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    Democrats use new tactic to highlight Trump’s gutting of Medicaid: billboards in the rural US

    The road to four struggling rural hospitals now hosts a political message: “If this hospital closes, blame Trump.”In a series of black-and-yellow billboards erected near the facilities, the Democratic National Committee (DNC) seeks to tell voters in deep red states “who is responsible for gutting rural healthcare”.“UNDER TRUMP’S WATCH, STILWELL GENERAL HOSPITAL IS CLOSING ITS DOORS,” one sign screams. The billboards are outside hospitals in Silex, Missouri; Columbus, Indiana; Stilwell, Oklahoma; and Missoula, Montana.The fate of rural hospitals has become a politically contentious issue for Republicans, as historic cuts pushed through by the GOP are expected to come into effect over the next decade. Donald Trump’s enormous One Big Beautiful Bill Act (OBBBA) cut more than $1tn from Medicaid, the public health insurance program for low-income and disabled Americans, insuring more than 71 million adults.“Where the real impact is going to be is on the people who just won’t get care,” said Dave Kendall, a senior fellow for health and fiscal policy at Third Way, a center-left advocacy organization.“That’s what used to happen before we had rural hospitals – they just don’t get the care because they can’t afford it, and they can’t get to the hospital.”In response to criticism, Republicans added a $50bn “rural health transformation fund” just before passage of the OBBBA. The fund is expected to cover about one-third of the losses rural areas will face, and about 70% of the losses for the four hospitals where Democrats now have nearby billboards. The rural health fund provides money through 2030, while the Medicaid cuts are not time-bound.That is already becoming a political football, as Democrats argued in a letter that the money is a “slush fund” already promised to key Republican Congress members.“We are alarmed by reports suggesting these taxpayer funds are already promised to Republican members of Congress in exchange for their votes in support of the Big, Ugly Betrayal,” wrote 16 Democratic senators in a letter to Dr Mehmet Oz, Trump’s head of Medicare and Medicaid.View image in fullscreen“In addition, the vague legislative language creating this fund will seemingly function as your personal fund to be distributed according to your political whims.”Rural hospitals have been under financial strain for more than a decade. Since 2010, 153 rural hospitals have closed or lost the inpatient services which partly define a hospital, according to the University of North Carolina Sheps Center for Health Services Research.“In states across the country, hospitals are either closing their doors or cutting critical services, and it’s Trump’s own voters who will suffer the most,” said the DNC chair, Ken Martin, in a statement announcing the billboards.The OBBBA is expected to further exacerbate those financial strains. A recent analysis by the Urban Institute found rural hospitals are likely to see an $87bn loss in the next 10 years.“We’re expecting rural hospitals to close as a result – we’ve already started to see some hospitals like, ‘OK, how are we going to survive?’” said Third Way’s Kendall.skip past newsletter promotionafter newsletter promotionA June analysis by the Sheps Center found that 338 rural hospitals, including dozens in states such as Louisiana, Kentucky and Oklahoma, could close as a result of the OBBBA. There are nearly 1,800 rural hospitals nationally, according to the Kaiser Family Foundation (KFF), a healthcare research non-profit.That perspective was buttressed by the CEO of the National Rural Health Association, Alan Morgan, who in a recent newsletter said 45% of rural hospitals are already operating at a loss.“When you remove $155bn over the next 10 years, it’s going to have an impact,” he said.In the fragmented US healthcare ecosystem, Medicaid is both the largest and poorest payer of healthcare providers. Patients benefit from largely no-cost care, but hospitals complain that Medicaid rates don’t pay for the cost of service, making institutions that disproportionately rely on Medicaid less financially stable. In rural areas, benefit-rich employer health insurance is harder to come by; therefore, more hospitals depend on Medicaid.But even though Medicaid pays less than other insurance programs, some payment is still better than none. Trump’s OBBBA cut of more than $1tn from the program over the coming decade is expected to result in nearly 12 million people losing coverage.When uninsured people get sick, they are more likely to delay care, more likely to use hospital emergency rooms and more likely to struggle to pay their bills. In turn, the institutions that serve them also suffer.“This is what Donald Trump does – screw over the people who are counting on him,” said Martin, the DNC chair. “These new DNC billboards plainly state exactly what is happening to rural hospitals under Donald Trump’s watch.” More

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    ‘We need some hope’: can a rural hospital on the brink survive Trump’s bill?

