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    Trump administration to cancel $1bn in Biden-era school mental health grants

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    The Trump administration is moving to cancel $1bn in school mental health grants, saying they reflect the priorities of the previous administration.Grant recipients were notified on Tuesday that the funding will not be continued after this year. A gun violence bill signed by Joe Biden in 2022 sent $1bn to the grant programs to help schools hire more psychologists, counselors and other mental health workers.A new notice said an education department review of the programs found they violated the purpose of civil rights law, conflicted with the department’s policy of prioritizing merit and fairness, and amounted to an inappropriate use of federal money.The cuts were made public in a social media post from the conservative strategist Christopher Rufo, who claimed the money was used to advance “left-wing racialism and discrimination”. He posted excerpts from several grant documents setting goals to hire certain numbers of nonwhite counselors or pursue other diversity, equity and inclusion policies.“No more slush fund for activists under the guise of mental health,” Rufo wrote.The education department confirmed the cuts. In an update to members of Congress that was obtained by the Associated Press, department officials said the Republican administration would find other ways to support mental health.“The Department plans to re-envision and re-compete its mental health program funds to more effectively support students’ behavioral health needs,” according to the notice.Donald Trump’s administration has cut billions of dollars in federal grants deemed to be related to diversity, equity and inclusion (DEI) and has threatened to cut billions more from schools and colleges over diversity practices. The administration says any policy that treats people differently because of their race amounts to discrimination, and it argues that DEI has often been used to discriminate against white and Asian American students. More

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      The United States is witnessing the return of psychiatric imprisonment | Jordyn Jensen

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      Across the country, a troubling trend is accelerating: the return of institutionalization – rebranded, repackaged and framed as “modern mental health care”. From Governor Kathy Hochul’s push to expand involuntary commitment in New York to Robert F Kennedy Jr’s proposal for “wellness farms” under his Make America Healthy Again (Maha) initiative, policymakers are reviving the logics of confinement under the guise of care.These proposals may differ in form, but they share a common function: expanding the state’s power to surveil, detain and “treat” marginalized people deemed disruptive or deviant. Far from offering real support, they reflect a deep investment in carceral control – particularly over disabled, unhoused, racialized and LGBTQIA+ communities. Communities that have often seen how the framing of institutionalization as “treatment” obscures both its violent history and its ongoing legacy. In doing so, these policies erase community-based solutions, undermine autonomy, and reinforce the very systems of confinement they claim to move beyond.Take Hochul’s proposal, which seeks to lower the threshold for involuntary psychiatric hospitalization in New York. Under her plan, individuals could be detained not because they pose an imminent danger, but because they are deemed unable to meet their basic needs due to a perceived “mental illness”. This vague and subjective standard opens the door to sweeping state control over unhoused people, disabled peopleand others struggling to survive amid systemic neglect. Hochul also proposes expanding the authority to initiate forced treatment to a broader range of professionals – including psychiatric nurse practitioners – and would require practitioners to factor in a person’s history, in effect pathologizing prior distress as grounds for future detention.This is not a fringe proposal. It builds on a growing wave of reinstitutionalization efforts nationwide. In 2022, New York City’s mayor, Eric Adams, directed police and EMTs to forcibly hospitalize people deemed “mentally ill”, even without signs of imminent danger. In California, Governor Gavin Newsom’s Care courts compel people into court-ordered “treatment”.Now, these efforts are being turbocharged at the federal level. RFK Jr’s Maha initiative proposes labor-based “wellness farms” as a response to homelessness and addiction – an idea that eerily echoes the institutional farms of the 20th century, where disabled people and people of color were confined, surveilled and exploited under the guise of rehabilitation.Just recently, the US Department of Health and Human Services (HHS) announced a sweeping restructuring that will dismantle critical agencies and consolidate power under a new “Administration for a Healthy America” (AHA). Aligned with RFK Jr’s Maha initiative and Donald Trump’s “department of government efficiency” directive, the plan merges the Substance Abuse and Mental Health Services Administration (SAMHSA), the Health Resources and Services Administration (HRSA) and other agencies into a centralized structure ostensibly focused on combating chronic illness. But through this restructuring – and the mass firing of HHS employees – the federal government is gutting the specialized infrastructure that supports mental health, disability services and low-income communities.The restructuring is already under way: 20,000 jobs have been eliminated, regional offices slashed, and the Administration for Community Living (ACL) dissolved its vital programs for older adults and disabled people scattered across other agencies with little clarity or accountability. This is not administrative streamlining; it is a calculated dismantling of protections and supports, cloaked in the rhetoric of efficiency and reform. SAMHSA – a pillar of the country’s behavioral health system, responsible for coordinating addiction services, crisis response and community mental health care – is being gutted, threatening programs such as the 988 crisis line and opioid treatment access. These moves reflect not just austerity, but a broader governmental strategy of manufactured confusion. By dissolving the very institutions tasked with upholding the rights and needs of disabled and low-income people, the federal government is laying the groundwork for a more expansive – and less accountable – system of carceral “care”.This new era of psychiatric control is being marketed as a moral imperative. Supporters insist there is a humanitarian duty to intervene – to “help” people who are suffering. But coercion is not care. Decades of research show that involuntary (forced) psychiatric interventions often lead to trauma, mistrust, and poorer health outcomes. Forced hospitalization has been linked to increased suicide risk and long-term disengagement from mental health care. Most critically, it diverts attention from the actual drivers of distress: poverty, housing instability, criminalization, systemic racism and a broken healthcare system.The claim that we simply need more psychiatric beds is a distraction. What we need is a complete paradigm shift – away from coercion and toward collective care. Proven alternatives already exist: housing-first initiatives, non-police and peer-led crisis response teams, harm reduction programs, and voluntary, community-based mental health services. These models prioritize dignity, autonomy and support over surveillance, control and confinement.As Liat Ben-Moshe argues, prisons did not simply replace asylums; rather, the two systems coexist and evolve, working in tandem to surveil, contain and control marginalized populations. Today, reinstitutionalization is returning under a more therapeutic facade: “wellness farms”, court diversion programs, expanded involuntary commitment. The language has changed, but the logic remains the same.This moment demands resistance. We must reject the idea that locking people up is a form of care. These proposals must be named for what they are: state-sanctioned strategies of containment, rooted in ableism, racism and the fear of nonconformity.Real public health does not rely on force. It does not require confining people or pathologizing poverty. It means meeting people’s needs – through housing, community care, healthcare and support systems that are voluntary, accessible and liberatory.As budget negotiations in New York continue to drag on – with expansions to involuntary commitment still on the table – and as RFK Jr advances carceral care proposals at the federal level, we face a critical choice: will we continue the long history of institutional violence, or will we build something better – something rooted in justice, autonomy and collective wellbeing?The future of mental health care – and of human dignity itself – depends on our answer.

