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healthcare
A Rural Health Fund Band-Aid Will Not Staunch the Bleeding
The Trump administration’s rural hospital fund, meant to soften the impact of the brutal Medicaid cuts in HR1, will require a murky submission process and will not come close to closing the gap for rural communities.
Nov 04, 2025
Amid furious efforts to cover their tracks, Republicans included $50 billion in new funding to offset the disastrous cuts that rural hospitals will face as a result of President Donald Trump’s House Resolution 1. Trump’s new Centers for Medicare and Medicaid Services Director, Dr. Mehmet Oz, gave an explanation which would be laughable if this weren’t so serious. He stated that the Rural Health Fund “is part of a broader effort to modernize rural healthcare… [and that] innovation is the reigning theme” citing growing opportunities for rural providers to become more engaged in the healthcare system.
The “Rural Health Fund” was established by HR1 to soften the impact of the legislation, which cuts $911 billion in federal Medicaid spending over 10 years, due to start after 2030. The good news is that the distribution of the $50 billion will begin before the Medicaid cuts take effect (conveniently before the midterms). The bad news is that the temporary $50 billion in new funding will offset a little over one-third (37%) of the estimated $137 billion in permanent cuts to federal Medicaid spending in rural areas. People everywhere can do the math. Fifty is a whole lot less than 137.
On September 15, Centers for Medicare and Medicaid Services (CMS) released a Notice of Funding Opportunity for states to apply for the funds. Half of the funds, $25 billion, will be distributed by CMS equally across all states with approved applications, and the other half distributed based on four factors identified by CMS, including priorities that align with the Make America Healthy Again agenda. While some of the goals are welcome, such as expanding access to opioid-use and substance-use disorder treatment and mental healthcare and recruiting and retraining clinicians in rural areas, other priorities, such as supporting value-based care, alternative payment models, and other innovative delivery arrangements that shift risk to practitioners away from insurance companies and that have been demonstrated to increase costs in Medicare, are worrisome. Predictably, no funds can be used to pay for abortions for women living in rural areas.
Each state, regardless of the size of their rural population and needs, will receive the same amount from the first $25 billion tranche. States with few rural hospitals, such as Delaware, with three rural hospitals, will receive equal funding as California, with 66 rural hospitals, some of which have closed and many which are at risk of closing, and that assumes that both states are approved for funding.
We urge residents of rural communities to stand together and demand the right to excellent healthcare that our wealthy nation can and must provide.
Disbursement of the funds promises to be a cronyism gravy train requiring applications, murky decision criteria, no administrative or judicial review, and nonexistent information as to the amount a state will receive, how the funds will be distributed, or even if the funds will go only to rural hospitals. A merit review panel will review the state applications with final award decisions made by CMS. The program runs for five years, but because CMS will reevaluate state initiatives every year, CMS could withhold, reduce, or even recover funding from the state depending on a state’s progress or if continued funding is “in the government’s best interests.” The only thing that is clear is that hospitals and their administrators will spend countless hours and resources on evaluation, reports, and contractors hired to write these reports.
The stakes for rural hospitals couldn’t be higher. As a result of the Medicaid cuts, hundreds of rural hospitals are at risk of closing. But even before cuts, rural hospitals have been shuttering: From 2005 to 2024, 193 rural hospitals closed. In the wake of HR1Sen. Ed Markey (D-Mass.) and others asked the Sheps Center to identify rural hospitals at risk of closing because of the Medicaid cuts. The Sheps Center identified 338 hospitals which either experienced three consecutive years of negative total margins, serve the highest share of Medicaid patients, or both. These are the hospitals that, because of their heavy reliance on Medicaid funds, will likely shutter.
What will happen to the millions of people who live in these rural communities when these hospitals close? The median travel distance to the next hospital, emergency room, substance-use, or heart specialty care center will jump seven- to eightfold. This translates to higher mortality from many common conditions: heart disease, cancer, stroke, and unintentional injury.
In "The False Promises of VA Privatization", author Suzanne Gordon highlights the plight of healthcare access for veterans and Americans who live in rural communities, the majority of whom already live in so-called medical and mental health deserts. For example, 81% of rural communities do not have even one psychiatric nurse practitioner and 65% do not have a single psychiatrist. The shuttering of rural hospitals will also mean the loss of thousands of healthcare worker jobs and the ensuing negative economic impact on those communities.
The $50 billion rural health fund earmarked by the Trump administration will not transform these rural medical deserts, will not protect the livelihood of workers and their families, nor will it safeguard their communities. The piddly funds will not staunch the bleeding the brutal cuts to Medicaid will cause.