    When her severely allergic toddler, Josie, began gasping for breath in the middle of the night, Krissy Cunningham knew there was only one place she could get to in time to save her daughter’s life.For 74 years, Pemiscot Memorial hospital has been the destination for those who encounter catastrophe in Missouri’s poorest county, a rural stretch of farms and towns in its south-eastern Bootheel region. Three stories of brown brick just off Interstate 55 in the town of Hayti, the 115-bed hospital has kept its doors open even after the county’s only Walmart closed, the ranks of boarded-up gas stations along the freeway exit grew, and the population of the surrounding towns dwindled, thanks in no small part to the destruction done by tornadoes.For many in Pemiscot county, its emergency room is the closest available without taking a 30-minute drive across the Mississippi river to Tennessee or the state line to Arkansas, a range that can make the difference between life and death for victims of shootings, overdoses or accidents on the road. In the wee hours of one spring morning, it was there that Josie received the breathing treatments and a racemic epinephrine shot that made her wheezing subside.“There is no way I would have made it to one of the farther hospitals, if it wouldn’t have been here. Her airway just would have closed off, and I probably would have been doing CPR on my daughter on the side of the road,” recalled Cunningham, a nurse who sits on the hospital’s board.View image in fullscreenYet its days of serving its community may be numbered. In May, the hospital’s administration went public with the news that after years of struggling with high rates of uninsured patients and low reimbursement rates from insurers, they may have to close. And even if they do manage to navigate out of their current crisis, Pemiscot Memorial’s leaders see a new danger on the horizon: the “big, beautiful bill” Republicans pushed through Congress earlier this month, at Donald Trump’s request.Centered around an array of tax cuts as well as funds for the president’s mass deportation plans, the bill will mandate the largest funding reduction in history to Medicaid, the federal healthcare program supporting low-income and disabled Americans. That is expected to have ripple effects nationwide, but will hit particularly hard in Pemiscot county and other rural areas, where hospitals tend to have frail margins and disproportionately rely on Medicaid to stay afloat.“If Medicaid drops, are we going to be even collecting what we’re collecting now?” asked Jonna Green, the chairwoman of Pemiscot Memorial’s board, who estimated 80% of their revenue comes from Medicaid as well as Medicare, another federal health program primarily for people 65 and older. “We need some hope.”The changes to Medicaid will phase in beginning in late 2026, and require enrollees to work, volunteer or attend school 80 hours a month, with some exceptions. States are also to face new caps on provider taxes, which they use to fund their Medicaid programs. All told, the non-partisan Congressional Budget Office forecasts that 10 million people nationwide will lose their healthcare due to the bill, which is nonetheless expected to add $3.4tn to the federal budget deficit through 2034.Trump carried Missouri, a midwestern state that has veered sharply away from the Democratic party over the past three decades, with more than 58% of the vote last November. In Pemiscot county, where census data shows more than a quarter of residents are below the poverty line and the median income is just over $40,000 a year, he was the choice of 74% of voters, and Republican lawmakers representing the county played a notable role in steering his tax and spending bill through Congress.Senator Josh Hawley publicly advocated against slashing the healthcare program, writing in the New York Times: “If Republicans want to be a working-class party – if we want to be a majority party – we must ignore calls to cut Medicaid and start delivering on America’s promise for America’s working people.” He ultimately supported the bill after a $50bn fund to help rural hospitals was included, but weeks later introduced legislation that would repeal some of the very same cuts he had just voted for.“I want to see Medicaid reductions stopped and rural hospitals fully funded permanently,” the senator said.View image in fullscreenJason Smith, whose district encompasses Pemiscot county and the rest of south-eastern Missouri, oversaw the crafting of the measure’s tax provision as chairman of the House ways and means committee, and has argued they will bring prosperity rural areas across the state. Like others in the GOP, he has said the Medicaid cuts will ferret out “waste, fraud and abuse”, and make the program more efficient.It’s a gamble for a state that has seen nine rural hospitals close since 2015, including one in a county adjacent to Pemiscot, with a further 10 at immediate risk of going under, according to data from the Center for Healthcare Quality and Payment Reform policy group.The Missouri Budget Project thinktank estimates that the bill will cost 170,000 of the state’s residents their health coverage, largely due to work requirements that will act as difficult-to-satisfy red tape for Medicaid enrollees, while the cap on provider taxes will sap $1.9bn from the state’s Medicaid program.