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      RFK Jr accused of ‘reckless disregard for science and the truth’ in Senate hearing

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      The US health secretary, Robert F Kennedy Jr, faced the Senate finance committee in a tense and combative hearing on Thursday, during which lawmakers questioned his remarks expressing vaccine skepticism, claims that the scientific community is deeply politicized and the ongoing turmoil plaguing the Centers for Disease Control and Prevention (CDC).In a hearing lasting more than three hours and ostensibly about the Trump administration’s healthcare agenda, Kennedy defended his leadership at the Department of Health and Human Services (HHS), claiming that his time at the agency will be focused on “unbiased, politics-free, transparent, evidence-based science in the public interest”.Senate Democrats on the committee began the hearing calling for Kennedy’s resignation. “Robert Kennedy’s primary interest is taking vaccines away from Americans,” ranking member Ron Wyden, a Democratic senator from Oregon, said in his opening remarks. “People are hurt by his reckless disregard for science and the truth in this effort. I hope the very least, Robert Kennedy has the decency to tell the truth this morning.”Raphael Warnock, also a Democrat, called Kennedy a “hazard to the health of the American people”, repeating calls for him to step down or for Donald Trump to fire him.Last week, Kennedy fired the CDC director, Susan Monarez, less than a month after she was confirmed to her position. She is now mounting a legal case challenging her removal.Shortly after Monarez’s termination, several leading public health officials at the CDC resigned from their positions, citing frustration with Kennedy’s approach to vaccines and his management style.Kennedy said Monarez was “lying” about her claims that she was fired for refusing to sign off on the secretary’s new vaccine policies. Instead, Kennedy said that she was removed after admitting to being untrustworthy.The Democratic senator Elizabeth Warren, of Massachusetts, was unconvinced – citing Kennedy’s prior characterization of the former CDC director as “unimpeachable”.“You had full confidence in her and you had full confidence in her scientific credentials, and in a month she became a liar?” she asked. Thom Tillis, the outgoing Republican senator of North Carolina, asked about the same contradiction in his questioning.Monarez’s lawyers responded in a statement to Kennedy’s comments, calling them “false” and “at times, patently ridiculous”. They added that Monarez would repeat her published claims “under oath”.Kennedy also justified wider firings at the CDC , calling them “absolutely necessary”.“We are the sickest country in the world,” he said. “That’s why we need to fire people at CDC. They did not do their job. This was their job to keep us healthy.”In June, Kennedy fired all 17 members of the CDC’s vaccine advisory committee – a move that defied a promise he made during his confirmation hearing to Republican senator Bill Cassidy, a physician who chairs the Senate health committee. Many of Kennedy’s replacements for the advisory panel have a history of vaccine skepticism.When asked about the changes to the advisory committee, and how that will change vaccine recommendations and scheduling, Kennedy said he didn’t anticipate changes to the MMR (measles, mumps and rubella) vaccine.In an exchange with Kennedy, Cassidy noted the possible conflict of interest with some of the panel’s new members who are involved in ongoing litigation with vaccine manufacturers.Cassidy cast a critical vote to confirm Kennedy earlier this year. He had previously expressed a number of concerns about the health secretary’s historic comments that undermined vaccine efficacy. The senator has since been critical of a number of Kennedy’s policies, including his decision to cut half a billion dollars worth of mRNA vaccine funding – calling the move “unfortunate”.skip past newsletter promotionafter newsletter promotionLast month, the Food and Drug Administration (FDA) approved the new batch of Covid-19 vaccines, but placed restrictions on who would be able to access them. The agency has authorized shots for people 65 and older, who are known to be more at risk from serious illnesses from Covid infections. Younger people will only be eligible if they have an underlying medical condition that makes them vulnerable. Infectious disease experts say that this policy could prove extremely dangerous, particularly for young children.On Tuesday, Kennedy defended HHS’s handling of the measles outbreak that affected several states in an opinion piece. While the secretary branded his agency’s response as effective, public health experts said Kennedy’s own messaging around vaccines was muddied and confusing.Cassidy concluded his remarks at the hearing by telling Kennedy that his policies were “effectively denying people the vaccine”, sharing an email from a doctor friend who expressed confusion about Covid inoculation eligibility given the FDA’s new recommendation policies.Kennedy snapped back: “You’re wrong.”The Republican senator John Barrasso, of Wyoming, also a doctor, expressed similar concerns about Kennedy’s policies. “In your confirmation hearing you promised to uphold the highest standard for vaccines,” Barrasso said. “Since then, I’ve grown deeply concerned.”During a back and forth with the Virginia senator Mark Warner, a Democrat, Kennedy falsely claimed that there are “no cuts to Medicaid” under the One Big Beautiful Bill Act – Trump’s hallmark domestic policy legislation that was signed into law in July.The congressional budget office estimates that around 7.8 million people stand to lose their health insurance over a decade, due to Medicaid changes under the law.Multiple Democrats on the committee had heated exchanges with the health secretary. Many of them pointed out the inconsistency between Kennedy’s recent support for the president’s “Operation Warp Speed” and his disparagement of the Covid-19 shot. He has previously called it the “deadliest” vaccine ever manufactured.At the hearing, Kennedy refused to acknowledge the wealth of data that shows that the Covid-19 vaccine has saved lives.“Trump has said the vaccine works, and has saved millions of lives. Your own process, on the other hand, has not been transparent,” said the Democratic senator Maggie Hassan, of New Hampshire. “You repeatedly choose to ignore data because it doesn’t match your preconceived notions and lies.” More

