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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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    Trump cracks down on homelessness with executive order enabling local governments

    The federal government is seeking to crack down on homelessness in the US, with Donald Trump issuing an executive order to push local governments to remove unhoused people from the streets.The order the US president signed on Thursday will seek the “reversal of federal or state judicial precedents and the termination of consent decrees” that restrict local governments’ ability to respond to the crisis, and redirect funds to support rehabilitation and treatment. The order aims to “restore public order”, saying “endemic vagrancy, disorderly behavior, sudden confrontations, and violent attacks have made our cities unsafe”, according to the order.The action comes as the homelessness crisis in the US has significantly worsened in recent years driven by a widespread shortage of affordable housing. Last year, a single-day count, which is a rough estimate, recorded more than 770,000 people experiencing homelessness across the country, the highest figure ever documented.Cities and states have adopted an increasingly punitive approach to homelessness, seeking to push people out of parks and city streets, even when there is no shelter available. The supreme court ruled last year that cities can impose fines and even jail time for unhoused people for sleeping outside after local governments argued some protections for unhoused people prevented them from taking action to reduce homelessness.Karoline Leavitt, the White House press secretary, told USA Today, which first reported on the executive order, that the president was “delivering on his commitment to Make America Safe Again” and end homelessness.“By removing vagrant criminals from our streets and redirecting resources toward substance abuse programs, the Trump Administration will ensure that Americans feel safe in their own communities and that individuals suffering from addiction or mental health struggles are able to get the help they need,” she said.The president’s order comes after last year’s US supreme court ruling, which was one of the most consequential legal decisions on homelessness in decades in the US.That ruling held that it is not “cruel and unusual punishment” to criminalize camping when there is no shelter available. The case originated in Grants Pass, Oregon, a city that was defending its efforts to prosecute people for sleeping in public.Unhoused people in the US have long faced crackdowns and sweeps, with policies and police practices that result in law enforcement harassment, tickets or jail time. But the ruling supercharged those kinds of aggressive responses, emboldening cities and states to punish encampment residents who have no other options for shelter.In a report last month, the American Civil Liberties Union found that cities across the US have introduced more than 320 bills criminalizing unhoused people, the majority of which have passed. The crackdowns have taken place in Democratic- and Republican-run states alike.Advocates for unhoused people’s rights have long argued that criminalization only exacerbates the housing crisis, shuffling people in and out of jail or from one neighborhood to the next, as they lose their belongings and connections to providers, fall further into debt and wind up in increasingly unsafe conditions.During his campaign last year, Trump used dark rhetoric to talk about the humanitarian crisis, threatening to force people into “tent cities”, raising fears that some of the poorest, most vulnerable Americans could end up in remote locations in settings that resemble concentration camps. More

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    Consent decrees force schools to desegregate. The Trump administration is striking them down

    In late April, the Department of Justice announced that it was ending a decades-long consent decree in Plaquemines parish, Louisiana, in a school district that has been under a desegregation order since the Johnson administration in the 1960s.The Plaquemines parish desegregation order, one of more than 130 such orders nationwide, was in place to ensure that the school district, which initially refused to integrate, followed the law. Many consent decrees of the era are still in existence because school districts are not in compliance with the law.Some experts, including former justice department employees, say the change in direction for the department could be worrying.These orders “provide students with really important protections against discrimination”, said Shaheena Simons, who was the chief of the educational opportunities section of the civil rights division at the justice department for nearly a decade. “They require school districts to continue to actively work to eliminate all the remaining vestiges of the state-mandated segregation system. That means that students have protections in terms of what schools they’re assigned to, in terms of the facilities and equipment in the schools that they attend. They have protection from discrimination in terms of barriers to accessing advanced programs, gifted programs. And it means that a court is there to protect them and to enforce their rights when they’re violated and to ensure that school districts are continuing to actively desegregate.”The justice department ended the Plaquemines parish desegregation order in an unusual process, one that some fear will be replicated elsewhere. The case was dismissed through a “joint stipulated dismissal”. Previously, courts have followed a specific process for ending similar cases, one in which school districts prove that they are complying with the court orders. That did not happen this time. Instead, the Louisiana state attorney general’s office worked with the justice department in reaching the dismissal.