      Jordyn Jensen is the executive director of the Center for Racial and Disability Justice at Northwestern Pritzker School of Law More

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      Trans soldiers served their country. Now the US is rolling back their healthcare

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      When Savannah Blake joined the air force at 22 years old, she was looking for stable employment and a way out of poverty. For the last few years of her service, she worked as a cyberdefense operator in the intelligence squadron. But the work, which involved overseeing computers operating drone surveillance, eventually took a toll on her mental health.“If I had to watch any more of this, I was going to not be alive anymore,” Blake said, who says she experienced suicidal ideations. “I just felt like the bad guy. I felt evil.”View image in fullscreenAfter seven years of service, Blake, who is trans, left the air force with PTSD, generalized anxiety disorder and chronic depression. But she also left with the hope she could finally live as herself without fear of harassment from fellow service members. Last year, she began receiving estrogen through the Department of Veterans Affairs. Now she fears for the future of that care.“Every day, I wake up and I don’t know what the rules are anymore in the country I live in,” said Blake. “It’s becoming increasingly hard to see a future where we’re OK.”Blake is one of about 134,000 transgender veterans living in the US. It’s an alarming time to be someone like her. On his first day in office, Donald Trump issued an executive order recognizing only two sexes, stamping out gender identity in federal documents and public spaces. A series of other orders have attempted to restrict trans rights, including participation in sports, access to gender-affirming care for youth, educational materials in schools and military service.The crackdown has sent shock waves through the VA, which functions as one of the US’s largest healthcare providers, offering free or low-cost care to more than 9 million veterans. After Trump’s inauguration, some VA health centers began removing LGBTQ+ affiliated objects, including pride flags, rainbow magnets, stickers and posters.When Mary Brinkmeyer’s medical center ordered the removal of LGBTQ+ patient flyers and other affirming material days after Trump’s executive orders, she refused, and ultimately resigned. For nearly three years, she had worked as a psychologist and LGBTQ+ veteran care coordinator at the VA facility in Hampton, Virginia. Hospital leadership ordered her to stop LGBTQ+ outreach, advocacy and gender-affirming training to departments because it could be considered “gender ideology”.View image in fullscreen“We all have ethics codes in our professions that say that you’re supposed to do no harm, and that if you’re caught between institutional pressure and the ethics code, you’re supposed to resolve it in a way that’s consistent with the ethics code,” Brinkmeyer said.Brinkmeyer fears for the mental health of trans veterans, whom she saw experience “really intense suicidal crises” after Trump announced a ban on trans people enlisting in the military in 2017. After the election last November, some of her patients requested the removal of trans identifiers in medical records, and others withdrew from coverage over fears of being targeted and losing access to care. For many, those fears have become a reality.Rollbacks became official in March when the VA rescinded directive 1341, a policy that ensured “the respectful delivery of health care to transgender and intersex Veterans”, and announced the phasing out of gender-affirming medical care. The agency had been providing gender-affirming treatment including hormone therapy, prosthetics, hair removal, voice coaching and pre-surgical evaluation including letters of support for more than a decade. While cisgender veterans will still be able to access these treatments, veterans diagnosed with gender dysphoria are now excluded. Mental health services for trans patients and existing VA and military coverage for hormone therapy won’t be affected, according to the memo, which also formalizes banning trans patients from using facilities that align with their gender identity.View image in fullscreen“I am scared for the huge amount of people that are about to be forcibly separated, because the VA is not there to actually catch these people,” Blake said, referring to an influx of trans service members who could be forced out of the military under Trump’s transgender military ban. “I hate that the ladder was pulled up behind me.”‘A death sentence’The changes have put trans veterans seeking gender-affirming care in limbo. It has also created a climate of fear for the trans veterans already receiving hormone therapy, who worry it could be pulled at any time.View image in fullscreenThat’s the reality for Kaydi Rogers. While at the moment her hormone therapy will not be disrupted, she is terrified of losing access to estrogen if the VA continues its crackdown.Rogers spent about five decades acquiring estrogen pills through pharmacies in Mexico or friends with prescriptions.“I was desperate,” Rogers said. “I didn’t know any way of doing anything about what was going on with me. It was not a common thing back in the 70s and 80s to come out trans.”She finally switched to VA coverage because of the potential health risks of taking unregulated pills. But Rogers said if the VA ever stopped prescribing her estrogen, the desperation would return and she would again rely on self-medication for survival.Beyond her concerns about continued access to care, Rogers feels the loss of welcoming and safe spaces inside VA clinics. She says she tries to avoid drawing attention to herself during appointments, fearful of being harassed or attacked.