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      Texas bill allowing residents to sue out-of-state abortion pill providers reaches governor

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      A measure that would allow Texas residents to sue out-of-state abortion pill providers advanced to the desk of the governor, Greg Abbott, on Wednesday, setting up the state to be the first to try to crack down on the most common abortion method.Supporters say it’s a key tool to enforce the state’s abortion ban, protecting women and fetuses.Opponents see it not only as another way to rein in abortion but as an effort to intimidate abortion providers outside Texas who are complying with the laws in their states – and to encourage a form of vigilantism.If the measure becomes law, it’s nearly certain to spark legal challenges from abortion rights supporters.Under the measure, Texas residents could sue those who manufacture, transport or provide abortion-inducing drugs to anyone in Texas for up to $100,000. Women who receive the pills for their own use would not be liable.Under the bill, providers could be ordered to pay $100,000. But only the pregnant woman, the man who impregnated her or other close relatives could collect the entire amount. Anyone else who sued could receive only $10,000, with the remaining $90,000 going to charity.Lawmakers also added language to address worries that women would be turned in for seeking to end pregnancies by men who raped them or abusive partners. For instance, a man who impregnated a woman through sexual assault would not be eligible.The measure has provisions that bar making public the identity or medical details about a woman who receives the pills.It wasn’t until those provisions were added, along with the limit of a $10,000 payment for people who aren’t themselves injured by the abortion, that several major Texas anti-abortion groups backed the bill.The idea of using citizens rather than government officials to enforce abortion bans is not new in Texas. It was at the heart of a 2021 law that curtailed abortion there months before the US supreme court cleared the way for other state bans to take effect.In the earlier law, citizens could collect $10,000 for bringing a successful lawsuit against a provider or anyone who helps someone obtain an abortion. But that measure didn’t explicitly seek to go after out-of-state providers.Pills are a tricky topic for abortion opponents. They were the most common abortion method in the US even before the 2022 supreme court ruling that overturned Roe v Wade and allowed states to enforce abortion bans.They’ve become even more widely used since then. Their availability is a key reason that the number of abortions has risen nationally, even though Texas and 11 other states are enforcing bans on abortion in all stages of pregnancy.The pills have continued to flow partly because at least eight Democratic-led states have enacted laws that seek to protect medical providers from legal consequences when they use telehealth to prescribe the pills to women who are in states where abortion is illegal.Anna Rupani, executive director of Fund Texas Choice, said the measure is intended to threaten those out-of-state providers and women in Texas.“This is about the chilling effect,” she said. “This is yet another abortion ban that is allowing the state to control people’s health care lives and reproductive decisions.”Earlier this year, a Texas judge ordered a New York doctor to pay more than $100,000 in penalties for providing abortion pills to a Dallas-area woman.The same provider, Dr Maggie Carpenter, faces criminal charges from a Louisiana prosecutor for similar allegations.New York officials are invoking their state’s shield laws to block extradition of Carpenter and to refuse to file the civil judgment.If higher courts side with Louisiana or Texas officials, it could damage the shield laws.Meanwhile, the attorneys general of Texas and Florida are seeking to join Idaho, Kansas and Missouri in an effort to get courts to roll back US Food and Drug Administration approvals for mifepristone, one of the drugs usually used in combination for medication abortions, contending that there are safety concerns. They say it needs tighter controls because of those concerns.If the states are successful, it’s possible the drug could be distributed only in person and not by telehealth.Major medical organizations including the American College of Obstetricians and Gynecologists say the drug is safe. More