National Single Payer has launched a “Save Our Rural Hospitals with National Single Payer” campaign. We believe that a national, improved Medicare for All, free from profit in the financing and the delivery of care, would provide the reliable, equitable funding needed to help hospitals and physicians not only survive, but thrive in rural areas. The funding from global budgets would be based on community healthcare needs and not on industry interests.
We urge individuals who live in districts where the at-risk hospitals are located to contact their representatives and ask them to cosponsor HR3069, the Medicare for All Act. If your representative is already a cosponsor, tell them to do more to put national single payer on the nation’s agenda.
People can also pass a resolution in their local organization or city council going on record in favor of saving and sustaining their rural hospitals by calling on Congress to pass national, improved Medicare for All, free from profit.
We urge residents of rural communities to stand together and demand the right to excellent healthcare that our wealthy nation can and must provide. The 46 million people living in America’s rural communities don’t need a temporary Band-Aid—they deserve what everyone deserves, no matter where they live—healthcare as a human right, free from profit.
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This May Be the Most Consequential Moment in US History Since the Civil War
Why Democrats must defend working people in the United States and not cave to Trump's authoritarianism and cruel attacks on healthcare and food assistance.
Nov 03, 2025
Democrats in the US Senate must stand with the working families of our country and in opposition to Donald Trump’s authoritarianism. They must not cave in to the president’s attacks on the working class during this ongoing government shutdown. If they do, the consequences will be catastrophic for our country.
This may be the most consequential moment in American history since the civil war. We have a megalomaniacal president who, consumed by his quest for more and more power, is undermining our constitution and the rule of law. Further, we have an administration that is waging war against the working class of our country and our most vulnerable people.
While Trump’s billionaire buddies become much, much richer, he is prepared to throw 15 million Americans off the healthcare they have—which could result in 50,000 unnecessary deaths each year. At a time when healthcare is already outrageously expensive, he is prepared to double premiums for more than 20 million people who rely on the Affordable Care Act. At a time when the United States has the highest rate of childhood poverty of almost any major country on earth, Trump is prepared, illegally, to withhold funding for the Supplemental Nutrition Assistance Program, or SNAP, despite a $5bn emergency fund established by Congress. That decision would threaten to push 42 million people—including 16 million children—into hunger.
And all of this is being done to provide $1tn in tax breaks to the 1%.
The choice is clear. If the Democrats stand with the American people, the American people will stand with them.
Let’s be clear: this government shutdown did not happen by accident. In the Senate, 60 votes are required to fund the federal government. Today, the Republicans have 53 members while the Democratic caucus has 47. In other words, in order to fund the government the Republican majority must negotiate with Democrats to move the budget forward. This is what has always happened—until now. Republicans, for the first time, are simply refusing to come to the table and negotiate. They are demanding that it is their way or the highway.
To make matters worse, the Republican contempt for negotiations is such that the House speaker, Mike Johnson, has given his chamber a six-week paid vacation. Unbelievably, during a government shutdown—with federal employees not getting paid, millions facing outrageous premium increases and nutrition assistance set to expire for millions more—Republicans in the House of Representatives are not in Washington, DC.
Trump is a schoolyard bully. Anyone who thinks surrendering to him now will lead to better outcomes and cooperation in the future does not understand how a power-hungry demagogue operates. This is a man who threatens to arrest and jail his political opponents, deploys the US military into Democratic cities and allows masked Immigration and Customs Enforcement agents to pick people up off the streets and throw them into vans without due process. He has sued virtually every major media outlet because he does not tolerate criticism, has extorted funds from law firms and is withholding federal funding from states that voted against him.
Day after day he shows his contempt for the constitutional role of Congress and the courts.
Given that reality, does anyone truly believe that caving in to Trump now will stop his unprecedented attacks on our democracy and working people?
Poll after poll shows that the Americans understand the need for strong opposition to Trump’s unprecedented and dangerous agenda. They understand that the Republican party is responsible for this shutdown. And, despite the Democratic party’s all-time low approval rating, independents and even a number of Republicans are now standing with the Democrats in their fight to protect the healthcare needs of the working families of our country.
What will it mean if the Democrats cave? Trump, who already holds Democrats in contempt and views them as weak and ineffectual, will utilize his victory to accelerate his movement toward authoritarianism. At a time when he already has no regard for our democratic system of checks and balances, he will be emboldened to continue decimating programs that protect elderly people, children, the sick and the poor while giving more tax breaks and other benefits to his fellow oligarchs.
If the Democrats cave now it would be a betrayal of the millions of Americans who have fought and died for democracy and our constitution. It would be a sellout of a working class that is struggling to survive in very difficult economic times. Democrats in Congress are the last remaining opposition to Trump’s quest for absolute power. To surrender now would be an historic tragedy for our country, something that history will not look kindly upon.