“Before last year, every time I went to the VA, I went dressed as Kaydi and no one seemed to bother me or care,” Rogers said. “Now, not so much.”Other veterans share these safety concerns, including Lindsay Church, the executive director and co-founder of Minority Veterans of America. Church, who is non-binary and uses they/them pronouns, has experienced harassment and discrimination inside VA clinics in the past, and began carrying a printed copy of directive 1341 to prove they were entitled to treatment that respected their gender identity. With that directive rescinded and no guarantee of protection, they’ve canceled VA appointments and sought care elsewhere.View image in fullscreenThe veterans affairs secretary, Doug Collins, stated that trans veterans “will always be welcome at VA and will always receive the benefits and services they’ve earned under the law”. In response to questions about the new policy, the VA press secretary, Peter Kasperowicz, directed the Guardian to the press release from 17 March.Church said the discriminatory climate is having a chilling effect on trans veterans, regardless of whether their care plans have been discontinued under the VA’s new policy. “If I can’t use [my healthcare plan] because I’m scared of being harassed and intimidated, and experiencing physical violence in a bathroom, I can’t use the system,” they said.They called the policy reversal a “death sentence”.View image in fullscreen‘We tell them we will take care of you, and that’s a lie’Trans veterans face higher rates of homelessness, unemployment, PTSD and military sexual trauma compared with cisgender veterans. They are also twice as likely to die by suicide compared with cisgender veterans, and almost six times more likely than the general US population. Advocates and providers say these psychiatric and socioeconomic risk factors, when combined with the loss of an affirming medical environment, places an already vulnerable population even more at risk.One VA clinical social worker, who requested anonymity, said his LGBTQ+ patients don’t feel safe and are experiencing more suicidal ideations than before Trump took office.“I have seen an increase in suicide risk evaluations,” he said. “I’ve done more of those in the last two months than I’ve done the last two years.”View image in fullscreenAnother LGBTQ+ veteran care coordinator said a trans patient attempted suicide at her facility after Trump’s inauguration, and she fears there could be more people who attempt the same. She said notifying trans patients of the policy change has been heartbreaking.“I’ve worked for the past two and a half years to gain people’s trust, and now all of a sudden, I’m pulling out the rug from under them,” she said. “It feels terrible.”She had to tell one patient wanting to start hormone therapy that the VA could no longer help them, and is preparing the same message for trans patients on a months-long waitlist to begin treatment. While she has been looking for ways to provide alternatives, many of her trans patients live in rural areas where accessing gender-affirming care is difficult.Other VA employees see cutting trans healthcare as a betrayal of the benefits promised to service members when they enlist.“We’re asking these 17-year-olds to give their entire bodies to the US government,” said one VA nurse, who requested anonymity over fear of losing her job. “And they’re given one promise, which is that we will care for them. And this is part of care, whether you like it or not.”Gender-affirming medical care has been endorsed by every major medical association in the US, and medical providers say that politicians shouldn’t be allowed to decide how they care for their patients.“You’re giving so much to the military. You give your whole life, you have no say over where you live,” the nurse said. “Then we tell them we will take care of you, and that’s a lie. We’re lying to people – and not just trans veterans, all veterans.” More

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      ‘Trump derangement syndrome’ and the Goldwater rule for psychiatrists | Letter

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      A bill was recently introduced to the Minnesota legislature to categorise “Trump derangement syndrome” as a mental illness. The proposed bill defines the syndrome as characterised by “verbal expressions of intense hostility toward” Donald Trump and “overt acts of aggression and violence against anyone supporting [Trump] or anything that symbolises [Trump].”Such a bill obviously infringes on our constitutional right to freely criticise our elected leaders and can serve as a stepping stone towards labelling and punishing political opponents under the guise of utilising a variety of compulsory psychiatric interventions. However, this bill is reminiscent of anti-Trump mental health professionals who have opined that President Trump poses a great danger because of a severe personality disorder.Clearly, a psychiatric diagnosis can only be made by mental health professionals who are licensed to do so, and only after having examined a patient. It poses great danger to our society both when legislators use their political power to impose a psychiatric label on their political opponents and when mental health professionals misapply their expertise to give a psychiatric label to those whom they fear.In the 1960s, many psychiatrists opined on the mental health of the Republican presidential candidate Barry Goldwater. As a result of that controversy, in 1973 the American Psychiatric Association developed the “Goldwater rule”, which applies to public figures. It states that it is unethical for a psychiatrist to offer a proper authorisation for such a statement.This rule is still in effect, though much too often broken. Perhaps we need to develop a comparable national rule prohibiting political personnel, both elected and appointed, from creating psychiatric diagnoses as a tool against their political opponents.Leon Hoffman Psychiatrist, New York City, US More

