Federal policy changes will hit Kansas and Missouri hard. Here’s what’s at stake.

The policy landscape for health and food assistance is shifting dramatically at the federal level — and the consequences for people in Kansas and Missouri will be severe. Health Forward Foundation has released a new report on the impact of H.R.1 that details what these changes mean for our region.

Across our two states, an estimated 186,000 people will lose health coverage, and nearly 200,000 will lose food assistance. Nationally, 10 million Americans will lose health coverage by 2034.

“It’s hard to overstate the detrimental impact of these policies on our communities here in Kansas and Missouri,” said McClain Bryant Macklin, Chief Policy Impact Officer at Health Forward Foundation. “In addition to the lost coverage for hundreds of thousands, taxpayers will be picking up the tab to cover the costs of implementing these harmful changes.”

Who will be most affected

The report documents the disproportionate impact on people of color, rural residents, people managing chronic conditions like diabetes, hypertension, HIV, asthma, and heart disease, and immigrants and refugees — including the elimination of coverage for lawfully present refugees and asylees.

Key policy changes driving these losses include: 

• Medicaid work requirements beginning January 1, 2027 (in Missouri, due to its expansion status)
• First-ever state cost-sharing requirements for SNAP
• Federal Medicaid cuts that will hit rural communities hardest — an estimated $155 billion in losses, more than triple the $50 billion Rural Health Transformation Fund

A Strain on Systems Already at Capacity

Most concerning is what these losses mean for the systems communities depend on. Health Forward’s regional partners featured in the report are candid about what’s coming.

“When people lose access to basic health care and nutrition support, we don’t just see individual suffering — it impacts whole families and entire communities,” said Kim Gasper, Chief Advancement Officer at Vibrant Health.

Food assistance cuts will push the burden onto food banks that are already stretched thin. “There will be tens of thousands of folks that get pushed off of SNAP because of the increased work requirements,” said Mallory Rusch of Empower Missouri. “Food banks are already operating at their maximum capacity — they cannot take on more folks.”

The ripple effects extend further than health and hunger. Vanessa Kennedy, an active-duty police officer and founder of Code 1 Wellness, put it plainly: “When people get cut off from nutrition and health, you’re going to have an uptick in crime. You’re going to have people stealing from the Dollar General. Your crime rate is going to go up.”

Rural hospitals face particular vulnerability. “Our rural hospitals are fragile already,” said Toniann Richard, CEO of HCC Network, “and so from a service delivery standpoint, I worry about their ability to sustain services and meet the needs of their community.”

What comes next

This report was built to be a resource — not just a record of what’s at stake, but a guide for what comes next. It includes an analysis of implementation challenges, the communities facing the greatest risk, and strategic approaches organizations and advocates can use to minimize harm.

Read the full report to understand H.R. 1’s impact on health and food assistance in Kansas and Missouri — and how we can work together to protect our communities.