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medicaid
Trump’s Budget Cuts Will Only Make Things Worse for Struggling Rural Hospitals
The budget bill will put enormous strain on rural hospitals, which are often the largest local employer in addition to crucial care providers.
Sep 14, 2025
Bari Senecal waits outside the emergency department at Columbia Memorial Hospital in Hudson, New York. “I do construction. I fell three stories,” Senecal explains. “I was on top of the scaffold and this new kid we hired didn’t put the braces on correctly.”
Like 70 million Americans, Senecal qualifies for Medicaid, the state and federally-funded public health insurance program for low-income patients. She also qualifies for Medicare. She’s what’s known as being “dual-eligible.”
At Columbia Memorial, 63% of patient service revenue is reimbursed through a combination of the two programs. But “we run a deficit every year,” says Dorothy Urschel, CEO of Columbia Memorial Health. “For many, many years, we’ve been reimbursed at well below cost.”
The hospital has the only emergency room serving the more than 110,000 residents scattered among two predominately rural counties. “Of course, we’re struggling,” says Urschel. “But rural community hospitals always struggle.”
Columbia Memorial already closed its maternity ward in 2020—part of a distressingly common trend. A recent study from the Journal of the American Medical Association found that more than half of rural counties now have no hospital-based obstetric services whatsoever.
Like other rural hospitals across the country, Columbia Memorial is bracing for the loss of Medicaid-covered patients and funding because of the Republican reconciliation bill, dubbed the “One Big Beautiful Bill Act,” which was signed by US President Donald Trump this summer.
Over the last decade more than 100 rural hospitals have closed across the country—50 of them in just the last eight years.
According to the nonpartisan Congressional Budget Office, the bill will cut $911 billion in federal Medicaid spending over the next decade and result in an estimated 10.3 million people losing their Medicaid health insurance. Add in cuts to the Affordable Care Act and the number of people expected to lose their insurance rises to 16 million.
According to Larry Levitt, vice president for health policy at the Kaiser Family Foundation, this amounts to “the biggest rollback in federal support for health coverage ever.” And it will put enormous strain on rural hospitals especially—which in Columbia County and elsewhere are often the largest local employer in addition to crucial care providers.
The GOP staggered these cuts so that the worst effects of the budget changes won’t be felt until after the midterm elections in 2026 are safely past. But “some rural hospitals around the country have already started closing” in anticipation of the cuts, warns Michael Chameides, a member of the Columbia County Board of Supervisors.
Senator Ed Markey (D-Mass.) provided a list of 338 rural hospitals in danger of either closing or drastically scaling back services. All 338 had experienced three consecutive years of negative total profit margins and were in the top 10% of institutions with patients on Medicaid.
Rural hospitals facing disaster are identified individually according to which state will see the losses. Kentucky, Louisiana, and California top the list with 35, 33, and 28 rural hospitals identified as at risk of closure, respectively. New York has 11. (Columbia Memorial isn’t officially one of them, but Garnet Medical Health Center Catskills, another Hudson Valley hospital, is.)
An estimated 1,796 hospitals remain in rural America, but those numbers obscure the level at which the services they offer may have already contracted. According to the Government Accountability Office, over the last decade more than 100 rural hospitals have closed across the country—50 of them in just the last eight years.
In New York and every other state, as federal funding runs dry it will be up to the governor and legislature to make provisions for struggling rural hospitals—or stand by and watch them collapse.
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US Court Lets GOP Defunding of Planned Parenthood Take Effect
"This cruel decision will disproportionately impact people of color and people living in rural communities and healthcare deserts," said one abortion rights activist.
Sep 12, 2025
A federal appeals court on Thursday gave the Trump administration the green light to cut off Planned Parenthood from receiving funding from Medicaid.
