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Primary care clinicians across the US are warning cuts to Medicaid in the Trump Administration’s new budget bill could push many of them out of practice and deepen access gaps for patients.

In a recent survey by researchers at the Green Center at Virginia Commonwealth University, in Richmond, Virginia, more than 1 in 4 physicians (26%) said their practice would suffer financially, and those figures were higher for rural doctors (31%) and those working at federally qualified health centers (FQHCs; 60%).

Nearly 70% of the physicians surveyed said the legislation’s tighter eligibility rules would worsen their administrative burdens, according to a June survey of 379 primary care physicians. That figure jumped to 87% among clinicians at FQHCs.

Only 13% of primary care clinicians said the proposed changes to the program were unlikely to affect their practice or patients.

“It’s sobering,” said Rebecca Etz, PhD, a professor of family medicine at Virginia Commonwealth and co-director of the Green Center. “Frontline clinicians are letting us know that reductions in Medicaid, they predict, will severely constrain access — which is already constrained in the US”

For Amy Ellingson, MD, a primary care physician at Three Rivers Family Medicine in Brewster, Washington, those numbers are not abstract.

Medicaid cuts “will seriously hurt our hospital and clinic’s viability since our payer mix is 31% Medicaid,” Ellingson told Medscape Medical News. “We are already on the edge due to low reimbursement, and this will only make things worse. It will also reduce patient volumes.”

Her greatest fear, however, is not just for her clinic but also for her patients.

“We don’t have any further cuts to services that we can make,” she said. “So our situation would be about our survival. In the clinic, we are already seeing people get cut from Medicaid due to an increase in paperwork burden. If they don’t have Medicaid, they can’t seek care. This will land them in the ER [emergency room], as all studies have shown.”

That cycle — from loss of primary care to overuse of emergency care to hospital debt — puts institutions like hers on a dangerous path.

“An increase in ER visits with people who are uninsured will then be part of a cycle of bad debt, leaving the hospital further at risk,” she said.

Primary Care at Particular Risk

The survey findings came in the wake of the passage in May of the House version of the “One Big Beautiful Bill,” which included more than $800 billion in Medicaid cuts over the next decade. The final version, which passed the Senate by one vote, cut the program by more than $1 trillion between now and 2034 and included monthly work or community service requirements and frequent eligibility verifications.

The Congressional Budget Office estimated roughly 12 million Americans would lose their healthcare coverage under the bill.

Medicaid currently covers more than 70 million Americans, including low-income families, children, seniors, pregnant women, and people with disabilities. Provisions in the bill would cap state-directed payments to hospitals and nursing facilities, reducing them 10% annually and stripping funding for staffing, patient outreach and care delivery.

Sumana Reddy, MD, a primary care clinician at Acacia Family Medical Group, Salinas, California, said the changes could upend care for the region’s farmworker community.

Requalification requirements for eligibility “will be a real challenge for my patients, many of whom are farmworkers,” Reddy said. “Primary care practices like ours already do a lot of this work, which is unreimbursed. There may be patients who lose Medicaid entirely and will really struggle with their untreated conditions.”

Her practice serves entire families, including young children, parents, and older adults who rely on Medicaid for preventive care, management of chronic diseases, prescriptions, and long-term care.

“This move will adversely affect the health of our community,” Reddy said. “Work requirements may leave elderly uncared for. Everyone will be affected.”

Yalda Jabbarpour, MD, director of the Robert Graham Center for Policy Studies and a practicing family physician in Washington, DC, said the cuts reflect a “deeply concerning trend” in health policy: the “systematic underinvestment” in primary care.

“At a time when more than a third of adults and 15% of children lack a usual source of care, we should be expanding access — not restricting it,” she said.

Maternal and Rural Practice in Jeopardy

Midwife Jennifer Seymour, CNM, operates an accredited freestanding birth center in rural New York, where 60% of births are covered by Medicaid. She said any threat to Medicaid funding puts entire communities at risk.

“New York already has too many maternity care deserts as hospitals close because they can’t be financially viable,” said Seymour, founder of Cocoon Wellness and Birth Center in Waverly, New York, about 85 miles south of Syracuse. “If 60% of births are not getting paid for, perinatal deaths of moms and babies will skyrocket over our already abysmal numbers.”

“Where will anyone go for their medical needs when that happens?” she added.

In a Green Center survey conducted in May, 34.7% of clinicians said their practice would become financially unviable if Medicaid reimbursements were cut. Nearly 40% said at least 10% of their patients would likely forgo preventive care.

Etz said while FQHCs and pediatric practices are often hit hardest by Medicaid policy shifts, the data show the financial stress is widespread.

“I was surprised at the large variety of demographics among those who said they’d lose their financial viability,” she said. “It really was small and large practices, hospital-owned, insurance-owned, direct primary care — everybody was predicting an impact.”

Ripple Effects Across the System

In the June survey, 74% of respondents predicted an increase in the use of high-cost emergency care by uninsured patients — a number that jumped to 95% among FQHCs.

“What you’re looking at is a reduction in access to primary care, and the ripple effect across the healthcare system is tremendous,” Etz said. “That means an influx of uninsured patients into hospitals already struggling to repair after the pandemic — patients who are often more complex and expensive to care for.”

Etz cited studies showing the life-and-death stakes of continuous access to primary care.

“A little investment in primary care can yield strong health outcomes,” she said. “When that access is lost, even briefly, mortality rates for manageable conditions like diabetes or Alzheimer’s can skyrocket.”

Jabbarpour agreed.

“In high-cost urban areas like Washington, DC, access to primary care is already strained due to low Medicaid reimbursement rates and provider shortages,” she said. “Cutting Medicaid further will push more patients to delay care until conditions worsen, when treatment becomes more complex and costly.”

Clinician Well-Being and the Future Workforce

Clinicians themselves are also under mounting pressure. In the June Green Center survey, 55% of clinicians reported high levels of burnout or moral injury — a number that rose to 68% among FQHC providers.

“Burnout suggests the problem is with the individual. Moral injury is about functioning in an inhumane system, seeing wrong things happen that you could fix, if only someone would let you,” Etz said.

Jabbarpour said the toll on the clinical workforce could be long-lasting.

“Medicaid cuts send a clear signal to early-career physicians: Choosing primary care, especially in underserved communities, comes with greater financial instability and fewer resources to care for patients effectively,” Jabbarpour said. “If we want to retain a new generation of mission-driven doctors, we have to invest in the systems and safety nets that support them.”

Reddy said her practice will likely cease to exist in the long run if reductions restrict what they have done for the past 27 years. “We try to see everyone in the community and provide continuity for our patients,” said Reddy. “It will be emotionally wrenching to have to turn away Medicaid patients we’ve seen for years. So far, we’ve never done that.”

A Systemic Warning

Ellingson was blunt about what is at stake.

“Rural hospitals and clinics are at extreme risk of closure should these cuts be put in place,” she said, leading to more healthcare “deserts.” “Mortality and morbidity in these communities, tragically, will increase quickly if this happens.”

Despite the threat, Etz said many clinicians remain deeply committed to their work.

“Even as they report all the sad things, 77% also reported high professional fulfillment,” she said. “They’re saying, ‘You’re making this hard — but I’ve never felt my work was more important.’”

Lara Salahi is a health journalist based in Boston.

The sources cited in this story reported having no relevant disclosures.