“There’s going to be some really hard conversations over the course of the next five years, and I think that healthcare in our region will look a lot different than what it does right now,” said Karen White, CEO of Missouri Highlands Health Care, which operates federally qualified health centers providing primary and dental care across rural south-eastern Missouri. She forecasts 20% of her patients will lose Medicaid coverage through 2030.As the bill was making its way through Congress, she contacted the offices of Smith, Hawley and Missouri’s junior senator, Eric Schmitt, all politicians she had voted for, asking them to reconsider cutting Medicaid. She did not hear back.“I love democracy. I love the fact that we as citizens can make our voices heard. And they voted the way that they felt they needed to vote. Maybe … the larger constituency reached out to them with a viewpoint that was different than mine, but I made my viewpoint heard,” White said.Spokespeople for Schmitt and Smith did not respond to requests for comment. In response to emailed questions, a spokeswoman for Hawley referred to his introduction of the legislation to partially stop the Medicaid cuts.Down the road from the hospital lies Hayti Heights, where there are no businesses and deep puddles form in the potholes and ditches that line roadways after every thunderstorm. Mayor Catrina Robinson has a plan to turn things around for her 500 or so residents, which involves bringing back into service the water treatment plant that is the town’s main source of revenue. But that is unlikely to change much without Pemiscot Memorial.“Half of those people that work at the hospital, they’re my residents. So how they gonna pay their bills? How they gonna pay their water bill, how they gonna pay their light bill, how they gonna pay rent? This is their source of income. Then what will they do?” Robinson said.View image in fullscreenTrump’s bill does include an array of relief aimed at the working-class voters who broke for him in the last election, including tax cuts on tips and overtime pay and deductions aimed at senior citizens. It remains to be seen if whatever financial benefits those provisions bring to the workers of Pemiscot county will outweigh the impact of the stress the Medicaid cuts place on its healthcare system.“The tax relief of server’s tips and all that, that’s not going to change the poverty level of our area,” said Loren Clifton, the hospital’s administrative director. “People losing their healthcare insurance absolutely will make it worse.”Work can be found in the county’s corn, wheat, soybean and rice fields, at a casino in the county seat Caruthersville and at a shipyard along the banks of the Mississippi . But Green questions if those industries would stick around if the hospital goes under, and takes with it the emergency room that often serves to stabilize critical patients before transferring them elsewhere.View image in fullscreen“Our community cannot go without a hospital. Healthcare, employment, industry – it would devastate everything,” Green said.The board is exploring partnerships with other companies to help keep the hospital afloat, and has applied for a federal rural emergency hospital designation which they believe will improve their reimbursements and chances of winning grants, though that will require them to give up other services that bring in revenue. For many of its leaders, the stakes of keeping the hospital open are personal.“This is our home, born and raised, and you would never want to leave it. But I have a nine-year-old with cardiac problems. I would not feel safe living here without a hospital that I could take her to know if something happened,” said Brittany Osborne, Pemiscot Memorial’s interim CEO.One muggy Wednesday morning in July, Pemiscot’s three county commissioners, all Republicans, gathered in a small conference room in Caruthersville’s courthouse and spoke of their resolve to keep the hospital open.“It’s 50-50 right now,” commissioner Mark Cartee said of the hospital’s chances of survival. “But, as long as we have some money in the bank of the county, we’re going to keep it open. We need healthcare. We got to have a hospital.”They were comparatively sanguine about the possibility that the Medicaid work requirements would harm the facility’s finances down the line.“We got a guy around here, I guess he’s still around. He’s legally blind but he goes deer hunting every year,” commissioner Baughn Merideth said. “There’s just so much fraud … it sounds like we’re right in the middle of it.”A few blocks away, Jim Brands, owner of Hayden Pharmacy, the oldest in the county, had little doubt that there were those in the county who took advantage of Medicaid. He also believed that fewer enrollees in the program would mean less business for his pharmacy, and more hardship overall.View image in fullscreen“Just seeing this community, the situation it’s in, the poverty, we’ve got to get people to work. There are a ton of able-bodied people that could work that choose not to,” he said.“To me, there’s got to be a better way to weed out the fraud and not step on the toes of the people who need it.” More

