Medicaid cuts will hurt rural Americans. If Congress doesn't shrink Medicaid, how can $4.5 trillion in tax cuts be made?

Republican lawmakers had planned to
cut Medicaid to help balance tax cuts.

The health of many rural Americans depends on Medicaid coverage, but that safety net seems to be threatened as Republican lawmakers plan to slash Medicaid spending to pay for President Donald Trump's planned massive tax cuts. Meanwhile, during a recent interview, Trump insisted that Medicaid isn't on the federal budget chopping block, reports Margot Sanger-Katz of The New York Times.

"Trump said Tuesday night on Fox News that he wouldn’t make cuts to Medicaid, the federal-state health insurance program that mostly covers poor Americans," Sanger-Katz writes. "But making substantial cuts to Medicaid is a key part of congressional Republicans’ plan to extend the tax cuts."

Small Towns/Rural Areas include non-metropolitan counties with no urban areas of at least 50,000 residents. (Georgetown University map, from 2022-2023 American Community Survey data)

Medicaid decisions matter for small-town America where in 2023, 40.6% of children were enrolled in Medicaid/CHIP compared to 38.2% in metro areas. Lawmakers' suggested reductions would also hurt rural non-elderly adults covered by Medicaid. Mike Johnson, the House Speaker, "has been hard at work on a major bill that can balance various priorities of Trump and his caucus," Sanger-Katz explains. "The budget Johnson negotiated calls for around $880 billion in cuts to Medicaid. . . . Trump’s comments may make that carefully negotiated package moot."

Over the past four years, Trump repeatedly promised to leave Medicare relatively untouched. "But he has always been more open to changes to Medicaid, which has become the biggest health insurance program in the country," Sanger-Katz reports. Since Trump's first term, the program has grown to cover 72 million Americans, including 7.2 million low-income seniors.

If Republican lawmakers move to shrink Medicaid spending, the fallout won't only impact individuals and families. It will complicate state budgets that are dependent on federal Medicaid dollars. Sanger-Katz adds, "Cuts would put fiscal pressure on Republican governors, not just poor patients who need help paying for their health care."

If Congress leaves Medicare, Medicaid and Social Security spending at their current levels, it's unclear how Johnson can produce a budget that includes Trump's "desire for $4.5 trillion in tax cuts," Sanger-Katz reports. "Hitting the target without Medicaid cuts would mean revising the bill’s language as well as enormous cuts to remaining programs."

U.S. postmaster general plans to step down; his planned changes could have impacted rural communities the most

After four difficult years, DeJoy is stepping down
from his post. (Adobe Stock photo)

 

Earlier this week, Postmaster General Louis DeJoy announced plans to step down "capping a contentious tenure since his 2020 appointment during the first Trump administration," reports Ester Fung of The Wall Street Journal. "The U.S. Postal Service didn’t provide a date for DeJoy’s exit." His resignation comes as the USPS continues to roll out its 10-year turnaround plan. 

With only modest improvements, increased debts and persistent delivery problems at the Postal Service, some lawmakers have regularly grilled DeJoy for what they see as a failed strategy. Fung reports, "The Postal Regulatory Commission, the federal agency that oversees the Postal Service, last month criticized his plan as having 'overly optimistic and unsubstantiated financial projections for cost savings' and said it could hurt rural communities."

DeJoy has repeatedly defended his plans and pointed out that "when he first arrived at the Postal Service, it was in 'devastating condition' and resistant to change, and faced excessive regulatory oversight," Fung adds.

Some of DeJoy's restructuring plans were successful, "including consolidating routes, replacing aging vehicles and improving working conditions in several facilities," Fung explains. "The agency has also taken market share in small packages from private-sector rivals such as FedEx and UPS as it ferries more parcels over longer distances, not just for final-mile deliveries."

Even with improved small package revenues, the Postal Service continues to lose money. Fung adds, "In 2024, the agency reported a net loss of $9.5 billion, which, after adjusting for workers’ compensation and retirement liabilities, resulted in a controllable loss of $1.8 billion." The Postal service does not rely on federal funding to pay its bills. Instead, it depends on the sale of postage, products and other services to cover its costs.

DeJoy's exit may not come as a surprise. "The Trump White House had been considering replacing DeJoy, according to two people familiar with the matter," Fung adds, "though the postmaster general is typically chosen by the board and not the president."

Opinion: Services for Kansas rural communities get chopped by D.C. 'wrecking crew'

An old barn stands on an abandoned homestead in
southwest Kansas. (Photo by Kevin Hardy, Stateline)

Rural communities often count on the Department of Agriculture for housing, food, economical and educational support. In rural Kansas, those foundational community pillars are being pulled apart, writes fifth-generation Kansan Christy Davis in her opinion for the Kansas Reflector.