“I’m not aware of anyone, any case, that has [ended] that way before,” said Deuel Ross, the deputy director of litigation of the Legal Defense Fund (LDF); the LDF was not specifically involved with the Plaquemines parish case. “The government as a plaintiff who represents the American people, the people of that parish, has an obligation to make sure that the district has done everything that it’s supposed to have done to comply with the federal court order in the case before it gets released, and the court itself has its own independent obligation to confirm that there’s no vestiges of discrimination left in the school district that are traceable to either present or past discrimination.”Despite the district not proving that it is compliant with the order, the justice department has celebrated the end of the consent decree.“No longer will the Plaquemines Parish School Board have to devote precious local resources over an integration issue that ended two generations ago,” Harmeet K Dhillon, assistant attorney general of the justice department’s civil rights division, said in a statement announcing the decision. “This is a prime example of neglect by past administrations, and we’re now getting America refocused on our bright future.”But focusing on the age of the case implies that it was obsolete, according to Simons, who is now the senior adviser of programs and strategist at the Lawyers’ Committee for Civil Rights Under Law. “The administration is trying to paint these cases as ancient history and no longer relevant.”In 1966, the Johnson administration sued school districts across the country, particularly in the south, that refused to comply with desegregation demands. At the time, Plaquemines parish was led by Leander Perez, a staunch segregationist and white supremacist.Perez had played a large role in trying to keep nearby New Orleans from desegregating, and once that effort failed, he invited 1,000 white students from the Ninth Ward to enroll in Plaquemines parish schools. By 1960, nearly 600 had accepted the offer. Perez was excommunicated by Archbishop Joseph Francis Rummel for ignoring his warning to stop trying to prevent schools run by the archdiocese of New Orleans from integrating.Perez attempted to close the public schools in Plaquemines parish, and instead open all-white private academies, or, segregation academies, which became a feature of the post-integration south. An estimated 300 segregation academies, which, as private schools, are not governed by the same rules and regulations as public schools, are still in operation and majority white.Students and teachers working in school districts today might be decades removed from the people who led the push for desegregation in their districts, but they still benefit from the protections that were long ago put in place. Without court oversight, school districts that were already begrudgingly complying might have no incentive to continue to do so.According to the Century Foundation, as of 2020, 185 districts and charters consider race and/or socioeconomic status in their student assignment or admissions policies, while 722 districts and charters are subject to a legal desegregation order or voluntary agreement. The justice department currently has about 135 desegregation cases on its docket, the majority of which are in Louisiana, Mississippi, Alabama and Georgia.skip past newsletter promotionafter newsletter promotion“Separate but equal doesn’t work,” said Johnathan Smith, former deputy assistant attorney general in the civil rights division at the justice department. “The reality is that students of color do better when they are in integrated classrooms … We know that the amount of resources that are devoted to schools are greater when there are a higher number of white students. So to have students attend majority-minority school districts means that they’re going to be shut out, whether that’s from AP classes, whether that’s from extracurricular activities. All the activities that make it possible for students to fully achieve occur when you have more integrated classrooms.”“Public education isn’t just about education for the sake of education,” he added. “It’s about preparing people to be citizens of our democracy and to be fully engaged in our democratic institutions. When you have students that are being shut out from quality public education, the impact is not just on those communities. It’s on our democracy writ large.”Smith, the current chief of staff and general counsel for the National Center for Youth Law, said that the decision “signals utter contempt for communities of color by the administration, and a lack of awareness of the history of segregation that has plagued our nation’s schools”.