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    Missouri’s governor signs repeal of state’s guaranteed paid sick leave law

    Eight months after voters approved it, Missouri’s governor, Mike Kehoe, signed the repeal of a law on Thursday that had guaranteed paid sick leave to workers and inflation-linked adjustments to the minimum wage.The move marked a major victory for the state’s largest business group and a frustrating defeat for workers’ rights advocates, who had spent years – and millions of dollars – building support for the successful ballot measure. The repeal will take effect on 28 August.Kehoe, who also signed a package of tax breaks on Thursday, described the paid sick leave law as an onerous mandate that imposed burdensome record-keeping.“Today, we are protecting the people who make Missouri work – families, job creators and small business owners – by cutting taxes, rolling back overreach and eliminating costly mandates,” Kehoe, a Republican, said in a statement released after a private bill-signing ceremony.The new tax law excludes capital gains from individual state income taxes, expands tax breaks for seniors and disabled residents, and exempts diapers and feminine hygiene products from sales taxes.Richard von Glahn, who sponsored the worker benefit ballot initiative, said many parents felt forced to go to work instead of staying home to care for a sick child in order to pay for their rent or utilities.“The governor signing this bill is an absolute betrayal to those families, and it hurts my heart,” said Von Glahn, policy director for Missouri Jobs With Justice.About one-third of states mandate paid sick leave, but many businesses voluntarily provide it. Nationwide, 79% of private-sector employees received paid sick leave last year, though part-time workers were significantly less likely to receive the benefit than full-time employees, according to US labor department data.Voters in Alaska, Missouri and Nebraska all approved paid sick leave measures last November. Only Alaska’s, which kicked in on 1 July, has remained unchanged by state lawmakers.Before Nebraska’s measure could take effect on 1 October, the state’s Republican governor, Jim Pillen, signed a measure last month exempting businesses with 10 or fewer employees from the paid sick leave requirements. The revision also allows businesses to withhold paid sick leave from seasonal agricultural workers and 14- and 15-year-olds.Missouri’s law allowed employees to earn one hour of paid sick time for every 30 hours worked, starting 1 May. By the time it’s repealed, 17 weeks will have elapsed. That means someone working 40 hours a week could have earned 22 hours of paid sick leave.If workers don’t use their paid sick leave before 28 August, there is no legal guarantee they can do so afterward.The Missouri Chamber of Commerce and Industry had made repealing the law its top legislative priority.The “paid leave and minimum wage policies were a job killer”, the chamber’s president and chief executive officer, Kara Corches, said.But Missouri voters could get a second chance at mandating paid sick leave.Von Glahn has submitted a proposed ballot initiative to the secretary of state that would reinstate the repealed provisions. Because the new measure is a constitutional amendment, the state legislature would be unable to revise or repeal it without another vote of the people. Supporters have not decided whether to launch a petition drive to try to qualify the measure for the 2026 ballot. More

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    After a Deadly Tornado, a Small Kentucky City Starts Picking Up the Pieces