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      Former CDC official ‘only sees harm’ to public health under RFK Jr’s leadership

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      The former immunizations director of the Centers for Disease Control and Prevention has warned of the future of American health under the leadership of Donald Trump’s health secretary, Robert F Kennedy Jr.In an interview on Sunday with ABC, Demetre Daskalakis – who resigned this week in protest over the White House’s firing of CDC director Susan Monarez – said: “From my vantage point as a doctor who’s taken the Hippocratic Oath, I only see harm coming.”He went on to add: “I may be wrong, but based on what I’m seeing, based on what I’ve heard with the new members of the Advisory Committee for Immunization Practices, or ACIP, they’re really moving in an ideological direction where they want to see the undoing of vaccination.”Daskalakis’s interview comes amid growing chaos across US health agencies and rare bipartisan pushback towards the White House’s firing of Monarez, which came amid steep budget cuts to the CDC’s work as well as growing concerns of political interference.There have also been growing public calls for Kennedy to resign, particularly as he has continued to make questionable medical and health claims – and be lambasted in response by experts and lawmakers alike.Explaining his resignation, Daskalakis said: “I didn’t think that we were going to be able to present science in a way free of ideology, that the firewall between science and ideology has completely broken down. And not having a scientific leader at CDC meant that we wouldn’t be able to have the necessary diplomacy and connection with HHS to be able to really execute on good public health.”Daskalakis also criticized Kennedy’s recent changes to the childhood Covid-19 vaccine schedule, noting that the vaccine is currently approved only for people aged 65 and older, as well as for children and adults with underlying health conditions.“That’s not what the data shows. Six months old to two years old, their underlying condition is youth. 53% of those children hospitalized last season had no underlying conditions. The data say that in that age range, you should be vaccinating your child. I understand that not everybody does it, but they have limited access by narrowing that recommendation. Insurance may not cover it,” Daskalakis said.He also cast doubt on Jim O’Neill, the new CDC chief who was a top aide to Kennedy and has no training in medicine or infectious disease science.In response to whether or not he trusts O’Neill saying that he is in favor of vaccines, Daskalakis said: “Honestly, I really want to trust it … But based on the very first post that I’ve seen from him on X where he says that CDC scientists manipulated data to be able to follow an ideology or an agenda in the childhood schedule, makes me think that I know what leader he serves, and that leader is one that does not believe in vaccination.”In a Saturday op-ed for the New York Times, Vermont senator Bernie Sanders accused Kennedy of “endangering the health of the American people now and into the future”, adding: “He must resign.”Since he assumed leadership over the health department, Kennedy – a longtime anti-vaccine advocate – has fired health agency workers and entertained conspiracy theories. Last week, more than 750 current and former employees at US health agencies signed a letter in which they criticized Kennedy as an “existential threat to public health”.The health agency workers went on to accuse the health secretary of being “complicit in dismantling America’s public health infrastructure and endangering the nation’s health by repeatedly spreading inaccurate health information”.The letter comes after a deadly shooting at the CDC headquarters in Atlanta earlier this month, when a 30-year-old gunman fired more than 180 rounds into the buildings, killing a police officer before dying from a self-inflicted gunshot wound. The shooter had been struggling with mental health issues and was influenced by misinformation that led him to believe the Covid-19 vaccine was making him sick, according to the gunman’s father. More

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      US health department moves to strip thousands of employees of collective bargaining rights

