From financial costs to physical proximity, accessing health care in the rural Ozarks—and beyond—can be challenging.
In southwest Missouri, Dr. John Lorette explained to me how he is working to make it easier for people to deal with these realities. In 2018, the retired emergency physician founded Medicine Christian County VolunteersA nonprofit that cares for uninsured people ages 18 to 64 and living at or below 200% of the federal poverty level, which is about $64,300 for a family of four in 2025, According to the Department of Health and Human Services.
volunteer-run non-profit, Part of the National Volunteers in Medicine Network (VIM), offers two clinics per month: one that runs throughout the region and the other located in a “small” house in a church parking lot.
“Being near a church, they’re like, ‘Are you preaching to me?'” Laurette told me. “No, we’re doing it in the name of God, where our hearts are, but we’re not trying to impose anything on anybody.
“We’re just trying to show a Christian attitude of caring for others who need health care.”
The “VIM” project grew out of a realization: After returning from an overseas mission trip, Lorette considered the need in her own backyard.
“I thought, ‘I know there are people who need care, but they don’t have medical insurance, so they don’t get the primary care they need,'” she said recently. This led to non-profit startups, supported exclusively by volunteers.
“I would say that most patients who come in have a problem,” Lorette says. “They have high blood pressure, high sugar. They’re told they have conditions that they could see a doctor for, but now because of a job loss, a marriage breakup, something going on in their family, they suddenly don’t have that care anymore.”
I became interested in the mission while advertising clinic sessions at rural community centers. Christian County, more than 88,000 per 2020 U.S. Census data, is a place of economic contrast.
It has the area’s two fastest-growing cities — Nixa and Ozark, the bedroom community of Springfield, the region’s largest city — smack dab in the middle of the county.
Yet on its fringes are tiny settlements, sparsely populated forests – and poverty. To put that into perspective, in one of those smaller areas, median household income drops more than $20,000 from the county average. Not everyone is troubled by economic realities, but this is a place where one’s loved ones can sell off their household goods days after paying their final expenses. (I saw it live.)
I wondered what VIM sees in that reality, and how — if it still makes sense — changes in the federally led health insurance marketplace have affected their work.
As it turns out, this is one of those stories that differs from expectations. Because the clinic needs more than funding and volunteers: more patients, who still haven’t arrived in numbers that nonprofit leaders feel correlates with local needs.
“Once patients are here, they stay here,” Laurette told me. “It’s getting them here.
“We get a lot of positive feedback. ‘Oh, I’ll tell my friend about this.’ or ‘Oh, that’s nice.’ I mean, people who don’t need it think it’s great — but getting to people who do need it has been a challenge.”
The group has many questions about why more people who need health care don’t come to the clinic. Is it pride? Lack of awareness? Lack of transportation? Misconceptions of need? Will those barriers fall as healthcare markets change? Or because federal and state efforts for low-income health coverage are working?
Clinic visit
On a recent sunny Wednesday morning my shoes crunched across the gravel parking lot in the three-room clinic. The group acquired the tiny house after using FEMA for tornado recovery in Kentucky. And inside I met Lanell Gould, a nurse with over 50 years of medical experience.
“We find that we have more patients here than anywhere else we go,” a VIM volunteer said of the home that was added in late 2025. “They know where we’re going, how to get there.”
Gold was soon joined by others: nurses, other physicians, and others without healthcare experience but a desire to help in ways that did not require medical training.
Apart from VIM’s volunteer team, other organizations have come forward to help The American Academy of Family Practice gave the clinic $25,000 to purchase needed equipment. Local colleges send students there to earn hours for their medical education. A local lab works with companies and pharmacies to provide free or low-cost services to patients.
Sometimes patients come with pressing needs. There are patients with high blood pressure, diabetes, gout, anemia, thyroid problems and various infections, Loret said. Others use it as a bridge; If they lose coverage, VIM can help provide continuity of care.
For patients like Caleb Eggleston, who has been coming to the clinic for about six months, VIM has been a big help with ongoing issues. He began receiving care there after changing jobs and losing his insurance.
“They were able to give me a cuff so I could monitor my own blood pressure and report it to the doctors and do follow-up checkups,” she said. “(They) were able to give me some advice on diet that I should try if I didn’t want to do medication. It was helpful to check a few things on the type I was ignoring.”