    On Sunday morning in a small Kentucky city, the sun shone and birds chirped.They provided an incongruent backdrop to a scene that looked like a war zone. Just two days before, a fierce tornado carved a 16-mile path of destruction through Laurel County, Ky., and in its county seat of London, the damage was clear: roofs ripped from homes, tree limbs sheared off, cars left as twisted hunks of metal. And several residents dead.By the afternoon, the Sunshine Hills neighborhood of London was filled with the cacophonous beeping of backhoes, accompanied by an army of faith-based volunteers.Those volunteers were among the many people in London, a city of 8,000 about 80 miles south of Lexington, who worked together this weekend to help not only those in need but also the whole community as it tried to process the disaster. Amid the grief and devastation, ensuring displaced people got the necessary supplies and assistance was top of mind for many.“It didn’t seem right to be sitting at home with our property being untouched with so many people struggling,” said Hannah Clark, who lives in neighboring Pulaski County but came to London to volunteer.The tornado was part of a storm system that tore through the central United States starting Friday, killing at least 28 people. Of those, 19 died in Kentucky, all but two in Laurel County. Outside of Kentucky, Missouri was also hit hard: Seven people died in that state, with five in St. Louis.Most of the victims in Laurel County were killed in Sunshine Hills, according to Gilbert Acciardo, a public affairs official for the county sheriff’s office, who did not give an exact number. Many of them were older, ranging in age from 50 to 70.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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    Missouri Lawmakers to Put Abortion on Ballot Again, Seeking Another Ban

    The state’s Republicans are putting abortion on a ballot question again, seeking to buck the trend of voters siding with abortion rights on ballot measures.In November, Missouri became the first state to overturn a near-total abortion ban by a citizen-sponsored ballot measure. On Wednesday, it became the first state to try to reverse that decision through a ballot question, after the Republican-controlled legislature approved a measure that would ask voters to ban abortion again.The question will appear on the ballot in November 2026, although Gov. Mike Kehoe, a Republican who opposes abortion rights, could choose to put the issue before voters in a special election before that.The measure would amend the state Constitution to ban abortion except in medical emergencies, or in cases of rape or incest if the assault was reported to police within 48 hours and the pregnancy is less than 12 weeks along. The measure would also ban gender-affirming surgery or medications for minors.The legislature approved the measure on the penultimate day of its session after fierce opposition from Democrats and infighting among Republicans, some of whom argued that the new amendment should not include exceptions for rape and incest.The move bucks the trend on abortion-related ballot measures. Voters have sided with abortion rights in 14 out of 17 times that the question has appeared on state ballots in the three years since the U.S. Supreme Court overturned Roe v. Wade, which had for five decades recognized a right to abortion in the Constitution. Opponents of abortion rights have grown wary of putting the question before voters, and in states such as Florida and Arkansas, are instead trying to make it harder for citizens to put questions on the ballot, or pass ballot measures.But Republicans who control the levers of state government in Missouri have long been fiercely anti-abortion; it was the first state to officially ban abortion after the court overturned Roe. They are hoping it will not take much to reverse the amendment approved in November, which passed with support from just under 52 percent of the vote.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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    Christopher Bond, Former Missouri Governor and U.S. Senator, Dies at 86

    A Republican known as Kit, he was the state’s youngest governor. When he retired from Congress after four terms, he said he didn’t want to be the state’s oldest senator.Christopher S. Bond, who was Missouri’s youngest governor and the state’s first Republican governor since 1945 when he was elected in 1972, and who went on to serve four terms in the U.S. Senate, died on Tuesday in St. Louis. He was 86.His death was announced by Gov. Mike Kehoe, a fellow Republican. The announcement did not say where in St. Louis he died.Mr. Bond, known as Kit, was 31 in 1970 when he was elected state auditor, defeating a 17-year incumbent. He served from 1971 to 1973, when he became governor, having been elected in November 1972 at age 33. He was the first Republican to hold that position since Forrest C. Donnell left office in 1945.Mr. Bond was defeated for re-election, but he staged a comeback in 1980 by ousting Joseph P. Teasdale, the Democrat who had replaced him. He succeeded Thomas F. Eagleton, a Democrat, in the Senate in 1987 after Mr. Eagleton retired.His election to a fourth term in 2004 was the seventh time that Mr. Bond won statewide office — more than any other candidate in Missouri’s history.In 2009, he announced that he would not seek a fifth term in 2010.Mr. Bond during his second term as governor of Missouri. He served from 1973 to 1977 and again from 1981 to 1985.UPI/Bettmann Archive, via Getty ImagesWe are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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    Trump to continue Biden’s court defense of abortion drug mifepristone

