GOP pushes to kill poor Texans

Plus: wins for workers in blue states, bold policy pilots, shock primaries, and lots of election data

Welcome to a Saturday edition of Progress Report.

I don’t want to ruin your weekend (mine is filled with work events) but I’ve got to be blunt: the United States is feeling pretty cooked these days.

The latest batch of Supreme Court rulings brought us even closer to a formal right-wing theocracy. Decisions have codified unsubtle bigotries, especially against LGBTQ+ people, and the president can now implement his sickest fantasies without fear of a nationwide injunction.

Hyperbolic? No, not really — not if you’re a brown person in this country, who are now being stalked by bounty hunters without recourse. But I’m no legal expert, so on Sunday afternoon, I’ll host a live stream with Chris Geidner, my old BuzzFeed colleague and the author of the vital newsletter Law Dork — stay tuned for timing.

Today, I’ve got a report on a catastrophic own goal embedded within Trump’s so-called Big Beautiful Bill, some important election roundups, and some big policy stories that you won’t read elsewhere.

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The Big, Beautiful Base-Killing Bill

When the East Texas Medical Center hospital system decided in 2017 not to renew the lease on its facility in Trinity County, its sheriff expressed confidence that a new provider would take over before services lapsed.

Instead, it took five years to find a new tenant to shoulder the risk of re-opening the county’s only hospital and then just over a year for Mid Coast Medical Center, the new hospital system, to throw in the towel.

Now, residents of Trinity County, a community north of Houston, have to drive at least 30 miles to visit an emergency room or deliver a child. It’s a dire situation for the county’s more than 13,000 people, half of whom live below the poverty line. But it’s not an unusual one in the state: 21 rural hospitals in Texas have permanently shut their doors since 2010, the most in the nation.

In November, analysis by the Center for Healthcare Quality and Payment Reform found that there were 87 rural Texas hospitals at risk of closing, including 22 that could be forced to shut down within the next three years. Advocates fear that the huge cuts to healthcare spending proposed in congressional Republicans’ budget bill will only expedite the closures.

“Lawmakers are not representing their constituents, they’re representing their party and the wealthy people who really make decisions for their party,” says Lynne Cowles, the director of health and food justice at the nonprofit Every Texan. “People will have to drive hours to get emergency care, to get surgery, or to undergo labor and delivery. Whole communities will suffer the loss of rural hospitals.”

As it stands, Republicans’ budget bill would implement so-called “work requirements” on enrollees in the expanded Medicaid program, which is open to people who earn up to 138% of the federal poverty rate. Because Texas is among the 10 states that have not expanded Medicaid, securing it the dubious honor of having the highest uninsured rate in the nation, the state won’t have quite as many people kicked out of the program—a pyrrhic victory to say the least.

Other new bureaucratic impositions on Medicaid recipients would directly impact Texans. Whereas the state is currently required to verify recipients’ ongoing eligibility once a year, the budget bill would bump that up to twice a year, further empowering a state Medicaid agency that aggressively and inappropriately unenrolled millions of people after the Covid-19 pandemic.

Add in the GOP’s decision to not renew tax credits to purchase insurance on the Affordable Care Act marketplace, and the health care policy nonprofit KFF estimates that around two million Texans would lose their health insurance by 2034.

Rural hospitals on the brink

Rural hospitals are particularly reliant on Medicaid, and over the past few decades, declining reimbursement rates compared to private insurance have helped push many toward disaster. But Medicaid compensation is far better than nothing, so rural hospitals in Texas, which serve poorer, sicker, and older communities, have suffered more than counterparts elsewhere due to the state’s refusal to expand the program.

If the Senate’s version of the budget bill prevails, limits to local Medicaid funding initiatives will have an even bigger impact than so-called work requirements.

Every state but Alaska uses a version of what’s known as a provider tax to secure more federal funding for low-income patients. Hospitals and other healthcare providers pay a small tax to a local government, which states use to fund their Medicaid obligation. Critically, the federal government provides a match in the revenue generated to each state. That money is used to increase Medicaid payments.

As the Georgetown University McCourt School of Public Policy notes, restrictions on these taxes would thus severely hurt rural hospitals, which rely on continued adjustments to the funding.

The House GOP proposed capping the tax rates where they are right now, which would cost Texas $4 billion over 10 years, John Henderson of the Texas Organization of Rural & Community Hospitals says.

Republicans have received plenty of heat from constituents and rural state lawmakers over the cuts, so they’ve been tinkering around the edges to turn perceptions around. The latest version of the bill, which dropped on Saturday morning, would delay the cuts to provider taxes until 2028, but would not change the damage they’d cause; the bill also provides a $25 billion fund for rural hospitals, which is a half a drop in the bucket compared to what will be cut.

Good new things in the states

Rhode Island: Gov. Dan McKee just signed a new law that bans the manufacture and sale of semi-automatic rifles, shotguns, and handguns in the state, a huge win for gun control advocates as the Trump White House works to roll back firearms regulations on the federal level.

The law goes into effect next year and carries penalties of up to 10 years in prison and/or a $10K fine for making or selling those military-style weapons. People who currently own the soon-to-be prohibited guns will be able to maintain possession but barred from selling them within the state.

New York City: Some families will receive free, city-subsidized childcare for kids under two thanks to a new pilot program established in the city’s upcoming budget. The program is aimed at low income families with children two and under, as the city already offers free 3-K and pre-K (though Eric Adams has underfunded the 3-K system).

This is a particularly timely pilot because Democratic mayoral nominee Zohran Mamdani has pledged to enact universal childcare — an idea, I’m proud to say, that I helped state Sen. Jessica Ramos pitch long before any other campaign. Obviously, that campaign ended poorly (long after I left!) and I’m very glad Mamdani picked up that baton.

The upside of such a program is almost incalculable for children, parents, and the economy. Childcare has become obscenely expensive in NYC — my wife and I pay $2800 a month for our son to go to a “play group” daycare that is on the cheaper end of the spectrum. It’s unsustainable and frankly the fact that the city provides 3K will be a huge factor in our monthly budget.

Read on for more on this story, new numbers behind the 2024 election, ballot initiative wars, shock vetoes and turmoil in a blue state, a controversy mea culpa, some big wins for workers, and more...