Weekend reads: A scramble to preserve Medicaid, DOGE axes NC contracts, Scientists have their say
North Carolinians protest cuts to government services and the social safety net in the name of government efficiency. (Photo: Clayton Henkel/NC Newsline)By
Gov. Josh Stein sent congressional leaders a letter asking them to spare Medicaid from budget cuts. About 3.1 million North Carolinians use the government health insurance.
The U.S. House is considering Medicaid cuts that could reach $880 billion over 10 years. North Carolina Medicaid Director Jay Ludlam told legislators last week a cut of that magnitude would mean a possible loss to North Carolina of $27 billion over 10 years. [Read more….]By
As the so-called Department of Government Efficiency (DOGE) works to slash contracts, grants, and leases around the country, North Carolina is set to lose more than 20 U.S. government facilities.
Those losses — largely in the form of leases DOGE says it has terminated — include Social Security Administration and Internal Revenue Service offices, court buildings, and environmental and agricultural posts around the state. While the agency lists some as transferred to federal spaces, others are described as permanently closed.[Read more…]By
Hundreds of scientists and students overtook Raleigh's Halifax Mall Friday to call for an end to the Trump administration's attacks on funding for the sciences and higher education, warning of calamity for North Carolina's research economy.
Part of a nationwide 'Stand Up for Science' protest that drew crowds from San Francisco's Civic Center Plaza to Boston Common — including a crowd of thousands outside the Lincoln Memorial — the demonstration at noon in Raleigh took aim at President Donald Trump's cuts to cancer research, support of anti-vaccine activists, and threats toward universities around the country. [Read more…]By
State officials charged with leading western North Carolina's recovery from Hurricane Helene have warned that there are years of rebuilding ahead.
But top state lawmakers made their expectations clear Thursday: they want shovels in the ground, and houses under construction, as soon as possible. [Read more…]By
Women living in Winston-Salem whose husbands were detained by U.S. Immigration and Customs Enforcement visited the state Legislative Building in Raleigh on Wednesday to share their stories with lawmakers.
The visit comes a day after the state Senate approved and sent to the House a bill dubbed the North Carolina 'Border Protection Act.' The legislation would require state agencies like the Department of Public Safety and Highway Patrol to enter agreements with ICE to assist with immigration enforcement.[Read more…]By
The Southern Association of Colleges and Schools Commission on Colleges (SACSCOC) has denied an appeal by Raleigh's Saint Augustine's University (SAU) to restore its accreditation. The historic HBCU was stripped of its accreditation by SACSCOC last December following a series of financial challenges. As NC Newsline previously reported, the college failed on multiple occasions to meet payroll, leaving faculty unpaid as they cancelled classes. [Read more…]
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The Wyoming Hospital Upending the Logic of Private Equity
The Atlantic Daily, a newsletter that guides you through the biggest stories of the day, helps you discover new ideas, and recommends the best in culture. Sign up for it here. After years of trying to improve his hospital in Riverton, Wyoming—first as a doctor, then as a board member and volunteer activist—Roger Gose was ready to give up. Gose, a Texas native, had been in Wyoming since 1978, when he saw an ad in a medical journal looking for a small-town internist. Ever since he was a kid, he had wanted to be a community doctor, the kind who made house calls and treated his neighbors from birth into adulthood. He found his calling in Riverton, a town of 10,000 people in one of the state's poorer counties. For 35 years, he ran a private practice and worked shifts at Riverton Memorial Hospital, even serving for a time as the chief of medicine there. After retiring from his practice in 2012, he joined the hospital board, still eager to do whatever he could to help. 'You want to leave a place better than you found it,' he told me. And for a long time, he felt like he had. But that was before LifePoint Health, one of the biggest rural-hospital chains in the country, saw his hospital as a distressed asset in need of saving through a ruthless search for efficiencies, and before executives at Apollo Global Management, a private-equity firm whose headquarters looms above the Plaza Hotel in Midtown Manhattan, began calling the shots. That was before Gose realized that, in the private-equity world, hospitals were just another widget, a tool to make money and nothing more. In late 2018, Gose and a group of his neighbors decided that trying to save their hospital was futile. It had already lost its maternity ward, leaving pregnant people to drive nearly 30 miles to deliver a baby. Data from the Wyoming Department of Health show that the number of air-ambulance flights from the county where Riverton sits to hospitals elsewhere in the state rose from 155 in 2014 to 937 in 2019. By the time I spent several days with Gose and a dozen other Rivertonians in the spring of 2023, they didn't even have a hospital anymore, they told me; they had a 'Band-Aid station.' The only way to ensure that their town had a real hospital, they decided, was to build one themselves. The conventional wisdom about rural hospitals in the 21st century