"I worked for two and half years to rebuild what the first Trump administration tore down," Davis writes. "And now I have an unparalleled (and unenviable) perspective as I watch the second Trump administration, in just a few short weeks, dismantle the federal programs that feed, house and employ his rural constituents."

The historical and ongoing impact of USDA Rural Development programs in Kansas is "hard to overstate," Davis explains. "The programs make investments that the private sector can’t do alone. With grants, direct loans and loan guarantees, RD offers workable financing for roads, water systems, sustainable energy, broadband, telehealth, hospitals, clinics, housing and businesses in rural America."

"To ensure that farmers have equitable access to critical programs, USDA’s Farm Service Agency and National Resources Conservation Service have long had offices in nearly every Kansas county, staffed with hundreds of Kansans who can help farmers apply," Davis writes. "Trump’s policies are devastating to the 2% of rural Americans engaged in farming. But what about the other 98%? The system is failing the communities that have already suffered decades of disinvestment."

"I am proud of the progress we made for rural Kansas in my short tenure. But I’m confounded at how quickly and easily the 'wrecking crew' has reversed it," Davis writes. "I am a huge advocate for making it easier to remove and replace ineffective employees and retain the best. The new administration’s approach to civil service has had the opposite effect. . . .Those who accepted DOGE’s recent buyout offers were top performers and seasoned employees."

New Mexico is an example of the battle over local law enforcement's role in federal immigration crackdowns

A marched outside the N. M. State Capitol. N.M. has about 60,000
undocumented immigrants. (Photo by A. Slepyan, The Daily Yonder)

On Jan. 21, the Department of Homeland Security rescinded Immigration and Customs Enforcement policy guardrails that prevented immediate raids in schools, hospitals and churches.
For local law enforcement officers, the change means they could be relied upon to conduct searches in their own communities. Not all law officers see that as part of their oath, reports Anya Petrone Slepyan of The Daily Yonder.

Sheriff Steve Miera, a 30-year law enforcement veteran in Taos, New Mexico, doesn't plan on doing federal immigration work. He told John Miller of the Taos News, "I have a sworn obligation to uphold the Constitution of the U.S., the laws of the state of New Mexico, and the laws of the county of Taos," Slepyan writes, "But that obligation does not include enforcing federal immigration policy, he said."

In sprawling rural Taos County, avoiding ICE entanglements is also a matter of limited financial resources and labor. Slepyan adds, "According to Miera, it would require over 100 deputies to adequately cover the county. But his office regularly employs only around 15 deputies to cover over 2,200 square miles."

Taos County's refusal to direct resources to support ICE actions is far from singular. "As the Trump administration implements increasingly restrictive immigration policies, enforcement efforts that rely on local and state cooperation are facing challenges in states, municipalities, and counties across the country," Slepyan explains. "Taos County, in northern New Mexico, has become one such battleground."

Miera's decision to leave federal agents to enforce federal law is "supported by a series of guidances issued by New Mexico Attorney General Raúl Torrez in response to a flurry of executive orders regarding immigration enforcement," Slepyan reports. "The guidance also specifies that under the reserved powers clause of the 10th Amendment, the federal government cannot 'force state employees to enforce federal law.'"

Meanwhile, the question of local law enforcement as a coordinating arm of federal immigration operations has "reached the New Mexico state legislature, with Democrats and Republicans each attempting to direct the responses of sheriff and police departments statewide" through various bills, Slepyan reports. 

Sales are brisk at this little-known clearinghouse that sells eggs by the billions

 ECI trade currency is eggs.
(Eggleston Farm Fresh Foods photo)

A big hot spot for egg sales isn't at the grocery store. It's at a New England clearinghouse affectionately known as the "Wall Street of Eggs," reports Patrick Thomas of The Wall Street Journal. "From an office building in New Hampshire, roughly a dozen people facilitate the trading of billions of eggs a year, a task that shapes what Americans pay per dozen at the supermarket or for omelets at diners."

Who knew? Very few. Thomas explains, "The Egg Clearinghouse, or ECI, is little known outside the industry: It operates an online marketplace that allows participants to place bids on eggs listed for sale and see the results of trades. Only ECI members — farmers and egg buyers — are allowed to trade."

Given the plummeting numbers of egg-laying hens due to bird flu deaths, the business is a seller's market. "Last year marked the company’s busiest, trading over 2.6 billion shell eggs and 39 million pounds of egg product valued at more than $600 million." ECI doesn't dominate the "broader egg market. . .but plays a crucial role in providing eggs for those in need or having trouble getting them, and how they are priced."

