From monetary costs to physical proximity, receiving 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 cope with those realities. In 2018, the retired emergency physician founded Volunteers in Medicine Christian County, a nonprofit that cares for uninsured individuals who are 18 to 64 and live at or below 200% of the federal poverty level, which in 2025 was about $64,300 for a family of four, according to the Department of Health and Human Services.
The volunteer-powered nonprofit, part of the national Volunteers in Medicine network (VIM), offers two clinics each month: One that moves throughout the region and another based in a “tiny” home on a church parking lot.
“Being by a church, they’re like, ‘Are you preaching to me?’” Lorette told me. “No, we’re doing it in the name of God. That’s where our heart is, but we’re not trying to force 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 his own backyard.
“I thought, ‘I know there are people that need care, but they don’t have medical insurance, so they don’t get the primary care that they need,’” he said recently. That led to the start of the nonprofit, which is supported exclusively by volunteers.
Dr. John Lorette addresses paperwork at the “Clinic on the Hill,” as Volunteers in Medicine Christian County’s headquarters is known. (Photo by Kaitlyn McConnell)
“I would say that most of the patients who come in are having an issue,” Lorette said. “Their blood pressure is high, their sugar’s high. They’ve been told they have some condition that they used to be able to see a doctor for, but now, because of a job loss, marriage disruption, something going on in their family, they suddenly no longer have that care.”
I was intrigued by the mission when I saw fliers advertising a clinic session at a rural community center. Christian County, home to more than 88,000 per 2020 U.S. Census data, is a place of economic contrasts.
It has two of the area’s fastest-growing towns – Nixa and Ozark, bedroom communities to Springfield, the region’s largest city – smack dab in the middle of the county.
Yet on its fringes are tiny settlements, sparsely populated woodlands – and poverty. To put it in perspective, in one of those smaller places, the median household income drops more than $20,000 from the county’s average. Not everyone is in troubling economic realities, but it’s the type of place where one’s loved ones might sell off their household goods just days after their passing to pay final expenses. (I’ve seen it firsthand.)
I wondered what VIM sees between those realities, and how — if it’s yet understandable — changes in the federally led Health Insurance Marketplace have affected their work.
Turns out, this is one of those stories that differs from expectations. Because this clinic is in need of something more than funding and volunteers: More patients, who haven’t yet arrived in the numbers the nonprofit’s leaders feel correlate with local need.
“Once patients come here, they stay here,” Lorette told me. “It’s the getting them here.
“We get a lot of positive responses. ‘Oh, I’ll tell my friend about this.’ Or ‘Oh, this is wonderful.’ I mean, individuals who don’t need it think this is great — but getting to the individuals who need it has been a challenge.”
The group has many questions about why more people who need healthcare don’t come to the clinic. Is it pride? Lack of awareness? Lack of transportation? Misperceptions of need? Will those hurdles fall as shifts come in the healthcare market? Or is it because federal and state efforts for low-income health coverage are working?
Volunteers in Medicine Christian County’s services area provide healthcare to any uninsured individual who resides within the southwest Missouri county or adjoining counties, is between 18 and 64, and earns less than 200% of the federal poverty level. (Photo by Kaitlyn McConnell)
Visiting the Clinic
My shoes crunched across the gravel parking lot to the three-room clinic on a recent sunny Wednesday morning. The group acquired the tiny home after it was used by FEMA for tornado recovery in Kentucky. And inside is where I met Lanell Gold, a nurse with more than 50 years of medical experience.
“We have found that we have more patients here than anywhere else we go,” the VIM volunteer says of the house, which was added in late 2025. “They know where we’re going to be, know how to get there.”
Gold is soon joined by others: Nurses, other physicians, and others without healthcare experience but a desire to help in ways that don’t require medical training.
Volunteers in Medicine Christian County is staffed entirely by volunteers. Some are retired health care professionals and students, while others represent a number of professional backgrounds. (Photo by Kaitlyn McConnell)
In addition to VIM’s volunteer team, other organizations have stepped up to help. The American Academy of Family Practice gave the clinic $25,000 to buy needed equipment. Local colleges send students there to earn hours toward their medical education. A local lab company and pharmacy works with them to provide free or low-cost services to patients.
Sometimes patients come for pressing needs. There are patients with high blood pressure, diabetes, gout, anemia, thyroid issues, and various infections, Lorette 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 visiting the clinic for about six months, VIM has been a big help for 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 back to the doctors and have follow-up checkups,” he said. “(They were able) to give me some advice on diet that I should try if I’m not wanting to do medicine. It was just helpful to get a few things checked up on that I’ve kind of been ignoring.”