Plot twist: Eggleston is actually a pastor at the church where the clinic now sits. He said it was an easy decision for the church, which Lorette also attends, to allow them to stay on the property. Although VIM is not religiously oriented, Eggleston said its mission is aligned with the work of the church.
“I think we see a biblical value of the church and Jesus taking care of people’s physical health as well as their spiritual health,” Eggleston said. “Being able to find additional resources and connect with people who want to make it as easy and accessible as possible for someone who needs help is so important, especially in the economy right now.”
VIM leadership shared testimonials from other patients who spoke to that work.
“I appreciate the care of those who don’t usually see a doctor,” wrote one. “Everyone is great to work with, and I feel confident in the help I get.”
One patient had not seen a doctor in 12 years; Another expressed relief at finally finding a thyroid problem.
In the hierarchy of needs, simple things like blood pressure checks and Pap smears are easy to overlook, even for those who have insurance, let alone those who don’t. Yet having these checks can make a significant difference in one’s long-term health and save money — and heartache — down the road.
“There aren’t many people who want to admit they need help until there’s a crisis,” said Carol Daniel, also a nurse leader at VIM. “Your priority is to put food on the table. Medically, we think we’re fine – but there are silent killers out there.”
This Wednesday morning, those who need translated seven expected patients. That’s a far cry from the 10,000 local people a study VIM leaders believe could use their services when the nonprofit starts.
Christian County in the broader context of need
But something happened just as VIM began: Missouri voters chose to expand Medicaid. Health care programs provide insurance to low-income individuals, and by extension, extended care to populations that may be served by VIM.
“Right now, because of Medicaid, we have decent coverage rates,” noted Heidi Lucas, executive director of Missouri Rural Health AssociationIn an email sent through a nonprofit communications representative.
That expansion doesn’t just serve individuals, Lucas explained. It also supports rural communities.
“Medicaid helps fill that coverage gap so rural Missourians can access the care they need,” Lucas continued. “Medicaid helps rural health care providers stay afloat, so they can serve everyone in their communities. In addition, health care and related services provide important jobs in rural Missouri.”
But present reality is not a guarantee of future. The budget may change due to the Trump administration’s One Big Beautiful Bill (OBBB). More than 10.3 million Americans are losing Medicaid coverageAccording to KFF, an independent news source for health information and updates.
Although VIM leaders and Lucas told me it’s too soon to tell, more changes could come from changes to subsidies for the health insurance marketplace, potentially leaving additional Missourians without insurance coverage.
“Cuts to Medicaid would be particularly devastating to rural residents in our state — both those covered by Medicaid, and those who are privately insured,” Lucas noted. “Rural Missourians are more likely to be covered by Medicaid than Missourians who live in urban areas.
“More than one in four Missourians living in rural areas are covered, compared to one in five in urban areas,” Lucas explained. “Individuals in rural areas are less likely to have private health insurance coverage from an employer and are more likely to have lower incomes.”
Lucas sees a silver lining in OBBB Rural Health Transformation Programme (RHTP), which is said to allocate $50 billion to eligible states over five fiscal years.
According to the Centers for Medicare and Medicaid Services, half of the RHTP funds are earmarked for all states, with the other half distributed based on various factors including the rural population and the state’s proportion of rural health facilities.
“(RHTP) has the potential to lay the foundation for positive changes in health care delivery and access,” Lucas wrote. “We’re hopeful that this money will help put mechanisms in place to mitigate the damage from Medicaid cuts and changes on the horizon.”
Where things stand is starting now
But much of it is rooted in uncertainty. We don’t know what Medicaid cuts lie ahead and the future of the healthcare marketplace, but the transition to the delicate system has the potential to cascade into a domino-like effect in rural communities.
The word that comes to mind with all of this is “fragility”. If federal and state budget changes cause more people to lose their health care coverage, grassroots health care providers like VIM could find themselves with more patients.
Right now, though, Lorette and VIM continue to work to reach out to patients because, regardless of what lies ahead, they know many local people — even if they’re limited in number — need help right now.
“Medicaid expansion, Medicaid repeal,” Laurette said of the uncertain reality. “We’re glad more people are taking care, but there are still people missing it. We’re here to help.”
–
this Article appeared first The Daily Yonder and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.
–
If you believe in the work we’re doing at The Good Men Project, please join us as a Premium Member today.
All premium members can watch The Good Men Project without any ads.
Need more information? A full list of benefits is here.
–
Photo credit: iStock.com