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      The US Department of Health and Human Services (HHS) has moved to strip thousands of federal health agency employees of their collective bargaining rights, according to a union that called the effort illegal.HHS officials confirmed Friday that the department is ending its recognition of unions for a number of employees and reclaiming office space and equipment that had been used for union activities.It’s the latest move by the Trump administration to put an end to collective bargaining with unions that represent federal employees. Previously affected agencies include the Department of Veterans Affairs (VA) and the Environmental Protection Agency (EPA).In May, an appeals court said the administration could move forward with Donald Trump’s executive order that the president aimed at ending collective bargaining rights for hundreds of thousands of federal employees while a lawsuit plays out.“This action ensures that HHS resources and personnel are fully focused on safeguarding the health and security of the American people,” department spokesperson Andrew Nixon said in a statement.Officials with the American Federation of Government Employees said strong union contracts do not hinder strong responses to public health emergencies. Rather, they help make agencies like the Centers for Disease Control and Prevention (CDC) have a stable, experienced and supported workforce, the union said.Some CDC employees said the union has been a source of information and advocacy for the agency’s employees during layoffs this year and in the wake of the 8 August shooting attack at the CDC’s main campus in Atlanta.Since then, the union has been trying to advocate for a better emergency alert system and better security.Other affected agencies include the Food and Drug Administration (FDA), the National Institutes of Health (NIH), the Administration for Strategic Preparedness and Response and the Office of Refugee Resettlement within the Administration for Children and Families. More

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      ‘Distracting the public’: group of health professionals call for RFK Jr to be removed

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      A grassroots organization of health professionals have released a report outlining major health challenges in the US and calling for the removal of Robert F Kennedy Jr from the US Department of Health and Human Services (HHS).The report from Defend Public Health, a new organization of about 3,000 health professionals and allies, is an attempt to get ahead of misinformation and lack of information from health officials.In an effort to keep making progress in public health, Defend Public Health’s report was slated to coincide with that of the anticipated second US report to “make America healthy again” (Maha). The first Maha report was released in May, and a second report was expected this week – but amid turmoil at the health agencies, it has reportedly been delayed for several weeks.“The Maha report is essentially a distraction from the real causes of poor health,” said Elizabeth Jacobs, professor emerita at the University of Arizona and a founding member of Defend Public Health.“This administration does not want to address things like poverty and education and access to healthcare. Instead, they’re distracting the public with information on solutions to problems that don’t actually exist. When the foundation of your policy is not evidence-based, it will collapse.”The Defend Public Health report diverges from the previous Maha focus on issues such as processed foods and environmental chemicals, but it covers familiar ground in public health.The group highlights the importance of food safety, security and access to food, including through the Supplemental Nutrition Assistance Program (Snap), and improved opportunities for physical activity.They seek to ensure equitable access to vaccines; expand access to healthcare, including comprehensive sexual and reproductive healthcare access; and build strategies for clean air.The report also recommends fully funding scientific research and public health systems; combatting scientific misinformation, including from the US government; and strengthening pandemic preparedness. They call for reductions in gun violence, now the number one cause of death for children.And their last recommendation is to remove Robert F Kennedy Jr, secretary of the US Department of Health and Human Services (HHS), from office, calling his removal “the single most important step toward improving the health of Americans”.The recommendations are exactly what the US needs to address to become healthier, said Georges Benjamin, executive director of the American Public Health Association (APHA). If you “look at the things that actually kill people, from the 10 leading causes of death, that is indeed the right list”.The US spends twice as much on healthcare as the next industrialized country, despite having poorer health outcomes, Benjamin pointed out.“The fracturing of our healthcare system undermines the accessibility of healthcare,” Benjamin said before noting that the US also spends less than other countries on the social determinants of health and social supports, and invests less in primary care and prevention.Such gaps are getting worse under the second Trump administration, with huge cuts to Medicaid, affordable housing, and nutrition programs like Snap.“If they’re serious about making America healthy again, I would suggest that we first begin by feeding children,” Jacobs said. “When, for example, RFK Jr is talking about food dyes, I don’t think that that is anywhere near as important as the fact that 13 million children in the United States do not know where their next meal is coming from.”Scientific misinformation is an “existential threat” to Americans, and the US government is a “major source” of misinformation and disinformation now, Jacobs said.The first Maha report “contains misinformation and uses references that don’t even exist”, she noted. The Defend Public Health report has a tongue-in-cheek note that it was “created by real human experts relying on real rigorous data”.Jacobs recommended working with social media companies, “one of the biggest amplifiers of misinformation”, to address the spread of harmful information. Educating children on how to evaluate the quality and accuracy of information is also important, she said.But one of the biggest purveyors of health misinformation is Kennedy himself.“Everything that he is doing is horrifying,” Jacobs said. “There is a saying in public health, ‘saving lives a million at a time’, and he is doing the opposite of that.”skip past newsletter promotionafter newsletter promotionShe called him a “genuine threat” who is “devastating” public health.“He has no knowledge, training or experience in any type of science. He’s never done an experiment, he’s never written a paper, he’s never gotten a grant to study anything. He has no understanding of the underlying causes of poor health in the United States,” Jacobs said.Defend Public Health launched in November, after Trump’s re-election because, as Jacobs said, “it was very clear to us that public health specifically was going to be under attack.”“We knew that it was going to be a tough fight. I don’t think that any of us knew how bad this was going to get, how quickly. But we are doing everything in our power to support our fellow researchers, public health workers, anybody that we can, and also continue to get accurate information out to the public,” Jacobs said.The group joins other established health organizations as well as other newcomers like the Vaccine Integrity Project to serve as reliable sources of information.There’s a long history of groups like these providing outside perspectives on official recommendations, Benjamin said. But the federal government is uniquely positioned to speak to the health of all Americans.“Pediatricians certainly have the nation’s trust around vaccines for kids, but there’s a big debate about at what point does a kid become an adolescent, become an adult? At what point do they go into the adult health system?” he said.That creates confusion around which advice a patient should follow. The same may be true of a patient who becomes pregnant, or someone who may fall under the purview of multiple health organizations. It’s not always easy to know who belongs in which group.“We have to be careful that each of these private sector organizations align our recommendations, so that we don’t further confuse the public,” Benjamin said.Yet, Benjamin continued, “as the federal government withdraws in its responsibility to protect the public, groups like ours will become more influential in filling that void until we can get the federal government again to step up into that place as a trusted advisor.”Benjamin and Jacobs – and other experts in these groups – hope that the federal government will once again become a source of reliable information.“We really wanted to start building a framework so that we’re ready when we have the opportunity to start putting some of our policy recommendations in place,” Jacobs said.“There is just rampant chaos right now around public health and science related to this administration, and we have got to stand firm and keep bringing the conversation back to the actual causes of poor health among Americans. I can’t control what the government is going to decide to do. What we can do is continue to provide accurate information to the public.” More