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      View from the couch: therapists on sessions in new Trump era

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      In his conversations with trans clients, Will Williams, a therapist in Oakland, California, sees the psychic toll exacted by the fusillade of recent executive orders targeting transgender protections. Many of his patients are filled with fear – and for legitimate reasons.In the days after Donald Trump took office, the administration required passports to be marked with sex assigned at birth, banned trans people from serving in the military and cut funding for gender-affirming care. On some federal websites, the “T” was removed from “LGBT”.“There’s this literal embodied experience of ‘Oh I’m a target,’” said Williams, who is trans. “[We are] the 1% that is going to be targeted and blamed, and when it comes down from the theoretical into daily life – psychically there’s an experience of being erased.”When clients ask him “Do I even exist?”, Williams can at least offer some comfort. He asks: “How is it to be in a room with another trans person?” The question makes plain what is in front of them: yes, they both exist. “The medicine is in that,” Williams says. “Trump can say the moon doesn’t exist anymore, but the moon still shines, and it still waxes and wanes.”Williams is among the many therapists who are figuring out how to navigate a profession that has been plunged into uncharted territory during a tense second Trump term. It’s a new atmosphere, and therapists say they are “learning beside” their clients as they go.Many of those who spoke with the Guardian requested anonymity so they could speak freely about sensitive issues.Liberal therapists say they sometimes incorporate their political views into the healing process to provide support for clients distressed by Trump’s actions. “You’re taught in school that therapists aren’t supposed to be political, but it’s very political,” one liberal practitioner said. “Now, at least in my therapist friend group, we’re like, ‘Screw that, no, this is very political.’”Trump’s policies, such as deporting immigrants, go against therapists’ code of ethics that requires them to uphold client’s dignity and worth, she said. That hasn’t precluded her from working with Trump-supporting clients. Some don’t return “and that’s OK”, but she successfully works with a range of conservative patients.On the other end of the spectrum, some therapists say they are encountering liberal clients who are fearful of coming to therapy: “They want to know if their therapist voted against their human rights.” Providing assurance to anxious clients is an instance in which many are choosing to share their political views. “When appropriate, I want to let them know that it’s really safe,” one therapist said.Liberal therapists, conservative clientsThe relationship between liberal therapists and conservative clients has demanded a slight revision of therapeutic calculus. A few said they find themselves revolted by their clients’ beliefs but figure out how to work with them effectively despite the fraught dynamic.None of the therapists I interviewed said they try to change clients’ political views, but therapy is often about getting people to think about problems in their lives differently – and sometimes there’s overlap.One therapist I spoke with used the example of some of her clients’ fear and hatred of transgender people. She asks them where those fears stem from, because they are often passed on generationally.“What kind of things were you taught as a child? If you heard your parents talking about this – do all of your values align with your parents’ values? Have you ever broken from them? Will you feel rejected by your family or community if you think differently?” she asks.As therapy progresses, fears are often unlocked, and some of those questions are answered. “Even if the client isn’t focused on the political aspect, we can work on some of those themes, like fear, without getting into politics,” she said.Another liberal practitioner who took on a Trump-supporting client had doubts about their potential for growth in part because of the latter’s very religious, conservative beliefs. The client was upset with their church’s liberal positions on some issues, and that was causing a problem in their life.The therapist encouraged the client to talk with church leadership and to try to understand a different viewpoint. “I didn’t look at it as an opportunity or say, ‘Oh, I got a chance to try to win them over,’” she said. “It was, ‘Oh, you have this conflict, and maybe if you can see another perspective that would help you.’”Sometimes, the roles are reversed and fear is on the other foot. A practitioner who fears fascism and societal collapse, and has stocked up on supplies in case “the shit hits the fan”, said the money she makes taking on conservative clients is worth it.“You know, I’m billing $90 an hour, and I can listen to that bullshit for 50 minutes for $90,” she said. “I feel gross saying that because I do think my [Trump-supporting] clients are doing something awful, and are the personification of the problems I deal with.”A website, ConservativeCounselors.com, highlights the work of conservative therapists around the country. The Guardian sent emails to five of them, but only one responded in a brief email.“Conservative therapists have formed a pretty tight group, and many of us have shared that you’ve reached out for an interview,” the therapist, Maria Coppersmith, said. “The general consensus is that the Guardian is so ultra-liberal, that any conservative therapist that shares his or her viewpoint is likely to have their words twisted and will be highly misrepresented. You might get a naive newbie therapist that will agree to an interview, but I am respectfully declining.”‘Screw that, this is very political’To describe what’s occurring in the interplay between therapy and politics, Bill Doherty, co-founder of Braver Angels, a non-profit that works toward depolarization, borrowed a term from practitioners in destabilized Latin American countries: political stress. “It’s the anxiety and psychological preoccupation that stems from what’s happening in our political situation, how government officials are behaving and how we’re treating each other when we disagree,” Doherty said. “The challenge is therapists have their own viewpoints – they vote – this is not external to their lives. So the major challenge that’s now happening is therapists trying to keep their own political leanings from influencing clients.”Broadly speaking, therapists say the profound shock and sharp sense of fear that was almost universal among liberal clients after Trump’s first win has been replaced with variations of numbness, hopelessness and resignation.“After Trump won in 2016 everyone was like, ‘Oh my God what’s going to happen? What are we going to do?’ And during Covid they were like, ‘Oh my God, there are no adults in Washington! What are we going to do?’” a therapist said. Now his clients are much more despondent. “They’re like, ‘Fuck it, let it burn,’” he said.Williams said there was indeed less “fear and scrambling” in November 2024, but it has been more difficult for trans clients this time around. Many are running against the clock to make changes to identification cards, birth certificates, passports and other documents.Similarly, a therapist who works with federal employees says there is a broad sense of “whiplash”. The administration has also attacked minorities and women employed at federal agencies, claiming that they are unqualified and were only hired due to DEI initiatives. That takes a toll on some clients, who may end up questioning how people view their worth.And then there’s intra-family strife. One therapist certified to practice in Michigan and California said familial stress is greater in Michigan, a purple, more religious state. His clients feel a dissonance: “They say, ‘I love my parents, and they’re showing up for me, but then I also know that they voted for this person who’s completely appalling.’”Start honoring the numbnessEach therapist who spoke with the Guardian said anger and numbness over the second administration are initially appropriate responses. “Anger is a protective force,” Williams added.But to help his clients to settle their nervous systems, he directs them inward: “In the stillness they can access the greater wisdom – usually the message is there of what’s going to be supportive to them.” He also urges them to “go to nature and connect to systems older and larger than this moment, and put energy toward something life-affirming and creative”.Another therapist has clients accept this new reality. “Normalize that there is this threatening energy that is closing down certain civil liberties and trying to change social norms,” he said, adding that he also urges people to be curious about their numbness.This doesn’t mean embracing being inactive, however. “Find ways to start honoring the numbness, while starting to move energy, whether that’s physical movement, or getting out, seeing people and finding light in what feels like a dark time for some folks, whether that’s through art, music or nature,” he added.Doherty recommends what he calls “buffering”: limiting intake of news and conversations with friends and family about politics. That’s an especially helpful strategy for couples he counsels who have differing political viewpoints. Many still make it work, Doherty said.Most therapists tell their clients to focus on what they can control. Some suggest putting energy into mutual aid projects or partaking in local political action. One therapist is seeing her siblings more, making herself an ally to trans folks. She also likes to listen to the Moth story hour as a healthy escape from reality.However, another therapist pointed to a meme in which a person is lying in the road, about to get hit by a large truck. In the meme, a nearby therapist waves, shouting: “Just focus on the things you can control!” She finds the advice to be ludicrous. “I feel like an asshole as a therapist sometimes, so I try to not say shit like that.”Liberal therapists often face many of the same fears as their clients. Williams recounted how he worked with some of his youngest clients who were “heartbroken”, and how there was synergy in that process.“What I tried to do in those situations was reconnect them to: ‘We’re here, we’re alive, there’s a purpose,’” Williams said. “I actually left those sessions feeling more purposeful, and feeling more power from what I witnessed after reconnecting them with themselves.”Another therapist said she felt a similar energy by opening up about her political views and fears: “It feels more like we’re in this together,” she said. More