is that they are, in a word, screwed. Young people move away; older residents left behind need more expensive care and are less likely than urban and suburban residents to have private insurance, which is more lucrative for providers than Medicare and Medicaid. A 2018 report from the U.S. Government Accountability Office found that twice as many rural hospitals closed from 2013 to 2017 than in the five years prior, and the ones that remained were in much worse financial shape than their nonrural counterparts. Emergency funding during the coronavirus pandemic improved the financial health of rural hospitals, but after that funding dried up, many were left facing labor shortages and supply-chain problems that increased prices. House Republicans' proposed cuts to Medicaid could drive even more hospitals out of business, the American Hospital Association argued in a letter to congressional leaders this April. The ability to stave off closure has been the chief value proposition that private-equity firms offer to rural hospitals. In my reporting on private equity's growing dominance in health care, I heard versions of the story that LifePoint and Apollo told Riverton residents again and again: Without us, you will be left with no hospital at all. Yours is running out of money, and our ability to consolidate and find efficiencies across our ever-growing system is the only thing that can keep it alive. Your community is too small and poor to support an obstetrics department, or general surgery, or mental-health services, so you won't have those anymore, but isn't something better than nothing? Accepting that private equity is the only option for rural hospitals, though, requires accepting that rural Americans deserve less access to care than their urban and suburban counterparts, and that the care they do receive will be measurably worse. A landmark 2023 study found that in the three years after a private-equity acquisition, the rate of serious preventable medical complications increased significantly. (LifePoint hospitals were not included in the study, which focused on acquisitions made before 2018.) Patients were more likely to fall in the hospital and more likely to acquire infections at the site of a surgical incision. The number of central-line infections, which often result from improper insertion or cleaning, rose 38 percent. Though the study didn't delve into the reasons for the increases, the implication was clear: Focusing on short-term profits was leading to cost cutting that could be dangerous for patients. In Riverton, the hospital's owner was cutting costs aggressively, while also raising prices. In 2014, LifePoint formally merged the hospital with one in wealthier Lander, a town 25 miles away, and renamed them SageWest Riverton and SageWest Lander. In 2017, the year before Apollo bought LifePoint, researchers examined hospital data for 14 individual Wyoming facilities and found that SageWest charged the highest relative prices; data from 2020 show that SageWest maintained the largest price disparity of any general hospital in the state after the Apollo acquisition. (LifePoint referred questions about the Riverton and Lander hospitals to SageWest; SageWest leaders did not respond to several requests for comment.) At the same time, the Riverton hospital was shrinking. In quick succession, SageWest suspended its obstetrics services, closed its inpatient mental-health unit, and shrunk other basic services. By 2022, the last year for which Centers for Medicare and Medicaid Services data are available, SageWest employed 227 people across its two campuses, nearly 40 percent fewer than before the Riverton-Lander merger. According to Gose, the number of physicians based in Riverton had dwindled from 20-something to just seven. If they were going to build a new hospital, Gose and his neighbors first needed to know whether it could theoretically be financially viable. By 2018, they had formed a nonprofit, Riverton Medical District, and one of the board members, Vivian Watkins—the former head of commercial lending for U.S. Bank's 14 branches across Wyoming, and the kind of person who can't leave the grocery store without stopping four times to ask about someone's kids or their neighborhood drama—began cold-calling hospital CEOs across Wyoming, looking for advice on where to start. One told her that she should go straight to Stroudwater Associates, a Maine-based consultancy with a specialty in rural-health-care finances. The Riverton nonprofit was not Stroudwater Associates' typical client. The company's chairman, Eric Shell, and his team usually work directly with rural hospitals, or occasionally with a larger chain looking for system-wide strategic planning. Gose, Watkins, and their allies didn't have a hospital, didn't have concrete plans for a hospital, didn't even have any money for a hospital. Still, Shell was intrigued by the brazenness of what they were dreaming up. After nearly 30 years working with rural hospitals, Shell believed that rural hospitals could survive, but that too few hospital executives think creatively about solutions. Over and over, he's seen cuts damage a hospital's business further: 'You win the battle, but you lose the war,' he told me. Instead of cutting costs by 'doing more with less' (to use the corporate jargon for layoffs and overworking employees), making rural hospitals run in the 21st century means increasing profits by expanding a hospital's business. One of Shell's go-to examples is Mahaska Health in Oskaloosa, Iowa, a nonprofit hospital in a city slightly bigger than Riverton. When the pandemic