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      Gunman in CDC attack fired over 180 shots at building and broke 150 windows

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      The man who attacked the CDC headquarters in Atlanta on Friday fired more than 180 shots into the campus and broke about 150 windows, with bullets piercing “blast-resistant” windows and spattering glass shards into numerous rooms, according to information circulated internally at the agency.It may take weeks or even months to replace windows and clean up the damage, Centers for Disease Control and Prevention personnel said.A Georgia man who had blamed the Covid-19 vaccine for making him depressed and suicidal opened fire late on Friday, killing a police officer. No one at CDC was injured.The shooter was stopped by CDC security guards before driving to a nearby pharmacy and opening fire late Friday afternoon, a law enforcement official has told the AP. The official wasn’t authorized to publicly discuss the investigation and spoke on condition of anonymity. The 30-year-old man, Patrick Joseph White, later died, but authorities haven’t said whether he was killed by police or killed himself.The US health secretary, Robert F Kennedy Jr, traveled to Atlanta and on Monday met with the agency’s director, Susan Monarez.Monarez posted a statement on social media on Friday night that said at least four CDC buildings were hit in the attack.The extent of the damage became more clear during a weekend CDC leadership meeting. Two CDC employees who were told about what was discussed at the meeting described details to the Associated Press on condition of anonymity because they weren’t authorized to reveal the information. Details also were also in an agency memo seen by an AP reporter.Building 21, which houses Monarez’s office, was hit by the largest number of bullets. CDC officials did not say if her office was hit.CDC employees were advised to work from home this week.Kennedy issued a statement on Saturday that said “no one should face violence while working to protect the health of others,” and that top federal health officials were “actively supporting CDC staff”.He did not speak to the media during his visit on Monday.A retired CDC official, Stephan Monroe, said he worried about the long-term impact the attack would have on young scientists’ willingness to go to work for the government.“I’m concerned that this is going to be a generational hit,” said Monroe, speaking to a reporter near the corner where a poster had been set up in honor of David Rose, the officer who was killed.Kennedy was a leader in a national anti-vaccine movement before Donald Trump selected him to oversee federal health agencies, and has made false and misleading statements about the safety and effectiveness of about Covid-19 shots and other vaccines.Years of false rhetoric about vaccines and public health was bound to “take a toll on people’s mental health”, and “leads to violence”, said Tim Young, a CDC employee who retired in April.Dr Jerome Adams, the US surgeon general during President Trump’s first administration, said on Sunday that health leaders should appreciate the weight of their words.“We have to understand people are listening,” Adams told Face the Nation on CBS. “When you make claims that have been proven false time and time again about safety and efficacy of vaccines, that can cause unintended consequences.” More