    Donald Trump’s administration on Monday pushed forward in defending US rules easing access to the abortion drug mifepristone from a legal challenge that began during Democratic former president Joe Biden’s administration.The US Department of Justice in a brief filed in Texas federal court urged a judge to dismiss the lawsuit by three Republican-led states on procedural grounds.While the filing does not discuss the merits of the states’ case, it suggests the Trump administration is in no rush to drop the government’s defense of mifepristone, used in more than 60% of US abortions.Missouri, Kansas and Idaho claim the US Food and Drug Administration acted improperly when it eased restrictions on mifepristone, including by allowing it to be prescribed by telemedicine and dispensed by mail.The justice department and the office of Missouri’s attorney general, Andrew Bailey, did not immediately respond to requests for comment.Trump said while campaigning last year that he did not plan to ban or restrict access to mifepristone. Robert F Kennedy Jr, the health and human services secretary, told Fox News in February that Trump has asked for a study on the safety of abortion pills and has not made a decision on whether to tighten restrictions on them.Last year, the US supreme court rejected a bid by anti-abortion groups and doctors to restrict access to the drug, finding that they lacked legal standing to challenge the FDA regulations.Those plaintiffs dropped their case after the high court ruling, but US district judge Matthew Kacsmaryk, a Trump appointee, allowed the states to intervene and continue to pursue the lawsuit.The US justice department moved to dismiss their claims days before Trump took office in January.In Monday’s filing, government lawyers repeated their arguments that Texas is not the proper venue for the lawsuit and that the states lack standing to sue because they are not being harmed by the challenged regulations.“Regardless of the merits of the States’ claims, the States cannot proceed in this Court,” they wrote.The three states are challenging FDA actions that loosened restrictions on the drug in 2016 and 2021, including allowing for medication abortions at up to 10 weeks of pregnancy instead of seven, and for mail delivery of the drug without first seeing a clinician in person. The original plaintiffs initially had sought to reverse FDA approval of mifepristone, but that aspect was rebuffed by a lower court.The Republican-led states have argued they have standing to sue because their Medicaid health insurance programs will likely have to pay to treat patients who have suffered complications from using mifepristone.They have also said they should be allowed to remain in Texas even without the original plaintiffs because it would be inefficient to send the case to another court after two years of litigation. More

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    A Funeral Director Brought Wind Power to Rock Port, Missouri

    Eric Chamberlain was at work, driving a hearse, when he first caught sight of the wind turbine that would set him on a path to change the fortunes of his hometown.It was the mid-2000s, and Mr. Chamberlain was leading a funeral procession in Iowa, across the border from his home in Atchison County in northwest Missouri, when giant white blades came into view. Mr. Chamberlain had heard of wind energy but not seen a commercial turbine before. He was intrigued, but obviously couldn’t pull over to take a closer look.“I didn’t stop,” said Mr. Chamberlain, whose family has operated Chamberlain Funeral Homes and Monuments since 1968. “I was polite.”Eric Chamberlain, a funeral director, grew up in Atchison, one of Missouri’s most rural counties.After the funeral, he visited a local newspaper in Iowa to ask people there about the wind energy project.Mr. Chamberlain, 70, grew up in Atchison, one of Missouri’s most rural counties, and over the years watched as waning opportunities and population decline steadily ate away at the place. Young people didn’t come back after college. School enrollment fell. Farms got bigger, and fewer farmers meant less tax revenue. Businesses on Main Street closed and the area went from having two grocery stores to one.Tell Us About Solutions Where You Live More