hit in 2020, hospitals across the country were overwhelmed with critically ill COVID patients, but also saw a decline in other types of cases. The result was a huge, unexpected loss of revenue for many hospitals, and a correspondingly huge number of layoffs: 1.4 million health-care workers lost their jobs in April 2020 alone. At Mahaska, though, CEO Kevin DeRonde—a former NFL linebacker—ran in the opposite direction: He hired many of the providers who had been laid off from other area hospitals, Shell said. His hospital took a short-term financial hit, but DeRonde wagered that patient volume would recover once the worst of the pandemic eased up. The bet paid off. After the drop in 2020, the number of non-COVID patients skyrocketed. Now many hospitals were understaffed, but not Mahaska. The hospital hadn't been doing well even before the pandemic, losing more than $5 million in 2017. By 2023, it made $7.5 million in net income, according to Shell and Mahaska Health officials. Growth, though, is more difficult at hospitals owned by private-equity firms, because of the need to keep shareholders happy through quick returns. 'When I look at what they're doing in Lander and Riverton, I shake my head and say, 'That's not the way I'd be running the company,'' Shell told me. 'But I'm not running the company, and they're driven by an external force. If they're not beating the market rate of compensation for their investors, their investors are going to walk.' Shell agreed to conduct a feasibility study for Riverton Medical District, and Stroudwater spent months digging into every aspect of Riverton's economy, population, and existing health-care options. Just 44 percent of Medicare recipients in the area who needed hospital treatment got it at either Riverton or its sister hospital, leaving an opening for a new hospital to quickly capture market share. The presence of the Wind River Reservation, which surrounds Riverton, boosted the financial case: The Eastern Shoshone and Northern Arapaho Tribes, which share the reservation, both provide private insurance to their members. In June 2019, Shell's firm handed over its report. Its takeaway: The area had the ability to 'support a financially viable rural health system with a range of medical, surgical, and specialty services.' The Riverton Medical District team had the answer they wanted, from a company with real bona fides in the rural health-care world. Gose and Watkins were jubilant. They were going to build a hospital—if they could find the money, that is. Friends and neighbors had banded together to cover the $150,000 Stroudwater study, but a whole new hospital was going to cost tens of millions. Shell didn't think they could pull it off. He told them so outright. He's an accountant, which means always assuming the worst. He couldn't fathom why a bank or a government would give Riverton Medical District a loan, considering the competition risk. The group, though, was unanimous: Shell's fears weren't going to stop them. They were the ones who lived there; they were the ones who, in Gose's words, felt an obligation to leave Riverton better than they found it. After months of looking into every other source of funding they could think of, Riverton Medical District turned to what the group considered the 'lender of last resort'—the U.S. Department of Agriculture, the primary government funder of projects affecting rural Americans. A community hospital in an underserved rural area fit the portfolio, which could qualify Riverton Medical District for low-interest loans. Applying for government money, however, required navigating government bureaucracy. In an email exchange that stretched over months, the USDA rural-development regional director for Wyoming, Lorraine Werner, was encouraging but exacting. Every time Werner needed more documents, including a third-party audit that cost an additional $50,000, the group would scramble to get them to her. Then she would ask for even more. It took Riverton Medical District more than a year to have its application accepted—not for funding, just for consideration. Yet somehow, Riverton residents never seemed to grow tired of what looked to many outsiders like a quixotic scheme. To house the hospital, the Eastern Shoshone Tribe agreed to sell eight acres on the north end of town and donated four more acres outright. People kept handing over money, frequently $5 or $10 at a time. Finally, after an application process that took nearly two years, USDA announced its ruling. The federal government agreed that a new hospital in Riverton could be financially viable, committing to fund the lion's share of the costs—more than $37 million. It was the largest USDA rural-development loan ever awarded in the state of Wyoming. The money would fund a hospital offering every routine service Rivertonians had lost. It would have 13 inpatient beds, a full surgical department, two labor-and-delivery rooms, two rooms equipped for intensive care, and space for physical and speech therapy. It would be staffed to perform surgery and deliver babies 24 hours a day. And the building would be designed to accommodate future growth, with the potential to add 11 new patient rooms, additional surgery space, and more parking, board members told me. In its report, USDA was more bullish than Shell and Stroudwater had been; the agency's official assessment of the project barely referenced the threat of competition from the existing hospitals. Citing numbers provided by the Riverton Medical District board, USDA found that the hospital could break even with just 30 percent market share, far