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      Top medical body concerned over RFK Jr’s reported plans to cut preventive health panel

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      A top US medical body has expressed “deep concern” to Robert F Kennedy Jr over news reports that the health secretary plans to overhaul a panel that determines which preventive health measures including cancer screenings should be covered by insurance companies.The letter from the the American Medical Association comes after the Wall Street Journal reported on Friday that Kennedy plans to overhaul the 40-year old US Preventive Services Task Force because he regards them as too “woke”, according to sources familiar with the matter.During his second term, Donald Trump has frequently raged against organizations and government departments that he considers too liberal – often without any evidence. The US president, and his cabinet members such as Kennedy, have also overseen huge cuts and job losses across the US government.The taskforce is made up of a 16-member panel appointed by health and human services secretaries to serve four-year terms. In addition to cancer screenings, the taskforce issues recommendations for a variety of other screenings including osteoporosis, intimate partner violence, HIV prevention, as well as depression in children.Writing in its letter to Kennedy on Sunday, the AMA defended the panel, saying: “As you know, USPSTF plays a critical, non-partisan role in guiding physicians’ efforts to prevent disease and improve the health of patients by helping to ensure access to evidence-based clinical preventive services.”“As such, we urge you to retain the previously appointed members of the USPSTF and commit to the long-standing process of regular meetings to ensure their important work can be continued without disruption,” it added.Citing Kennedy’s own slogan of “Making America healthy again,” the AMA went on to say: “USPSTF members have been selected through an open, public nomination process and are nationally recognized experts in primary care, prevention and evidence-based medicine. They serve on a volunteer basis, dedicating their time to help reduce disease and improve the health of all Americans – a mission well-aligned with the Make America Healthy Again initiative.”According to the Affordable Care Act, public and private insurance companies must cover any services recommended by the Preventive Services Task Force without cost sharing.In a statement to MedPage Today, Department of Health and Human Services spokesperson Andrew Nixon did not confirm the reports, instead saying: “No final decision has been made on how the USPSTF can better support HHS’ mandate to Make America Healthy Again.”Reports of Kennedy’s alleged decision to overhaul the taskforce come after the American Conservative published an essay earlier this month that described the taskforce as advocating for “leftwing ideological orthodoxy”.It went on to accuse the panel of being “packed with Biden administration appointees devoted to the ideological capture of medicine”, warning that the “continued occupation of an important advisory body in HHS – one that has the capacity to force private health insurers to cover services and procedures – by leftwing activists would be a grave oversight by the Trump administration”.In response to the essay, 104 health organizations, including the American Medical Association, issued a separate letter to multiple congressional health committees in which they urged the committees to “protect the integrity” of the taskforce.“The loss of trustworthiness in the rigorous and nonpartisan work of the Task Force would devastate patients, hospital systems, and payers as misinformation creates barriers to accessing lifesaving and cost effective care,” the organizations said.In June, Kennedy removed all 17 members of a US Centers for Disease Control and Prevention panel of vaccine experts. Writing in a Wall Street Journal op-ed, he accused the committee of having too many conflicts of interest.Kennedy’s decision to overhaul the immunization panel was met with widespread criticism from health experts, with the American Public Health Association executive director Georges Benjamin calling the ouster “a coup”.“It’s not how democracies work. It’s not good for the health of the nation,” Benjamin said. More

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

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      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