ECI operations are similar to stock exchanges, using eggs as their currency. It was created "as an alternative way to price and trade the commodity versus larger exchanges that operated in New York and Chicago," Thomas explains. "ECI began brokering trades in 1971 and its board was made up of industry executives including Fred Adams Jr., the founder of the largest U.S. egg producer, Cal-Maine."

The notion of egg trading is unique among food commodities which generally don't rely on "little-known exchange service to determine their value," Thomas reports. "All trades are blind, and only after a deal does ECI allow the parties to know each other’s identity."

Even as egg prices climb, American consumers continue to pay the painful cost per dozen. "Consumers on average are paying about $5 a dozen, a record high and double the price from roughly a year ago, according to the Labor Department," Thomas writes. "Demand has remained steady despite the high sticker prices, prompting some restaurants to add surcharges for egg dishes and consumers to step up purchases of liquid eggs or substitutes."

To read more about the egg "stock market," read the full story here.

Hundreds of rural hospitals are 'vulnerable to closure' and 46% operate in the red, new report finds

Many rural hospitals have dropped some type of
inpatient care to save money. (Adobe Stock photo)

Despite some limited improvements, the newest statistics on rural hospitals from healthcare advisory firm Chartis are startling. "The group’s latest report on the state of rural healthcare providers found that 46% of rural hospitals are operating at a loss while 432 hospitals are deemed 'vulnerable to closure,'" reports Dave Muoio for Fierce Healthcare. The 2024 report from Chartis "outlined 50% of rural hospitals operating in the red and 418 hospitals at risk of closure."

A rural hospital's median operating margin and Medicaid expansion status are among the factors Chartis used to determine financial health. "Nationwide median operating margin for rural hospitals currently sits at 1%, with 16 states having medians below 0%," Muoio writes. "In the 10 non-Medicaid expansion states, which hold 30% of all rural hospitals, 53% of rural hospitals [operate] in the red, with a median operating margin of -1.5%."

Rural hospitals that aren't in the red have often shuttered their obstetric units and shed inpatient care or other services to stay solvent. "Inpatient care access has ended across 182 rural communities since 2010, due to either closures or transitions," Muoio explains. "Between 2011 and 2023, 293 rural hospitals stopped offering obstetrics services. . . . A similar trend was evident regarding chemotherapy. . . from 2014 to 2023, 424 rural hospitals ended the service."

The report highlighted the "key hurdles for rural hospitals, such as a 2% Medicare reimbursement cut that 'will cost rural hospitals more than $509 million this year and result in over 8,000 jobs lost,'" Muoio reports. "Chartis’ dire national snapshot comes shortly after a Wipfli survey found sparks of optimism among rural healthcare organization leaders. . . .[But] some of their views may have already changed in light of recent weeks’ political developments."

A whirlwind of policy changes and funding cuts have left rural America on shaky ground: 'Billions are at stake.'

As USDA funds are frozen, U.S. farmers face uncertainty
and possible big financial losses. (Adobe Stock photo)

A whirlwind of policy changes from the Trump Administration has left many people in rural America unprepared to navigate agricultural spending cuts that target farming income and investments.

"Billions of dollars in funding are at stake," report Linda Qiu and Julie Creswell of The New York Times. "One executive order targets. . . money for farmers to conserve soil and water and to complete energy projects. Other directives touch on grants to states and producers. Another temporarily left hundreds of millions of dollars worth of food and supplies sitting in ports and has stopped future purchases of grains and goods."

The loss of income and promised funds from the Department of Agriculture puts farmers and farming communities in a "potentially precarious position," the Times reports. "Even as courts have halted many of the orders, rural communities are reeling from the effects, setting off confusion and panic among one of President Trump’s core constituencies."

Once inaugurated, Trump "ordered an indefinite pause on funding provided by the Inflation Reduction Act. . . . Though a federal judge ordered the Trump administration to unfreeze the funds, it is unclear when and whether it will follow suit," Qiu and Creswell explain."Asked if it would release the money, the USDA did not directly respond, saying only that it had ordered 'a comprehensive review' of its contracts, work and personnel.'"

When farmer pocketbooks took a hit from Trump's first-term tariff wars, the administration tapped the USDA's Commodity Credit Corporation and sent checks to farmers to cover losses. That isn't happening now. "Trump has also paused payments made by the CCC," Qiu and Creswell add. "It is unclear how much of the funding has been frozen."

When U.S. farmers overwhelmingly voted for Trump, it's unlikely they thought his policy changes could force some farms into bankruptcy -- but that could happen. The Times reports, "If funds remain frozen, that could affect more than 25,000 conservation contracts worth $1.8 billion funded by the climate change law, potentially involving thousands of farmers nationwide."

Thousands of federal agriculture probationary employees terminated. USDA warns, 'This is just the beginning.'