“Even though we are 71 years after the Brown v Board [of Education] decision, schools of this country remain more segregated today than they were back in 1954,” he said. “The fact that the administration is kind of wholeheartedly ending these types of consent decrees is troubling, particularly when they’re not doing the research and investigation to determine whether or not these decrees really should be ended at this point.”Smith said that the decision in the Plaquemines parish case may be a “slippery slope” in which other school districts begin reaching out to the Trump administration.“The impact they can have across the country and particularly across the south is pretty huge,” he said. “I worry that we’re going to see more and more of these decrees falling and more and more of these districts remaining segregated without any real opportunity to address that.” More

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    So big, so beautiful: Fox News ignores the critics and champions Trump’s bill

    Donald Trump’s mega-bill has been widely criticized in the press. News outlets and Democrats have warned that millions of people could be stripped of their health coverage through cuts to Medicaid, that cuts to food programs would see children go hungry, and that the legislation would cause the deficit to balloon.Fox News sees it differently.“This legislation is packed with massive, huge, important wins for you, the American people,” Sean Hannity told viewers on Monday, as US senators debated the bill in Washington.“Here’s what the bill doesn’t do. It does not decrease Medicaid, Medicare, Snap or social security benefits,” Hannity continued, a claim that completely contradicted the assessment of the Congressional Budget Office, which estimates the bill will cut Medicaid across the US by 7.6 million to 10.3 million people.Hannity had more.“The big, beautiful bill also does not increase the deficit. Instead, the deficit will go down around a little shy of $2tn – that’s to begin with, according to estimates,” he said.“Because guess what? That’s what happens when you cut taxes. It stimulates the economy, creates jobs, gets people off the welfare rolls. Guess what? People are working, now they’re paying taxes.”It was unclear where Hannity got his $2tn number from, because he didn’t say. But the CBO says the bill would add at least $3.3tn to the national debt over the next nine years, while the tax cuts will benefit high earners more than others.Hannity held up Ronald Reagan’s tax cuts in 1981 as an example of how the deficit will be reduced – a take that ignored that those tax cuts saw an increase of the deficit, and had to be reversed over the rest of Reagan’s presidency.Still, Hannity was sold.“The American people are on the verge of a level of prosperity they have never experienced before,” he said.Hannity’s interpretation was starkly different from the one many Americans were seeing.Even Republican senators have been dubious about the bill’s benefits, with three voting against it in the early hours of Tuesday morning, and House Republicans wavering on Wednesday.Yet, on Tuesday, Laura Ingraham largely ignored the bill – framing it only as Democrats losing a battle to “derail” the legislation before going on a minutes-long riff about a “slide in patriotism” in the US.She went on to offer complaints that there were “more foreign flags waving” in America’s streets and that leftwing politicians believe that “America can only be redeemed when she’s totally dismantled and then remade, with millions of new people from other countries”.Elsewhere, there were occasional, albeit small, concessions that the “big, beautiful bill” might not quite be the masterly piece of legislation the White House would have people believe.“It’s not perfect, but it does need to pass if we want this tax cut,” Ainsley Earhardt said on Fox & Friends at the start of the week. Her co-host Brian Kilmeade at least presented some of the negative points in an interview with Scott Bessent, the treasury secretary, on Tuesday, challenging him to address the claim that “this is a tax break for the rich”. But Bessent didn’t even attempt to address that, and Kilmeade was unwilling or unable to press him further.Later that day, the theme continued. Trace Gallagher pulled up data from the Tax Foundation and the Tax Policy Center during his show, with a series of bullet points claiming that if Trump’s bill failed it would lead to tax increases for families and small business owners.Gallagher left out the part of the Tax Foundation’s analysis where the organization said the bill would reduce incomes by 0.6% and result in a nearly $3.6tn deficit increase, and ignored the Tax Policy Center’s verdict that most of the tax cuts in the bill would go “to the highest-income households”.His guests seemingly overlooked those bits, too, as they kept up the ruse.“No bill is perfect,” Elizabeth Pipko, a former spokesperson for the Republican National Committee, told Gallagher, as she claimed “the Democrats seem to have forgotten that” before accusing the mainstream media, with no irony, of not accurately representing the bill.Pipko added: “I think it will pass, and I think it’ll go down in history as again another false alarm from the legacy media, from the Democrats, and another victory for President Trump.” More