less than SageWest's 44 percent. The Riverton Medical District project, evaluators wrote, had generated a remarkable level of local support; the agency noted donations from individuals and businesses that added up to more than $1 million, and more than 200 letters of support. Several of the letters said that without a new hospital, they would move out of Riverton. Multiple business owners wrote that the lack of a fully functioning hospital left them unable to recruit and retain workers. Most of the USDA report was written in bureaucracy-speak, but at one point the author slipped into first person: 'The applicant started a true grassroots movement to bring back essential services to the community and has exhibited a level of community support, both monetarily and otherwise, that is unseen in my experience.' In December 2024, just before the soil froze for the season, work crews broke ground on Riverton's new community hospital. In early June, 400 people turned out for a community celebration, cheering for state-government officials and Riverton Medical District board members and signing a beam that will be installed into the new facility. Building a new, locally owned hospital isn't a scalable way to help every community where hospitals owned by private-equity firms are providing less health care. The particular combination of ingredients in Riverton Medical District's recipe baked into something resembling a miracle. But to Gose's mind, following Riverton's example doesn't require building a community hospital in every rural county in the country. What it requires is people with knowledge of, and investment in, one specific community making decisions for that community—the exact opposite of the private-equity ethos of consolidation at all costs. 'Often you'll see a lot of people get excited and involved in something for two or three months or six or whatever, but then they get disillusioned and quit,' Gose told me. 'And I think that's what LifePoint thought we were doing. And they underestimated that failure was not an option.' This article has been adapted from Megan Greenwell's forthcoming book, Bad Company: Private Equity and the Death of the American Dream. Article originally published at The Atlantic
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‘Unfathomable': Seth Rogen Torches Lawmakers Threatening Cuts to Medicaid
Lauren Miller Rogen was 22 years old, celebrating her graduation from college the first time she noticed something was happening to her mother, Adele. It was relatively minor: 'She repeated herself — she told a story a few times about a friend of hers,' Rogen says. But for Lauren, who had watched Adele care for her own parents as they slowly succumbed to Alzheimer's disease, it was the potential future that unnerved her. Within two years, Adele, a first-grade teacher, would be diagnosed with early-onset Alzheimer's at age 55. By that time, Lauren was living in Los Angeles, and dating her then-boyfriend, the actor Seth Rogen. When the couple married a few years later, Adele's condition had progressed to the point that it wasn't clear at their wedding if she even realized who Lauren was. 'She knew I was the bride — she kept calling me the bride,' Lauren recalled in Taking Care, a documentary the couple made to raise awareness about the challenges that families face while caring for a person with advancing dementia. The toll of caring for Adele was hardest on Lauren's father. 'There was a time early on, before we brought care in, where we were like, 'Oh, we're gonna lose him first.' This — caring for her — seemed like it's literally killing him,' she says. 'Without being able to afford outside help, I dread imagining what would have happened,' Lauren says. The couple went on to found a nonprofit, Hilarity for Charity, that disburses grants to offset the cost of caring for a person with dementia. 'Until we were part of the care system, we didn't realize how broken it was,' Seth says in a video they recorded on behalf of the organization Caring Across Generations, to raise alarms about the threat families face under a pair of proposals to slash health care programs for the poor and disabled that are being considered at the state and federal level, and encourage people to contact their legislators. He adds, 'Millions of low income families, families of people with disabilities, families that have older adults in them, are facing this struggle every day right now. And that is why it is so unfathomable that federal and state legislatures are making massive cuts to Medicaid as we speak.' 'We are cutting crucial services for people who are aging and disabled,' he explains. 'That means these people will be losing access or have less access to the health care they need, creating more out-of-pocket expenses and medical debt.' In Washington, President Donald Trump's 'Big Beautiful Bill,' which was recently approved by the Republican majority in the House of Representatives, would cut roughly $600 billion from Medicaid in order to help pay for a new round of tax cuts for the wealthy. The Trump tax bill is projected to kick over 10 million people off Medicaid, the government health insurance program for low-income and disabled Americans. The legislation would also limit so-called provider taxes, which states use to provide supplemental payments to hospitals, doctors, and other health care providers to help pay the costs of treating Medicaid patients. The bill would additionally impose a financial penalty on states, like California, that offer health coverage to undocumented immigrants. In California, the situation could be compounded by further cuts proposed by Governor Gavin Newsom (D) that would slash Medi-Cal, the state's Medicaid program. Roughly one quarter of the five million Americans with dementia rely on Medicaid, the country's largest payer of long-term care. Medicaid is a pillar for caregivers — some 12 percent of recipients are people who can't work because of their responsibilities caring for a family member. Their ability to access the program could be jeopardized by the Big Beautiful Bill, which would impose work requirements on all able-bodied adults under 65 in order to qualify for Medicaid. 