As reported by Reuters, the 1st US Circuit Court of Appeals placed a hold on a preliminary injunction granted by a lower court that had kept Medicaid funding to Planned Parenthood in place. Planned Parenthood was blocked from receiving Medicaid funding after US President Donald Trump signed the so-called "One Big Beautiful Bill Act" into law earlier this year.
In a statement released after the ruling, Planned Parenthood said that it would result in more than 1.1 million patients being unable to use Medicaid to access needed healthcare services at its clinics.
"Patients who rely on the essential healthcare that Planned Parenthood health centers provide, can’t plan for their futures, decide where they go for care, or control their lives, bodies, and futures," said Alexis McGill Johnson, president and CEO of Planned Parenthood Federation of America. "All because the Trump administration and its backers want to attack Planned Parenthood and shut down health centers."
Johnson added, however, that she wasn't giving up and said that Planned Parenthood "will continue to fight this unconstitutional law, even though this court has allowed it to impact patients."
Brittany Fonteno, president and CEO of the National Abortion Federation, warned that taking away funds from Planned Parenthood would only put more strain on other hospitals and clinics that are already bracing for the negative impact of the GOP's Medicaid cuts.
"When Planned Parenthood health centers are forced to close, pressure mounts on other clinics already stretched thin to provide sexual and reproductive health services," she said. "This cruel decision will disproportionately impact people of color and people living in rural communities and healthcare deserts, who will be left with even fewer options and longer wait times to get the care they need. Any additional barriers to care are both unacceptable and dangerous."
Sen. Elizabeth Warren (D-Mass.) took to social media to warn that up to 200 Planned Parenthood clinics could close thanks to the loss of Medicaid funding, which she said would have devastating consequences for women's healthcare.
"How many people will be denied cancer screenings, birth control, and STI testing?" she asked. "Millions. It's horrific."
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Why Male Suicide Prevention Requires Policy, Not Just Awareness
On this Suicide Prevention Day, the question is whether we will stop treating male suicide as a seasonal headline and start treating it as a preventable epidemic.
Sep 10, 2025
Today is September 10, World Suicide Prevention Day. The hashtags are already out. Politicians are tweeting about “awareness.” Nonprofits are posting hotline numbers. News outlets will run a few stories, maybe a profile of a grieving family or a segment on rising youth anxiety. Communities will hold vigils and light candles. And then, as happens every September, Congress will return to debating budgets that cut the very services that keep people alive.
Suicide has become an annual ritual of shock, treated as if it were a hurricane that blew in unannounced instead of a slow-moving crisis we have been measuring for decades.
Suicide is not weather. It is not random. It is patterned, predictable, and preventable. Rates climb where jobs collapse and housing becomes unstable. They spread where guns are plentiful and mental healthcare is scarce. They grow in cultures that equate vulnerability with weakness. And they accelerate when elected officials strip away the programs that keep people from falling over the edge.
I know the consequences of silence. My father died by suicide when I was young. For more than a decade, I did not know how he died. My family believed silence could protect me. But silence also isolates, leaving questions that cannot be asked and grief that cannot be named. That fog never fully lifts. It is a reminder that behind every statistic is a family that carries loss forward, often without words for it.
That loss is now multiplied across nearly 50,000 American families each year. Almost 50,000 people died by suicide in 2022—the highest number ever recorded—and nearly 50,000 again in 2023. That is one death every 11 minutes. Three out of four were men. Men are half the country yet nearly 80% of its suicides. The rate for men over 85 is the highest of any group, 15 times higher than women of the same age. Middle-aged men follow close behind, especially in rural counties where work has dried up, institutions have withered, and guns are everywhere. Even among younger men, suicide remains a leading cause of death.
The methods matter. More than half of suicides now involve a firearm. Men are far more likely than women to use a gun, and that choice often makes the difference between an attempt and a death. A gun is immediate and almost always fatal. A moment of despair becomes permanent because the tool at hand was designed to be permanent. Where lethal means are easy and care is scarce, brief despair turns irreversible. States with higher gun ownership have higher suicide rates. The connection is not mysterious. It is arithmetic.