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    ‘A dark day for our country’: Democrats furious over Trump bill’s passage

    Democrats have erupted in a storm of outrage over the passage of the Donald Trump’s budget bill, delivering scathing critiques that offered signs of the attack lines the party could wield against Republicans in next year’s midterm elections.Party leaders released a wave of statements after the sweeping tax and spending bill’s passage on Thursday, revealing a fury that could peel paint off a brick outhouse.“Today, Donald Trump and the Republican party sent a message to America: if you are not a billionaire, we don’t give a damn about you,” said Ken Martin, the Democratic National Committee chair.“While the GOP continues to cash their billionaire donors’ checks, their constituents will starve, lose critical medical care, lose their jobs – and yes, some will die as a result of this bill. Democrats are mobilizing and will fight back to make sure everybody knows exactly who is responsible for one of the worst bills in our nation’s history.”The bill’s narrow passage in the House on Thursday, with no Democratic support and only two no votes from Republicans – which came from Thomas Massie of Kentucky and Brian Fitzgerald of Pennsylvania – is “not normal”, wrote congresswoman Alexandria Ocasio-Cortez.Ocasio-Cortez highlighted the contradictions in the bill that Democrats can be expected to campaign on over the next two years, pitting its spending on immigration enforcement against the loss of social benefits for working-class Americans. She noted that Republicans voted for permanent tax breaks for billionaires while allowing a tax break on tips for people earning less than $25,000 a year to sunset in three years.She also noted that cuts to Medicaid expansion will remove tipped employees from eligibility for Medicaid and remove subsidies for insurance under the Affordable Care Act, and reduce Snap food assistance benefits.“I don’t think anyone is prepared for what they just did with Ice,” Ocasio-Cortez wrote on Bluesky. “This is not a simple budget increase. It is an explosion – making Ice bigger than the FBI, US Bureau of Prisons, [the] DEA and others combined. It is setting up to make what’s happening now look like child’s play. And people are disappearing.”Many critics referred to choice remarks made by Republicans in the run-up to the bill’s passage that displayed an indifference to their voters’ concerns.Senator Mitch McConnell was reported by Punchbowl News to have said to other Republicans in a closed-door meeting last week: “I know a lot of us are hearing from people back home about Medicaid. But they’ll get over it.”And Republican senator Joni Ernst, of Iowa, speaking at a combative town hall in Parkersburg in late May, responded to someone in the audience shouting that people will die without coverage by saying, “People are not … well, we all are going to die” – a response that drew groans.Cuts to Medicaid feature prominently in Democratic reaction to the bill.Congresswoman Rashida Tlaib described the bill as “disgusting” and “an act of violence against our communities”.She said: “Republicans should be ashamed for saying, ‘Just get over it’ because ‘We’re all going to die.’ They are responsible for the 50,000 people who will die unnecessarily every year because of this deadly budget.”“There is no sugarcoating this. This is a dark day for our country,” wrote senator Raphael Warnock.“Republicans in Washington have decided to sell out working people. As a result, millions will lose their healthcare and many millions more will see their premiums go up. Rural hospitals and nursing homes across Georgia will be forced to close. Children will be forced to go hungry so that we can give billionaires another tax cut.”But budget hawks on the left and the right have taken issue with the effects this budget will have on the already considerable national debt.“In a massive fiscal capitulation, Congress has passed the single most expensive, dishonest, and reckless budget reconciliation bill ever – and, it comes amidst an already alarming fiscal situation,” wrote Maya MacGuineas, the president of the oversight organization Committee for a Responsible Federal Budget, in reaction to the House’s passage of the bill.“Never before has a piece of legislation been jammed through with such disregard for our fiscal outlook, the budget process, and the impact it will have on the wellbeing of the country and future generations.”“House Republicans just voted – again – to jack up costs, gut health care, and reward the elite with tax breaks,” wrote the House Majority Pac, a Democratic fund.“They had a chance to change course, but instead they doubled down on this deeply unpopular, toxic agenda. They’ll have no one to blame but themselves when voters send them packing and deliver Democrats the House majority in 2026.”“Republicans didn’t pass this bill for the people,” wrote Jasmine Crockett, a Texas Democrat. “They passed it to please Trump, protect the powerful and push cruelty disguised as policy.” More