'Almost everyone in this country knows or loves someone that relies on Medicaid, even if they don't rely on Medicaid themselves. And we have the power together,' Lauren says in the video. 'We need to reject any cuts or changes that would take more care away from families that need and deserve it,' Seth adds. 'At the state level and the federal level.' More from Rolling Stone Trump Continues Inflaming L.A. Protests: 'BRING IN THE TROOPS!!!' ABC News Suspends Journalist for Calling Stephen Miller and Trump 'World-Class Haters' Republicans Say They're Cool With Trump Deploying Troops Against Protesters Best of Rolling Stone The Useful Idiots New Guide to the Most Stoned Moments of the 2020 Presidential Campaign Anatomy of a Fake News Scandal The Radical Crusade of Mike Pence
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Democrats have a dirty secret - they actually like some of the tax cuts in Trump's ‘big beautiful bill'
Some of the sweeping tax cuts proposed in President Donald Trump's massive spending package have found support among Democrats — even as they are expected to oppose the legislation over proposed cuts to Medicaid and other government services when it comes up for debate in the Senate later this month, according to a new report. The gargantuan budget package, which House Republicans and the White House have dubbed the One Big Beautiful Bill Act, passed the House by a single vote last month and is now drawing heat from fiscal hawks in both chambers as well as Tesla CEO Elon Musk, who was fresh off his months-long stint as a special government employee when he began threatening to back challengers to any legislator who votes for the bill. Still, there are facets of the proposal that have appeal for some Democrats, the New York Times reports. Virginia Rep. Don Beyer, a Democrat who is also a wealthy car dealership owner, told the Times his party is 'in general very much in favor of reducing taxes on working people and the working poor' when asked about Trump's plan to end taxes on service workers' tips. 'Those people are living on tips,' he added. Trump's tip tax cut plan has also attracted attention from Sen. Jacky Rosen of Nevada, a state where service workers make up a large and powerful voting bloc that has traditionally supported Democrats but shifted to Trump in large numbers during the 2024 presidential election, handing him the Silver State's electoral votes. Rosen, a Democrat, took to the Senate floor last month to advance a bill approving Trump's 'no tax on tips' plan. It passed unanimously even though the measure was largely symbolic because the U.S. constitution requires tax laws to originate in the House 'I am not afraid to embrace a good idea, wherever it comes from,'. she said at the time in remarks on the Senate floor. Yet despite the support for some of the individual tax provisions in the plan, it's highly unlikely that it will be able to muster enough if any Democrats to ease the way to Trump's desk, even under a Senate procedure known as budget reconciliation, which fast-tracks some types of spending legislation without subjecting it to the upper chamber's de facto 60-vote threshold for passage. Democrats are expected to unanimously vote against the legislation in the upper chamber, where it has also attracted opposition from some Republicans who've complained that the cuts to spending in the package don't go far enough to offset the reduced revenue caused by provisions meant to enact Trump campaign promises to end taxes on tips for service workers, as well as taxes on overtime pay for hourly workers and on social security benefits for seniors. Nonpartisan experts such as those at the Congressional Budget Office have warned that the reduced tax receipts would blow a massive hole in the federal budget and jeopardize America's long-term fiscal outlook, but that hasn't stopped some prominent Democrats from getting behind the individuals tax cuts. Trump and his allies hope the prominent tax cut proposals will blunt Democrats' efforts to paint the One Big Beautiful Bill Act as a giveaway to wealthy GOP donors that will gut government services while only providing limited relief for working-class voters. To that end, the president and others in his camp have routinely taken to social media to argue that anyone who votes against the bill is effectively voting for tax increases because the legislation makes permanent a number of temporary tax cuts enacted in the 2017 Tax Cuts and Jobs Act, which Trump signed into law during his first term. Democrats, meanwhile, remain opposed to the bill's massive cuts to Medicare and other measures that make it harder for people to claim tax credits meant to boost lower-income Americans' bottom lines. Rep. Brad Schneider, an Illnois Democrat, told the Times that the whole bill had to be considered rather than any individual provision or provisiosn. 'Any one thing — a tax credit or a tax cut — might make sense, but you've got to take a look at the whole picture,' he said.
