years, according to reporting by ABC News.
The consequences of these closures have been swift and severe. Kootenai Health, located an hour south of Sandpoint, inherited a wave of new patients, many of whom now travel two to three hours for prenatal visits or to give birth. Dr. Brenna McCrummen, an OB-GYN at Kootenai, described the dangers this distance poses: “There have been patients that have delivered on the side of the road because they’re not able to get to the hospital in time. There have been babies that have gone to the NICU who didn’t do as well as they probably would have had they not had to travel long distances,” she told ABC News.
These stories are not isolated incidents. A recent study published in JAMA Network Open found that Idaho has lost over a third of its OB-GYNs—94 out of 268—since the abortion ban was enacted. The majority of those who remain are clustered in the state’s seven most populous counties, leaving just 23 OB-GYNs to serve more than half a million people scattered across the state’s vast rural regions. For many patients, securing an annual exam—critical for cancer screenings and preventive care—now means waiting as long as five months.
Medicaid, which insures more than 350,000 Idaho residents, has long served as a crucial safety net. But this too is under threat. Earlier this year, Governor Brad Little signed a Medicaid cost bill, and the state began seeking federal approval for new work requirements. According to an analysis by KFF, these changes could cost Idaho $3 billion in federal funding over the next decade and leave 37,000 residents without coverage. The Medicaid cuts were passed into law in July as part of President Donald Trump’s sweeping tax and policy bill.
Supporters of the cuts, like Idaho Senator Mike Crapo, argue that the reforms are necessary. In a recent press release, Crapo defended the bill, stating that “targeting waste, fraud and abuse in the program ensures that it stays financially viable for the populations who need it most.” He also highlighted the $50 billion rural hospital fund included in the legislation, calling it “the largest investment in decades in rural health care.”
Yet for many on the ground, the reality looks far more precarious. More than a third of all births in Idaho are covered by Medicaid, according to the March of Dimes. Maintaining labor and delivery units is already an expensive proposition, especially in rural areas where patient volumes are low and Medicaid reimbursements fall short of actual costs. “What you’ll see in Idaho, before you see hospitals close, is we’ll have more closures of labor and delivery services,” Toni Lawson, vice president of the Idaho Hospital Association, told ABC News. Recruiting and retaining OB-GYNs has become a Herculean task, particularly under the state’s strict abortion laws.
The ripple effects are profound. Amy Klingler, a physician assistant specialist in central Idaho, outlined the dangers for patients who lose Medicaid coverage: “If patients don’t have access to insurance and they don’t have access to Medicaid, sometimes they delay prenatal care, we don’t catch complications early enough, and it puts the baby and the mother’s lives at risk,” she explained. In her region, the nearest hospital equipped for deliveries is a 60-mile drive away, with 45 miles lacking cell service—a daunting prospect for anyone, let alone a pregnant woman in distress. “So in the best circumstances, it takes planning and forethought. And then when things are serious and complicated, it’s much more dangerous,” Klingler said. “Complicated pregnancies in Idaho are the scary ones right now.”
These dangers are compounded by the state’s abortion restrictions. While a state court ruling in April 2025 slightly expanded the medical exception to Idaho’s abortion ban, advocates argue that the law continues to constrain physicians’ ability to provide adequate emergency care. Melanie Folwell, executive director of Idahoans United for Women and Families, a group working to restore abortion rights via a 2026 ballot initiative, summed up the stakes: “We are living with the consequences of when you criminalize practicing medicine, you lose doctors, and I think that, coupled with these cuts at the federal level, are going to prove devastating for Idaho’s already precarious rural health system,” she told ABC News.
Nationally, the problem of so-called “maternity care deserts”—areas lacking essential obstetric services—is growing. More than 35% of U.S. counties now fit this description, according to Dr. Michael Warren of the March of Dimes. “The worry is that as these changes are happening in the Medicaid space, it’s going to be harder, particularly for rural hospitals, to maintain those obstetric services, and if they discontinue those, we’ve got more maternity care deserts, and we’ve got a greater risk of both moms and babies having worse outcomes,” Warren said.
Advocates and health professionals agree that no single solution will resolve Idaho’s crisis. Lawson, of the Idaho Hospital Association, emphasized the need for a multifaceted approach: “There is no silver bullet to solve depleted access to maternal and reproductive care. It is going to have to be a combination of things and certainly removing barriers to recruitment is an important part of that,” she said. Addressing the financial instability of rural hospitals is equally critical.
For many Idahoans, the current landscape is daunting, especially for Black people, rural residents, low-income individuals, and others with the capacity to give birth. Breana Lipscomb, senior manager of maternal health and rights at the Center for Reproductive Rights, warned: “It’s making health care even further out of reach for people, and this is particularly concerning for Black people, for people living in rural areas, for low income folks and for people with capacity to birth. I am really afraid of what we might see.”
As the state moves toward another election and the possibility of a ballot initiative to restore abortion rights, Idaho’s health care providers and advocates are bracing for a future in which access to maternal and reproductive care could become even more limited. The choices made in the coming months and years will shape the health—and the lives—of Idaho’s families for generations to come.