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      Medicaid recipients fear ‘buzzsaw cuts’ for Trump’s agenda: ‘We’re not going to be alive forever’

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      At the age of 62, Marya Parral knows that her, and her husband’s, years of being able to care for their two developmentally disabled sons are numbered, and so they have done everything they can to ensure their children can continue to live independently.For their oldest, Ian, that’s meant placing him in a program on an organic farm that caters to people diagnosed with autism. For Joey, their youngest, who has both autism and Down syndrome, Parral has found a caregiver who can help him deliver newspapers and run errands around their community of Ocean City, New Jersey.Parral said none of this would be affordable without help from Medicaid, the federal government’s insurance program for poor and disabled Americans. But this week, the Republican-controlled House of Representatives approved a budget framework that would make deep cuts to the program, and Parral worries her sons will lose what she has worked so hard to build.“We’re not going to be alive forever. We’re trying to set up a life for them, but that entire life that we’re working so hard to set up for them is dependent on Medicaid,” Parral said. “So it’s really devastating to think about cuts.”Producing a budget is the first step in the Republican-controlled Congress’s drive to enact legislation that will pay for Donald Trump’s priorities. House lawmakers will now spend weeks working to write and pass a bill that is expected to approve $4.5tn in extended tax cuts, as well as funding for Trump’s plan for mass deportations of undocumented immigrants.To pay for it, Republicans are considering a rollback of the federal social safety net, particularly Medicaid, which has nearly 80 million enrollees in all 50 states. The budget plan proposes an $880bn reduction in funding for the insurance over the next 10 years, an amount that experts warn would hollow out the program and have ripple effects across the entire American healthcare system.Megan Cole Brahim, a professor at Boston University School of Public Health and an expert on Medicaid, said the cut was the largest ever proposed, and if enacted would “have far-reaching impacts not just for those who rely on Medicaid, but for entire communities and economies”.“These changes mean millions of Americans – including the low-income, elderly, persons with disabilities, children – will lose health insurance coverage,” she said. “Others may see significant reductions in benefits or limited access to care. The impact on hospitals and health systems will be significant, particularly for safety-net and rural hospitals, which are already on the brink of closure. Patient revenues will fall, uncompensated care will rise. There will be staff layoffs and site closures.”John Driscoll, a healthcare executive and chair of the board of UConn Health in Connecticut, said: “The scale of the buzzsaw cuts to Medicaid would undermine every hospital’s ability to actually support its mission to care for the community, and would be a dangerous cut to the nursing-home infrastructure in the country.”Republican leaders backed the cuts to Medicaid, as well as to similar programs such as one that helps poor Americans afford food, as a way to mollify lawmakers in their party who want the US’s large budget deficit addressed. Still, not everyone is pleased. As the budget was being debated, eight Republican representatives, some of whom Democrats are keen to unseat in next year’s midterm elections, wrote to the House speaker, Mike Johnson, warning that their districts’ large Hispanic populations would be harmed.“Slashing Medicaid would have serious consequences, particularly in rural and predominantly Hispanic communities where hospitals and nursing homes are already struggling to keep their doors open,” they said.All eight ultimately voted for the resolution, but the dissent may be a warning sign for the budget’s prospects of enactment, particularly in the House, where the GOP has a mere three-seat majority. It also remains unclear whether Republicans will try to pass all of Trump’s priorities in one bill, or split them into two.The GOP has made clear they want to fully pay for the extension of Trump’s tax cuts, and Elyssa Schmier, vice-president of government relations for advocacy group MomsRising, said Medicaid and social safety programs are the party’s prime targets for cost savings.“If you’re not going to go after, say, the Pentagon budget, if they’re only going to go to some of these big mandatory spending programs, there’s only so many places that Republicans feel that they can go,” she said.In the days since the budget’s approval, Johnson and Trump have scrambled to downplay the possibility of slashing Medicaid, insisting they intend only to root out “fraud, waste and abuse.”“The president said over and over and over: ‘We’re not going to touch social security, Medicare or Medicaid.’ We’ve made the same commitment,” Johnson told CNN in an interview.Democrats have little leverage to stop the budget, which can be passed with simple majorities in both chambers. But the Democratic senator Ruben Gallego warned that gutting the social safety net to extend tax cuts that have mostly benefited the rich will alienate voters who sided with the GOP last November.“It will be on Donald Trump and Republicans, the fact that he’s going to side with the ultra-rich versus the working poor,” said Gallego, who won election to his seat in Arizona even as Trump captured the state’s electoral votes. “Families that are barely making a living, scratching a living, they’re now going to get kicked off healthcare to give tax cuts to the mega-rich.”The proposed cut to Medicaid would remove billions of dollars in funding from congressional districts nationwide that are represented by lawmakers from both parties, according to an analysis by the liberal Center for American Progress.In California’s San Joaquin valley, the Democratic representative Jim Costa’s district would lose the third-largest amount of funding, according to the data, and Medicaid coverage would be imperiled for more than 450,000 residents.“This reckless budget prioritizes the wealthy while devastating those who need help the most,” Costa said. “I voted no because this resolution is bad for our valley and a threat to the wellbeing of the people I represent.” More