(Photo by Chris Clayton, DTN)

In an effort described as "optimization," thousands of Department of Agriculture employees were fired last week, reports Chris Clayton of Progressive Farmer. "The job cuts were part of a broader effort by the Trump administration to reduce the federal workforce. The administration moved to terminate most of the estimated 200,000 probationary employees."

Federal firefighters escaped termination, but "3,400 Forest Service employees were let go," Clayton writes. In response to questions, the USDA released a statement that "explained the cuts as part of a plan to 'optimize its workforce by eliminating positions that are no longer necessary. . . . Per the President's directives, Secretary Rollins will lead a new era of USDA to ensure that it is the most efficient, nimble, and innovative department . . .'"

In addition to labor cuts, the USDA "terminated 78 contracts, which totaled more than $132 million," Clayton reports. "The USDA's press office added, 'This is just the beginning. Over the next few days and weeks, Secretary Rollins will have the opportunity to review thousands of contracts, grants, cooperative agreements and spending across the agency to ensure that every dollar is being spent as effectively as possible to serve the people, not the bureaucracy.'"

Everett Kelley, national president of the American Federation of Government Employees, told Clayton, "This administration has abused the probationary period to conduct a politically driven mass firing spree, targeting employees not because of performance, but because they were hired before Trump took office. . . . There is no evidence these employees were anything but dedicated public servants."

Educators work to calm students' and parents' fears about immigration raids by sharing policies and ICE limitations

Children from Africa, Latin America and Asia are
part of the U.S. unauthorized population. (Adobe photo)

U.S. educators, students and parents live with anxiety and fear that Immigration and Customs Enforcement agents will raid their schools or homes since the "Trump administration reversed a longstanding policy that directed immigration agents to avoid sensitive locations such as schools, churches and hospitals," reports Ray Sanchez of CNN News. The change has left teachers "scrambling for guidance on what to do if agents appear and how to reassure worried students and parents."

Acting Homeland Security Secretary Benjamine Huffman said the policy shift prevents criminals from hiding in sanctuary places; however, the threat of ICE agents coming into schools has "contributed to a recent drop in classroom attendance in some communities," Sanchez writes. While there have been "no confirmed reports of ICE agents at U.S. schools," their looming threat can be traumatizing for any educational community.

To help students and families, educators "have been dispensing information on the type of warrant ICE agents must have to gain access to schools," Sanchez reports. Deb Gesualdo, president of the teachers union in Malden, Massachusetts, told Sanchez, "Agents don’t get unfettered access. . . We refer them to the superintendent’s office. . . It would be so damaging for any of our students not only to be detained at school but to witness that happening.”

Educators in Barren County Schools in Warren County, Kentucky, are working to calm fears by sharing their policies on how ICE agents will be managed should they appear on campus. "BCS stated that in addition to following state and federal guidelines for student’s safety and well-being, it has procedures for if federal immigration officers arrive at a school," reports David Mamaril Horowitz of Bowling Green Daily News. BCS said it would require ICE agents to present a "valid warrant or court order for the district's legal team to review before any action is taken."

Sanchez notes, "About 733,000 school-aged undocumented children live in the U.S., according to the Migration Policy Institute think tank."

Fire departments can't get trucks or truck repair parts because the industry has consolidated to make big profits

Fire departments can wait years for a new fire truck.
(Adobe Stock photo)

Firefighters and fire trucks are the backbone of fire protection in most communities, but over time, keeping fire trucks repaired or buying replacements has become increasingly difficult. "Fire engine manufacturing is now largely controlled by three companies," report Mike Baker, Maureen Farrell and Serge F. Kovaleski of The Wall Street Journal. "Some departments have waited years for replacement vehicles while hunting the internet for parts to keep their older rigs going."

Wall Street executives sought to eliminate competition among fire truck makers "in a plan to boost profits from fire engine sales," the Journal reports. "One company, backed by a private equity firm, cut its own manufacturing lines as part of a streamlining strategy and then saw a backlog of fire engine orders soar into billions of dollars."

Edward Kelly, general president of the International Association of Fire Fighters, said the pandemic caused production delays, but it isn't the main problem. He told the Journal: "In hindsight, it was masking what ends up being a main driver of higher cost and lag time in production: the monopolizing of fire truck and ambulance manufacturing in the United States. . . . Absent competition, monopoly capitalism is a shakedown.”

With no new competitors in sight, U.S. fire departments have no choice but to order from the three big companies that still make trucks. One of those companies, Rev Group "has created a more standardized vehicle that can be made in less than a year," the Journal reports. "If more fire departments choose this standardized model, said Mike Virnig, a Rev Group executive, it is likely that overall wait times will drop."