I understand what people across this country are going through. My Democratic colleagues and I are getting calls every day from federal employees who are angry about working without pay and Americans who are frantic about feeding their families and making ends meet. But my Democratic colleagues must also understand this: Republicans are hearing from their constituents as well. There is a reason why 15 Republican Senators are finally standing up to Trump and, along with every member of the Democratic caucus, support funding SNAP benefits.
There is a reason why 14 Republican members of the House are on record calling for the extension of tax credits for the Affordable Care Act. Understandably, Republicans do not want to go home and explain to their constituents why they voted to double or, in some cases, triple healthcare premiums. They do not want to go home and explain why they are throwing large numbers of their constituents off healthcare. They do not want to go home and explain why they are taking food off the tables of hungry families.
We are living in the most dangerous and pivotal moment in modern American history. Our children and future generations will not forget what we do now. Democrats must not turn their backs on the needs of working people and allow our already broken healthcare system to collapse even further. Democrats must not allow an authoritarian president to continue undermining our constitution and the rule of law. The choice is clear. If the Democrats stand with the American people, the American people will stand with them. If they surrender, the American people will hold them accountable.
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Sanders Warns Trump Will 'Accelerate Movement Toward Authoritarianism' If Dems Cave
"Does anyone truly believe that caving in to Trump now will stop his unprecedented attacks on our democracy and working people?" asked Sen. Bernie Sanders.
Nov 03, 2025
US Sen. Bernie Sanders over the weekend implored his Democratic colleagues in Congress not to cave to President Donald Trump and Republicans in the ongoing government shutdown fight, warning that doing so would hasten the country's descent into authoritarianism.
In an op-ed for The Guardian, Sanders (I-Vt.) called Trump a "schoolyard bully" and argued that "anyone who thinks surrendering to him now will lead to better outcomes and cooperation in the future does not understand how a power-hungry demagogue operates."
"This is a man who threatens to arrest and jail his political opponents, deploys the US military into Democratic cities, and allows masked Immigration and Customs Enforcement agents to pick people up off the streets and throw them into vans without due process," Sanders wrote. "He has sued virtually every major media outlet because he does not tolerate criticism, has extorted funds from law firms and is withholding federal funding from states that voted against him."
If Democrats capitulate, Sanders warned, Trump "will utilize his victory to accelerate his movement toward authoritarianism."
"At a time when he already has no regard for our democratic system of checks and balances," the senator wrote, "he will be emboldened to continue decimating programs that protect elderly people, children, the sick and the poor while giving more tax breaks and other benefits to his fellow oligarchs."
Sanders' op-ed came as the shutdown continued with no end in sight, with Democrats standing by their demand for an extension of Affordable Care Act (ACA) tax credits as a necessary condition for any government funding deal. Republicans have so far refused to negotiate on the ACA subsidies even as health insurance premiums skyrocket nationwide.
The Trump administration, meanwhile, is illegally withholding Supplemental Nutrition Assistance Program (SNAP) funding from tens of millions of Americans—including millions of children—despite court rulings ordering him to release the money.
In a "60 Minutes" interview that aired Sunday, Trump again urged Republicans to nuke the 60-vote filibuster in the Senate to remove the need for Democratic support to reopen the government and advance other elements of their agenda unilaterally. Under the status quo, Republicans need the support of at least seven Democratic senators to advance a government funding package.
"The Republicans have to get tougher," Trump said. "If we end the filibuster, we can do exactly what we want. We're not going to lose power."
Congressional Democrats have faced some pressure from allies, most notably the head of the American Federation of Government Employees (AFGE), to cut a deal with Republicans to end the shutdown and alleviate the suffering it has inflicted on federal workers and many others.
But Democrats appear unmoved by the AFGE president's demand, and other labor leaders have since voiced support for the minority party's effort to secure an extension of ACA subsidies.
"We're urging our Democratic friends to hold the line," said Jaime Contreras, executive vice president of the 185,000-member Service Employees International Union Local 32BJ.
In his op-ed, Sanders asked, "Does anyone truly believe that caving in to Trump now will stop his unprecedented attacks on our democracy and working people?"
"If the Democrats cave now, it would be a betrayal of the millions of Americans who have fought and died for democracy and our Constitution," the senator wrote. "It would be a sellout of a working class that is struggling to survive in very difficult economic times. Democrats in Congress are the last remaining opposition to Trump's quest for absolute power. To surrender now would be an historic tragedy for our country, something that history will not look kindly upon."
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