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      In this age of rage, it’s easy for Trump to keep stoking people’s anger | Henry Porter

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      Donald Trump and the Republican party may have won a decisive victory, but do not expect the anger that has blighted America since Trump announced he was running for office nine years ago to subside. Anger and grievance are the fuel rods of Maga populism, and they must be kept at dangerously high temperatures for the movement and a second Trump term to operate.Watching the last four weeks of the campaign, the uninhibited rage of Trump and his supporting acts at rallies was very striking. There was no attempt at decent norms. As the election neared, speeches became louder and more laced with vitriol, to the degree that commentators believed they had gone too far for the American public.First lesson of the Democrat defeat is that most US voters lapped it up. This is what they want. America is a very angry place, much more so that than its neighbour to the north, Canada. In the US, dissatisfaction with opportunities, the state of the country and the government have risen sharply since the Reagan era, whereas in Canada dissatisfaction has only increased over the government’s failure to protect the most vulnerable in society. That says a lot about the wildly differing tone of the two societies as well as levels of available empathy.Road rage in the US doubled between 2019 and 2022, with 44 people killed or wounded by gunfire on the roads every month, a ­figure that bucks the trends of violent crime and murder that have been generally declining in the US since 1990.There are a lot of people walking around with the bewildering, hair-trigger rage of John Goodman’s character Walter Sobchak in the Coen brothers’ 1998 film The Big Lebowski. Trump echoes the craziness, amplifies it, then uses the energy tha t it returns to him.This is a feedback loop, but the anger doesn’t just circle with the same intensity between Trump and his people; it steadily increases.At a Trump rally you became aware of the exuberant high of the outrage, that this is a fix enjoyed across America both by those who tend towards unreflective negativity, racism and misogyny and by people who have a genuine complaint about their lives. In both cases they have acquired the habit of rage, and it has become a meaningful and gratifying part of their identity.The anger is not simply going to evaporate when Trump takes over in January, not only because it’s too important to people’s sense of political self but also because the communication channel between the president and his supporters works only at this level. There is no exchange of ideas, of course, no sense that he leads with a vision other than the one that meets their anger with a promise of destruction.The early evidence of this political wrecking machine comes with the appointments of Tulsi Gabbard as director of national intelligence, Matt Gaetz as attorney general and Fox News anchor Pete Hegseth at the Pentagon, all of whom cannot fail to vandalise and degrade the institutions they take over. Indeed, that appears to be their brief.When he moves back into the White House with the Senate, Congress and supreme court in the control of the Republican party, he will be one of the most powerful presidents ever to have governed and he will be 100% responsible for the fortunes of Americans.How will his supporters, so used to reflexively blaming Washington and the government, confront his responsibility when he fails to improve their lives, as he certainly will because of a suicidal tariff regime, tax cuts to the rich and corporations that will increase national debt, cuts to Medicaid and mass deportations of undocumented immigrants that will severely damage growth as well as cause unbelievable pain to separated families across America?His failure will be a problem for his supporters, who can’t lose faith in their idol, and also for Trump, who must not let their support fall away. The solution for both parties will be to maintain the anger but divert it away from Trump.skip past newsletter promotionafter newsletter promotionAnd this is where we should fear for America. Trump has been lining up scapegoats. He has promised to persecute “the enemies within” and “radical left communists” like Adam Schiff, the new senator for California, and the former speaker Nancy Pelosi. He has made threats to Michelle Obama and Liz Cheney, who endorsed Democrat candidate Kamala Harris, and has demanded that CBS’s broadcast licence be revoked. He has suggested “one really violent day” and “one rough hour” against petty criminals.He will resort to this list whenever he needs to, but it will be America’s undocumented immigrants who will initially suffer, for next to the economy they topped the concerns of Republican voters. Trump will always be able to satisfy Maga anger by promising new and more cruel actions against immigrants, among which measures are likely to be privately run detention camps.There is no telling where this will end, no sense where national resistance will come in a society that is unused to dealing with an authoritarian who exploits dark and violent emotions as expertly as Trump does.The Democrats are plunged in a round of recriminations about the defeat, but they need to find new leadership and a strategy to deal with the anger that now threatens America and its institutions of government. When fuel rods overheat in a nuclear reactor, the result is usually meltdown. More