Suicide is not inevitable. It rises when supports are stripped and stigma is reinforced.
Economics tell the same story. Men who lose jobs, homes, or the ability to provide are at higher risk. One national study found that more than 1 in 5 men aged 45 to 64 who died by suicide had recently lost a job, faced eviction, or been buried by debt. When a man’s sense of worth is tied to being a provider, losing that role can feel like losing his reason to live. Economists Anne Case and Angus Deaton called these “deaths of despair,” and the label fits. But despair is not destiny. Raise the minimum wage, expand tax credits, stabilize housing, and suicides among working-class men decline. Let wages stagnate, strip away safety nets, and suicides rise. If despair tracks wages and rent, then budgets decide who lives long enough to get help.
Budgets are moral documents. In 2025, the Trump administration proposed cutting more than a billion dollars from the nation’s main mental health agency. That means fewer clinics, fewer treatment teams, fewer crisis counselors. The same budget threatened to scrap parts of the 988 crisis line, including its LGBTQ youth service. At the Department of Education, $1 billion in school counselor grants was pulled back, leaving rural districts that had finally hired mental health staff facing layoffs. Insurance rules that would have forced companies to cover therapy on par with physical health were paused. On homelessness, the administration reversed Housing First, vowing instead to sweep encampments, force treatment, and “bring back asylums.” Each of these choices falls hardest on men. When Medicaid is cut, when housing supports vanish, when community clinics close, the men most in need are left to cycle through emergency rooms, jails, or morgues.
Policy failures meet cultural stigma. Only about a third of men say they would seek professional help if depressed, compared to nearly 60% of women. The rest say they would handle it on their own, or not at all. That reluctance is reinforced by leaders and influencers. US President Donald Trump once suggested veterans with PTSD “aren’t strong.” Andrew Tate tells millions of young men that “depression isn’t real.” Jordan Peterson blames despair on feminism and political correctness. These voices frame pain as weakness, recast systemic causes as personal failings, and tell men that asking for help makes them lesser. For someone already on the edge, that message can be lethal.
And when suicide is mentioned in politics, it is often weaponized rather than addressed. Commentators invoke male suicide to claim that society only cares about women or minorities. Lawmakers cite “what’s happening to our boys” while voting against Medicaid expansion or school mental health funding. Grievance substitutes for prevention. The fire is pointed to, then the water is cut.
The alternative is straightforward, if not simple. Treat the 988 crisis line like 911: permanent, funded, universal. Expand Medicaid and enforce insurance parity so therapy is covered like any other medical need. Keep counselors in schools. Invest in housing with voluntary supports. Build mobile crisis teams so despair meets a trained counselor, not a police squad. And meet men where they are: union halls, barber shops, job sites, veterans’ groups.
We know this works. In Colorado, “Man Therapy” has used humor and direct language to reach men who would never otherwise consider counseling. Veterans’ peer networks reduce stigma and improve follow-through on care. In Australia, the “Men’s Shed” movement has built thousands of local spaces where older men gather, work on projects, and informally support one another—a model credited with reducing isolation and depression. These are not small-scale experiments. They are blueprints for national policy.
Suicide is not inevitable. It rises when supports are stripped and stigma is reinforced. It falls when care is reachable, affordable, and treated as normal. My father’s death remains a personal loss. But the broader crisis is a collective choice. We know the patterns. We know the risks. We know the solutions. What remains is whether policymakers are willing to act on them.
On this Suicide Prevention Day, the question is not whether we will keep raising awareness. It is whether we will stop treating male suicide as a seasonal headline and start treating it as a preventable epidemic. If policymakers can count the dead, they can also count the votes that decide whether men keep dying at this scale. The choice is not between silence and hashtags. It is between burying another 50,000 next year—or building a country where men live long enough to be heard.
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