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    Trump’s tax-and-spending bill passes Congress in major win for president

    The US House of Representatives passed Donald Trump’s sweeping tax and spending bill on Thursday, handing the president the first major legislative victory of his second term and sending to his desk wide-ranging legislation expected to supercharge immigration enforcement and slash federal safety net programs.The 218-214 vote came after weeks of wrangling over the measure that Trump demanded be ready for his signature by Friday, the Independence Day holiday. Written by his Republican allies in Congress and unanimously rejected by Democrats, the bill traveled an uncertain road to passage that saw multiple all-night votes in the House and Senate and negotiations that lasted until the final hours before passage. Ultimately, Republicans who had objected to its cost and contents folded, and the bill passed with just two GOP defections: Thomas Massie, a rightwing Kentucky lawmaker, and Brian Fitzpatrick, who represents a Pennsylvania district that voted for Kamala Harris in last year’s election.“We’ve waited long enough, some of us have literally been up for days now, but this day – this day – is a hugely important one in the history of our nation,” the Republican House speaker, Mike Johnson, said, just before voting began.“With one big, beautiful bill, we are going to make this country stronger, safer and more prosperous than ever before, and every American is going to benefit from that.”The legislation is expected to speed up and expand Immigration and Customs Enforcement deportations, and will probably make Trump’s longstanding desire for a wall along the border with Mexico a reality.It also strikes a blow against the US government’s efforts to fight the climate crisis by phasing out tax incentives created under Joe Biden that were intended to spur investments in electric cars, wind and solar power and other green energy technologies.The bill’s centerpiece is a permanent extension of tax cuts made in 2017, during Trump’s first term, as well as the creation of new, temporary exemptions for tips, overtime pay and car loan interest that the president promised voters during last year’s campaign.The government will lose trillions of dollars in revenue from those provisions, and to offset their costs, Republicans approved an array of cuts to Medicaid, the federal program providing health insurance coverage to poor and disabled Americans, and the Supplemental Nutrition Assistance Program (Snap).Those changes are expected to cost millions of people their benefits, but the bill remains expensive, with the non-partisan Congressional Budget Office (CBO) saying it will add $3.3tn to the country’s debt through 2034.Massie explained his decision to vote against the bill in a post on X, writing that “it will significantly increase U.S. budget deficits in the near term, negatively impacting all Americans through sustained inflation and high interest rates”.Fitzpatrick issued a statement saying “it was the Senate’s amendments to Medicaid, in addition to several other Senate provisions, that altered the analysis” for his district and made him vote no.Democrats blasted the proposal as “one big, ugly bill” that dismantles anti-poverty programs to fund tax breaks for the wealthy. Analyses have shown that high earners benefited most from Trump’s tax policies.The Democratic House minority leader, Hakeem Jeffries, made a last-ditch effort to halt the bill’s passage by delivering a floor speech that lasted eight hours and 44 minutes, the longest ever.“This is extraordinary. This assault on everyday Americans, assault on children, veterans, seniors, people with disabilities. It’s incredible to me, all of this in this one, big, ugly bill,” Jeffries said.“Ripping food out of the mouths of vulnerable Americans – that’s extraordinary that that’s what we’re doing, extraordinary. And all of this is being done, this unprecedented assault on everyday Americans, is being unleashed on the American people, Mr Speaker, on the most vulnerable among us, all of this is being done to provide massive tax breaks to billionaire donors. Shame on this institution. If this bill passes, that’s not America. We’re better than this.”Trump has described the bill as crucial to the success of his second term, and congressional Republicans made its passage their top priority. It was a tall task – the GOP won small majorities in both the House and Senate in last November’s election, and could afford no more than three defections in either chamber.The party’s lawmakers broadly support Trump but were divided on a host of other issues. There were lawmakers who wanted big spending cuts, rapid phase-outs of green energy incentives and an expanded deduction that would mostly benefit taxpayers in Democratic-led states. Their demands butted against others who sought to moderate the bill, but over the course of weeks, Republicans leaders managed to forge a compromise.Trump appears to have also offered some concessions to hard-line holdouts from the Republican House freedom caucus at a meeting at the White House on Wednesday and in subsequent discussions, as his advisers rushed to ensure the bill passed without returning to the Senate.The details of Trump’s concessions – possibly coming in the form of executive actions at a later date – were not immediately clear, and House freedom caucus chair Andy Harris declined to describe their discussions with Trump.