Plot twist: Eggleston is actually a pastor at the church where the clinic’s home now sits. He said it was an easy decision for the church, which Lorette also attends, to allow it to be on their property. While VIM isn’t religious-based, Eggleston said its mission aligns with the church’s work.
“I think we see a Biblical standard of the church and Jesus taking care of people’s physical health along with their spiritual health,” Eggleston said. “Being able to find those additional resources and get connected with people that want to make it as easy and accessible as possible for anyone who needs help is just vital, especially in the economy right now.”
VIM leadership shared testimonials from other patients that speak to that work, too.
“I appreciate the care for those who don’t usually see doctors,” one person wrote. “Everyone is great to work with, and I feel confident in the help I receive.”
One patient hadn’t seen a doctor in 12 years; another expressed relief at finally having figured out a thyroid issue.
In the hierarchy of needs, simple things such as blood-pressure checks and pap smears are easy to overlook, even for those with insurance, let alone those without. Yet having those checks can make a significant difference in one’s long-term health, and save money — and heartache — down the road.
“There are not a lot of folks who want to admit they need help until there’s a crisis,” said Carol Daniel, also a nurse leader with VIM. “Your priorities are to put food on the table. Medically, we think we’re A-OK – but there are silent killers out there.”
On this Wednesday morning, those needs translated to seven anticipated patients. It’s a far cry from the 10,000 local people a study led VIM leaders to believe could utilize their services when the nonprofit began.
Patients are seen for a variety of issues, and a need for preventative care – such as pap smears – is shared by practitioners. If specialist care is needed, VIM can often help facilitate those connections. (Photo by Kaitlyn McConnell)
Christian County in the Broader Context of Need
But something happened right as VIM was getting started: Missouri voters chose to expand Medicaid. The health care program provides insurance to low-income individuals, and under the expansion, extended care to populations that could have been served by VIM.
“Right now, because of Medicaid, we have decent coverage rates,” noted Heidi Lucas, executive director of the Missouri Rural Health Association, in an email sent through the nonprofit’s communications representative.
That expansion not only serves individuals, Lucas explained. It also supports rural communities.
“Medicaid helps to fill that coverage gap so that rural Missourians can access the care they need,” Lucas continues. “Medicaid also helps rural health care providers stay afloat, so they can serve everyone in their communities. Moreover, health care and related services provide critical jobs to Missouri’s rural areas.”
But the current reality isn’t a future guarantee. Budget shifts due to the Trump Administration’s One Big Beautiful Bill (OBBB) could result in more than 10.3 million Americans losing Medicaid coverage, according to KFF, an independent news source for health data and updates.
While I’m told by VIM leaders and Lucas that it’s too soon to tell, further shifts may 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 of our state — both those covered by Medicaid, and those 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 fewer than 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 low incomes.”
Lucas sees a silver lining in the OBBB in its Rural Health Transformation Program (RHTP), which is said to allocate $50 billion to approved states over five fiscal years.
According to the Centers for Medicare & Medicaid Services, half of the RHTP funds are slated for all states, with the other half distributed based on a variety of factors that include rural population and the proportion of rural health facilities in the state.
“(RHTP) has the potential to lay the foundation for positive changes in health care delivery and access,” Lucas wrote. “We are hopeful that this money will help put processes in place to mitigate harm from the Medicaid cuts and changes that are on the horizon.”
Starting From Where Things Stand Now
But a lot of this is rooted in uncertainty. We just don’t know if Medicaid cuts are ahead and the future of the Healthcare Marketplace, but shifts to the delicate system have the potential to cascade down in a domino-like effect in rural communities.
The word that comes to mind with all of this is “fragility.” Grassroots health care providers like VIM may find themselves with more patients if federal and state budget shifts cause more people to lose their healthcare coverage.
Right now, though, Lorette and VIM keep working to reach patients because, regardless of what’s ahead, they know many local folks — even if they are limited in number — need help right now.
“Medicaid expanding, Medicaid retraction,” Lorette said about the uncertain reality. “We’re glad that more people are getting care, but there’s still people missing it. We’re here to try to help with that.”
The post Ozarks Notebook: A Non-Profit Running Two Clinics in the Ozarks Has an Unexpected Need–More Patients appeared first on The Daily Yonder.