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      Donald Trump is a superspreader of a craziness that has split America in two | Simon Tisdall

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      Is Donald Trump going mad? It depends how you define the word. But since he’s hoping to be elected US president on Tuesday, it would be handy to know. Democrats describe him as “weird” and “unhinged”. His rival, Kamala Harris, raised the “M” question again last week. “This is someone who is “unstable, obsessed with revenge, consumed with grievance, and out for unchecked power,” she warned.Harris, to her credit, was being relatively polite, though goodness knows why, given the way he disses and demeans her. So let’s pose the question in more colloquial, idiomatic terms. Has stark raving Trump finally lost his marbles? Are there bats in the belfry? If he’s off his rocker, not playing with a full deck and away with the fairies, the world and the voters have a right to know.Harris’s assessment is obviously not an objective medical diagnosis of mental disorder. It’s a normal person’s reaction to the abnormal things Trump says and does. Crazy-strange campaign speeches by him and his supporters, notably at Madison Square Garden last weekend – a gathering akin to a Nazi Nuremberg rally – are reviving the debate about his sanity that began during his first term.In The Dangerous Case of Donald Trump, published in 2017, a group of 27 psychiatrists, psychologists, and other mental health professionals raised numerous red flags. One contributor suggested he was clearly off his chump: “Trump is now the most powerful head of state in the world, and one of the most impulsive, arrogant, ignorant, disorganised, chaotic, nihilistic, self-contradictory, self-important, and self-serving.”That professional opinion, made seven years ago, still rings true. Yet is the madness of “King” Trump, like the madness of King George (whose tyrannical rule Trump seeks to emulate), getting worse?By one measure – his wild, deranged language – the deterioration is marked. “His speeches have grown coarser and coarser,” wrote veteran White House watcher Peter Baker, who dubs him “the profanity president”.“Counting tamer four-letter words like ‘damn’ and ‘hell,’ he has cursed in public at least 1,787 times in 2024,” Baker wrote. His analysis shows Trump is using such language 69% more often than when he ran in 2016. It’s shocking, even by today’s tawdry standards. Trump calls Harris a “shit vice-president” who is “mentally impaired”. Doubtless he knows of what he speaks.Vulgarity, however gross, is not proof of madness. But it may be symptomatic. The Merriam-Webster dictionary, America’s oldest, defines a mad person as one “completely unrestrained by reason and judgment; unable to think in a clear or sensible way”. Trump aces this definition every time he opens his mouth. It fits him to a tee. Exhibit A: his oddball musings about golfer Arnold Palmer’s penis.Bizarre Trump traits, such as compulsive, blatant lying, meet another dictionary definition of madness – behaviour that is “incapable of being explained or accounted for”.A third definition, rooted in US rather than British usage, suggests that Trump is indisputably bananas, in the sense that he is constantly “intensely angry or displeased”. Always feeling furious, feeling “mad as hell”, must be exhausting. It’s enough to drive anyone round the bend. Older people often get irritable, of course; and screw-loose Trump is 78. So is incipient senility, or cognitive decline, another cause of his exceptional looney-ness?Trump stumbles, mispronounces words, forgets where he is and loses his train of thought. Just like Joe Biden, in fact. But Biden is merely old. Trump is nuts.Trump has refused to take credible mental acuity tests or release his medical records. Last month, more than 230 healthcare specialists urged him to be more transparent. “As we all age, we lose sharpness and revert to base instincts,” they noted. “We are seeing that from Trump as he uses his rallies… to crudely lash out.”It may go back to childhood. One theory is that Trump, bullied and bullier, was driven up the wall by maternal love denied. Another theory is that he suffers from “disinhibition”. This is when people become less restrained, the older they get.But the Atlantic journalist McKay Coppins, who interviewed Trump 10 years ago, says he’s always been this way. His “depthless vanity, his brittle ego, his tragic craving for elite approval” haven’t changed one bit, Coppins wrote.skip past newsletter promotionafter newsletter promotionNarcissism, hedonism, obsession, a need to provoke, scare, shock and scandalise, and chronic, paranoid feelings of victimhood are all indicators of worsening mental imbalance, if not early-onset imbecility. Recent Trump lunacies include claims that flies are buzzing round his head for “suspicious” reasons, North Korea is trying to kill him, the 6 January riot was a “lovefest”, pet-eating migrants are akin to Hannibal Lecter, and that God saved him in the assassination attempt on his life.If Trump were to go mad on his own time, no problem. Unfortunately, by publicly projecting and displaying mental dysfunction daily on a national stage, he is driving America nuts, too – fans and foes alike. He brings out the worst in everyone, right and left. It could be termed national derangement syndrome (NDS).The poisonous effect of NDS was on show at Madison Square Garden, where “comedians” amplified Trump’s sexist, racist, hate-filled messages. This superspreader craziness destroys reasoned debate, splits the country into opposing camps (hence the dead-heat opinion polls) and sends blood pressure soaring. Many Americans fear civil violence. That’s bonkers.This collective madness, akin to mass hysteria, is all-consuming and universally destructive. Like much that happens in America, it reverberates around the globe. Trump’s fascistic Mad Hatter world is also the world of sicko revanchist dictators like Russia’s Putin, Europe’s far-right ultra-nationalist fruitcases, Iran’s manic mullahs and off-their-heads Israeli génocidaires.It’s a mad, mad, mad, mad world – to hijack the title of Stanley Kramer’s 1963 comedy classic – but it’s no laughing matter. It may be about to get madder still. Simon Tisdall is the Observer’s Foreign Affairs Commentator More