“When we looked at this entire package, the significant agreements we got with the administration in the last 24 hours made this package a much, much better package,” Harris told reporters after the vote. “The agreement is with the president. If you want to know, ask the president.”The bill is only able to affect revenue, spending and the debt limit, under the rules of budget reconciliation that allowed the GOP to avoid a filibuster by Democrats in the Senate. Under Biden, Congress’s then Democratic majority had used the same procedure to pass legislation to spur the economy’s recovery from the Covid-19 pandemic and curb US carbon emissions.Trump’s bill allocates $45bn for Ice detention facilities, $14bn for deportation operations and billions of dollars more to hire 10,000 new agents by 2029. An additional $50bn will go towards the border wall and other fortifications.Enrollees of Medicaid and Snap will face new work requirements, and states will be forced to share part of the cost of the latter program for the first time ever. The CBO estimates the bill’s Medicaid changes could cost as many as 11.8 million people their healthcare, and the left-leaning Center on Budget and Policy Priorities forecasts about 8 million people, or one in five recipients, may lose their Snap benefits.The legislation also forces changes to provider taxes, which states use to finance their share of Medicaid spending. That is expected to further increase the financial stress of hospitals in rural areas, and when the bill was in the Senate, a $50bn fund was added to support those facilities.Some in the GOP were openly nervous about the cuts to safety net programs that their constituents rely on. Thom Tillis, a senator who represents swing state North Carolina, refused to support the bill for those reasons, leading Trump to announce he would support a primary challenger when he stands for re-election next year. Tillis then made public his plans to retire, a potential boost for Democrats’ hopes of claiming his seat.“It is inescapable this bill will betray the promise Donald Trump made,” Tillis said on the Senate floor.“What do I tell 663,000 people in two years or three years when President Trump breaks his promise by pushing them off of Medicaid because the funding’s not there any more, guys?” More

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    America is over neoliberalism and neoconservatism. Trump is not | Samuel Moyn

    The convergence of the US Senate’s passage of Donald Trump’s so-called “big, beautiful bill” in domestic policy with his strike on Iran in foreign policy has finally resolved the meaning of his presidency. His place in history is now clear. His rise, like that of a reawakened left, indicated that America was ready to move on from its long era of neoliberalism and neoconservatism. In office, Trump has blocked the exits by doubling down on both.The first of those slurs, neoliberalism, refers to the commitment across the political spectrum to use government to protect markets and their hierarchies, rather than to moderate or undo them. The second, neoconservatism, is epitomized by a belligerent and militaristic foreign policy. The domestic policy bill now making its way through Congress, with its payoff to the rich and punishment of the poor, is a monument to neoliberalism; the Iran strike a revival of neoconservatism.Up to now, uncertainty about Trump’s place in history has prevailed, in part because he has done little and dithered so much. From before he took office, apocalyptic premonition of the doom he might bring reigned supreme. Everyone assumed that the Trump era was going to be different, disagreeing only about the exact shape of the horror. On the right, some projected their hopes for transformation on the president, anticipating a different future, wishcasting without knowing whether (or when) their leader would side with them.Now, with his bill and his bombing, Trump has confirmed beyond any doubt that he is a man of a familiar past instead. Though the damage that neoliberalism and neoconservatism wrought helped make Trump’s charlatanry a credible choice for millions, the man himself stands for the eternal return of those very same policies. Trump’s appeal to the working class and more measured rhetoric about war from the start of his political career suggested that he might renege on these two dominant creeds from the beltway “swamp”. He renewed them both instead.This is where Trump’s ultimate significance so clearly lies: in continuity, not change. He busted a lot of norms from the first in 2017. Cries of abnormalcy and authoritarianism arose before there was evidence to back them – and evidence has accumulated through both terms. Charlottesville and January 6 in the first – intimations of deeper reservoirs of hate that could come out of American woodwork, with Trump coyly pandering to the mobs – were preludes