What good are cheaper drugs if there’s no hospital left to prescribe them?

In her June 3 guest column in the Poweshiek County Chronicle Republican, Rep. Ashley Hinson applauded President Trump’s executive orders targeting pharmacy benefit managers — or PBMs — the industry middlemen who often drive up costs and squeeze out small-town pharmacies.

I don’t disagree with her that prescription drug prices are too high. They are. I see it every week — patients rationing insulin, skipping medications, and making impossible choices between food and medicine.

But as much as I worry about the price of medicine, I’m even more alarmed by the growing collapse of the places and people who provide it.

What’s missing from Hinson’s message is the other half of the story: how these same politicians, while decrying PBMs, are pushing forward a federal budget that would slash Medicaid, trigger Medicare cuts, and devastate the very systems rural Iowans depend on.

You can’t claim to protect patients while gutting the programs that keep them alive.

I work in rehabilitation care, serving stroke survivors, older adults, and people living with disabilities. Many live in rural communities. And many rely on Medicaid — not as a handout, but as the only way to afford therapy, home health services or transportation after a brain injury.

One of my patients, a retired farmer, now drives 45 minutes to refill oxygen tanks — something the local clinic used to provide before it closed last year. He didn’t ask for pity. He just asked whether he’d still be able to make it through the harvest.

According to a June 2025 policy brief based on Congressional Budget Office data, the Medicaid provisions in the House-passed “One Big Beautiful Bill” are expected to increase hospital uncompensated care costs by more than $42 billion over the next decade. That means fewer providers accepting Medicaid, more rural hospitals on the brink, and longer delays for emergency care — particularly in areas like ours, where resources are already thin.

Even for veterans, dialysis appointments often depend on a fragile mix of VA, Medicare, and Medicaid coverage — and cuts to any part of that system put lives at risk.

These aren’t abstract policy debates. They’re choices. They happen when lawmakers prioritize tax breaks over treatment beds. When a child’s speech therapy session or a veteran’s dialysis appointment becomes budgetary collateral.

In Iowa’s schools, Medicaid also quietly pays for services that federal law mandates but local budgets can’t cover: speech-language therapy, nursing care, mental health services, and wheelchair-accessible transportation. Cutting Medicaid doesn’t just affect clinics — it affects classrooms.

So yes, we need to address PBM abuse and lower drug costs. But let’s not pretend an executive order — which lasts only as long as the president who signed it — is a substitute for real, long-term reform. And let’s not allow it to distract from the deeper threat: the slow dismantling of rural health infrastructure under the guise of fiscal responsibility.

If Rep. Hinson truly wants to protect rural Iowa, she’ll vote like our hospitals matter — not just talk like our pharmacies do.

Dr. Christopher R. Crossett, Cedar Rapids