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      Therapy-speak and 80s hairstyles: will Harris’s Brené Brown sit-down swing white female voters?

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      In the quest to win over white female voters – 53% of whom showed up for Donald Trump in 2020 – Kamala Harris made her case on a podcast hosted by one of their beloved avatars, the vulnerability researcher Brené Brown. The episode, released on Monday, was a mostly fluffy discussion about leadership, trauma and the notion of voting as agency in an uncontrollable news cycle.Brown, a University of Houston professor and bestselling author who has spent two decades studying social sciences, became an overnight celebrity after giving a 2010 Ted Talk called “the power of vulnerability”. One could argue the talk, which birthed Brown’s Oprah-approved speaking empire, also spawned our culture’s current obsession with therapy-speak.Brown’s mottos, such as “courage over comfort” and “what we know matters, but who we are matters more”, align with Harris’s oft-maligned tendency toward a self-help speaking style and vibes-only posturing. Brown’s podcast, Unlocking Us, leads the relationship genre on Apple Podcasts. The vice-president’s campaign might have also hoped that an endorsement from Brown, a 58-year-old church-going Texan, will swing undecided white female voters – a crucial demographic that would help shore up Harris’s record support among women and counterbalance Trump’s popularity with men.That’s not to say Brown’s own politics are inscrutable: she reportedly donated to the White Women for Kamala Harris fundraiser, and she kicked off the episode by declaring herself an “unapologetic Harris/Walz supporter”. Thus began an hour-long chat about “courageous leadership”.Harris spoke about the importance of family and friends as a support system for leaders. She spoke lovingly of her mother, a late cancer researcher, and of her lifelong girlfriends whom she considers just as valuable, if not more so, than romantic partners – a line that probably resonated with gen Z women, who increasingly prioritize platonic relationships, and the many older women who are learning to live alone. When asked about her two biggest values in a leader, Harris called out “fairness and justice”. “That’s so powerful,” Brown cooed back.With just a week to go before election day, as she struggles to communicate policy issues with voters, Harris cycled through her greatest hits. While speaking on reproductive rights, she said she was the first sitting vice-president to have visited an abortion clinic. She imagined Trump in the Oval Office on the first day of his second presidency drafting an “enemies list”, unlike the “to-do list” she would be looking at – he’ll stew while she gets to work. In this vein, much of the conversation focused on fear of another Trump presidency. Using a favorite therapy buzzword, Harris said Americans were “traumatized” by the “cruelty” of Trump’s Maga movement. “Trauma blunts our senses,” and voting blue was a way to take back some of the power, she said.Harris seems to genuinely enjoy speaking to people in these lower-stakes, conversational formats, and some of her standout bits with Brown appeared off the cuff. We learned that her college nickname was “C Cubed”, which stood for “cool, calm and collected”. And despite having what Brown described as a “Depeche Mode haircut” in her 20s (a closely cropped, asymmetrical look), Harris said she was never big on the goth sound – though her husband, Doug Emhoff, loves the group.Except for the two women’s emphatic support of abortion rights, the chat came off as cozy and largely apolitical. That tactic could play well with Unlocking Us listeners, who probably come to Brown’s lovey-dovey podcast as an escape from the hyper-partisan news cycle. Harris seemed, if not the candidate you want to have a beer with, then the pleasant-enough person sitting next to you at an airport bar sipping on a glass of chardonnay.Positioned against Trump’s macho posturing, which reached an apex this weekend with an appearance on Joe Rogan’s podcast and the racist Madison Square Garden bonanza, Brown’s interview with Harris was like a cardigan on the first day of fall. And we know how much white women love fall. More