to both mass and targeted immigration roundups in this term, reminiscent of classical fascism.Yet climactically, and when it mattered most, Trump has chosen to walk in lockstep with the dead consensus in domestic and foreign policy of the past half-century – not merely among conservatives, but among many liberals. Americans do best when the rich do best of all, with the poor punished for crime and sloth: that has long been our outlook. And the country must go it alone with military force, in order to back our interests or principles or both, Americans have long presumed.Neoliberalism and neoconservatism each has more complexity than this – but, leaning into both, Trump has shown in recent weeks they are not much more complicated either. And if so, Trump is far more a politician of American continuity with the past 50 years than many originally feared (or hoped).The “beautiful” domestic policy bill is one of the morally ugliest in American history. Making Trump’s signature tax cuts from his first term permanent requires both draconian cuts to programs (Medicaid for the poor, worst of all) and piling up even more debt for future generations to figure out. It turns out that Ronald Reagan and the Democrats who followed him in lowering taxation and “reforming” welfare (including by imposing work requirements, as this bill does) were not in another world from Trump. He is in theirs. Revealingly, the main trouble that Trump faced in getting the obscenity of a bill passed – and that he still faces in the House – is convincing Republicans who claim to hate deficit spending so much to rationalize even greater cuts to welfare.On the world stage, Trump has longed for the recognition of a Nobel peace prize. But the deals he thinks will deserve it have proved elusive. In Israel/Palestine, the ceasefire he helped force has broken down and the civilian toll has worsened. In Ukraine, the considerable distance between the warring parties has meant that Trump has not managed to either antagonize or lure either to come to terms. Unlike during his first four years, his Iran intervention means that, rather than bringing peace, exacerbating war is his foreign policy legacy for now.Squandering the inclinations of his base and outraging many more lukewarm supporters sick of foreign entanglements, it was a surprise that he acted with the reckless militarism that was once American common sense. He is no doubt open to any deals that come his way – apparently thinking that Canada or Greenland should clamor to be annexed. But it was foolish in response to the early rhetoric of his second term to expect Trump to revert to expansionist war by sending troops. But in sending B-2 bombers on so escalatory a mission to Iran, he clarified his support for war – incurring risks like no other presidents have taken. If the peace he wants to brag about doesn’t materialize, he is not above a dose of coercive violence.skip past newsletter promotionafter newsletter promotionIronically, Trump’s warlike turn meant that a long list of his neoconservative “never Trump” scourges became “sometimes Trump” supporters overnight. Where populist Republicans have had to grit their teeth and support a neoliberal bill – so much for the working-class party they promised – it was even more spectacular that neoconservatives overcame the hatred for Trump that had helped them launder their former reputations for catastrophic warmongering.With neocon scion Bill Kristol in the lead, after the Iran strike they fawned over the man whom they had spent years castigating as irresponsible, or malignant, or both. No wonder: Trump, far from acting as an isolationist or realist, was executing one of the longest-held and longest-denied neoconservative fantasies: that bombing Iran’s nuclear program off the map would work, and might have the fringe benefit of causing the regime to fall. It remains a fantasy. But Trump’s place in history is now defined by that fantasy more than by any other foreign policy choice he has made so far.Like in his first term, when he ordered the assassination in Iraq of Iranian general and terror master Qassem Suleimani in 2020, Trump’s strike on Iran’s nuclear facilities was illegal. But as the saying goes, Trump’s escalatory and risky use of bunker-busting munitions to wipe Fordow and other sites off the map was worse than a crime; it was a mistake. At best, it elicited a face-saving attack from Iran so that it could come to the negotiating table with a nuclear program to continue in the future; at worst, it will prompt Iran to intensify its efforts to achieve the weapon. And while Israel has certainly set back Iran’s regional designs and capacity for sponsoring terror, there are no signs the regime will relent in its policies.With hopes that he might stand for restraint shredded, it is likelier that a lackey will find a place on Mount Rushmore than that Trump will get the call from Oslo he badly wants. But like the politicians whose faces are already carved in the granite of South Dakota, Trump is a man of the past – and never more clearly than in recent weeks, as America continues to look for someone to liberate it from the zombie neoliberalism and neoconservatism that still define their disastrous present and president.

    Samuel Moyn is the Kent professor of law and history at Yale University, where he also serves as head of Grace Hopper College More

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    Planned Parenthood CEO warns Trump bill will lead to $700m loss and ‘backdoor abortion ban’

    Planned Parenthood stands to lose roughly $700m in federal funding if the US House passes Republicans’ massive spending-and-tax bill, the organization’s CEO said on Wednesday, amounting to what abortion rights supporters and opponents alike have called a “backdoor abortion ban”.“We are facing down the reality that nearly 200 health centers are at risk of closure. We’re facing a reality of the impact on shutting down almost half of abortion-providing health centers,” Alexis McGill Johnson, Planned Parenthood Federation of Americas’s CEO, said in an interview Wednesday morning. “It does feel existential. Not just for Planned Parenthood, but for communities that are relying on access to this care.”Anti-abortion activists have longed to “defund” Planned Parenthood for decades. They are closer than ever to achieving their goal.That $700m figure represents the loss that Planned Parenthood would face from a provision in the spending bill that would impose a one-year Medicaid ban on healthcare non-profits that offer abortions and that received more than $800,000 in federal funding in 2023, as well as the funding that Planned Parenthood could lose from Title X, the nation’s largest family-planning program. In late March, the Trump administration froze tens of millions of dollars of Title X funding that had been set aside for some Planned Parenthood and other family-planning clinics.“Essentially what you are seeing is a gutting of a safety net,” said McGill Johnson, who characterized the bill as a “backdoor abortion ban” in a statement.Medicaid is the US government’s insurance program for low-income people, and about 80 million people use it. If the latest version of the spending-and-tax bill passes, nearly 12 million people are expected to lose their Medicaid coverage.Donald Trump has said that he would like the bill to be on his desk, ready for a signature, by 4 July.The provision attacking Planned Parenthood would primarily target clinics in blue states that have protected abortion rights since the overturning of Roe v Wade three years ago, because those blue states have larger numbers of people on Medicaid. Although not all Planned Parenthood clinics perform abortions, the reproductive healthcare giant provides 38% of US abortions, according to the latest data from Abortion Care Network, a membership group for independent abortion clinics.Among the clinics at risk of closure, Planned Parenthood estimated, more than 90% are in states that permit abortion. Sixty percent are located in areas that have been deemed “medically underserved”.In total, more than 1.1 million Planned Parenthood patients could lose access to care.“There’s nowhere else for folks” to go, McGill Johnson said. “The community health centers have said they cannot absorb the patients that Planned Parenthood sees. So I think that we do need to just call it a targeted attack because that’s exactly how it is.”Nationally, 11% of female Medicaid beneficiaries between the ages of 15 and 49 and who receive family-planning services go to Planned Parenthood for a range of services, according to an analysis by the non-profit KFF, which tracks healthcare policy. Those numbers rise in blue states like Washington, Oregon and Connecticut.In California, that number soars to 29%. The impact on the state would be so devastating that Nichole Ramirez, senior vice-president of communication and donor relations at Planned Parenthood of Orange and San Bernardino counties, called the tax-and-spending package’s provision “a direct attack on us, really”.“They haven’t been able to figure out how to ban abortion nationwide and they haven’t been able to figure out how to ban abortion in California specifically,” said Ramirez, who estimated that Planned Parenthood of Orange and San Bernardino counties stands to lose between $40m and $60m. Ramirez continued: “This is their way to go about banning abortion. That is the entire goal here.”skip past newsletter promotionafter newsletter promotionIn a post on X, the prominent anti-abortion group Live Action reposted an image of a Planned Parenthood graphic calling the provision “backdoor abortion ban”. “They might be onto us,” Live Action wrote.The Planned Parenthood network is overseen by Planned Parenthood Federation of America, but it also consists of dozens of independent regional affiliates that operate nearly 600 clinics across the country. In June, as the spending-and-tax bill moved through Congress, Autonomy News, an outlet that focuses on threats to bodily autonomy, reported that Planned Parenthood Federation of America’s accreditation board had sent waivers out to affiliates to apply for approval to cease providing abortions in order to preserve access to Medicaid funding. On Wednesday, the New York Times reported that a memo sent to the leadership of one California affiliate suggests that leaders there had considered ending abortion services.McGill Johnson said that there have been discussions within Planned Parenthood’s network about what it would mean to stop offering abortions. But no affiliates, to her knowledge, are moving forward with plans to stop performing the procedure.“Educating our volunteers and teams around hard decisions to stand and understand the impact of that is different than weighing and considering a stoppage of abortion,” McGill Johnson said.The budget bill and Title X funding freeze aren’t the only sources of pressure on the group. The US supreme court last week ruled in favor of South Carolina in a case involving the state’s attempt to kick Planned Parenthood out of its state Medicaid reimbursement program – a ruling that will likely give a green light to other states that also want to defund Planned Parenthood.At least one other organization that provides abortion and family-planning services, Maine Family Planning, will be affected by the provision, according to the organization’s CEO, George Hill. Maine Family Planning directly operates 18 clinics, including several that provide primary care or are in rural, medically underserved areas. If the provision takes effect, Hill estimates, the organization would lose 20% of its operating budget.“It’s dressed up as a budget provision, but it’s not,” Hill said. “They’re basically taking the rug out from under our feet.” More