A Trump county worries Medicaid cuts could throw them back into opioid spiral | The president has said entitlement programs like Medicaid, Medicare and Social Security will remain untouched, even as he pushes for a contraction of federal spending

# Harlan County, Kentucky

> “If it were to go away today, I would be homeless tomorrow. I would lose everything. All my counseling, all my treatment. I would absolutely be homeless tomorrow,” said Fee, 42, who has lived in Harlan all her life, most of it spent in a cycle of addiction and rehabilitation. A Medicaid-funded treatment program she entered last year has her feeling, for the first time, optimistic about not living a life dominated by substance abuse.

> “I am stepping out onto my own, getting my house with my kids sooner or later, but if I lost [Medicaid-funded treatment] today, I would lose my job, I would lose everything that I’ve worked so hard to rebuild over the last year,” said Fee, who can’t vote because she has a felony conviction, but is not a supporter of Donald Trump. “If [Trump] takes the things that they’re saying, it’s going to be devastation for Eastern Kentucky for sure. We’re scraping off the bottom already.”

> Almost 90 percent of voters in this Appalachian county in Kentucky’s southeastern corner voted for Trump, who has said his party’s effort to eradicate waste, fraud and abuse will culminate in a “big beautiful bill” that will lay the groundwork for slicing at least $1.5 trillion from the federal budget in the next decade. The president has repeatedly said entitlement programs like Medicaid, Medicare and Social Security will remain untouched, even as he pushes for a contraction of broader federal spending.

# Medicaid funding is precarious

> But Democrats, including the governor of Kentucky, warn that the kind of cuts the GOP is considering are impossible without cutting essential services like Medicaid, which provides health care to low-income people. The Congressional Budget Office agreed, saying this month that Republicans cannot cut their desired amount of federal spending without cutting Medicaid or Medicare benefits.

> And despite Trump’s assurances that the programs are safe, some Republicans have advocated that reform is needed.

> Three members of the ultraconservative House Freedom Caucus recently penned an op-ed on Fox News saying “lawmakers must reform Medicaid. To do anything less borders on malfeasance.”

> “Medicaid was never meant to be this expansive,” the opinion piece says, echoing concerns that have been expressed by other Republicans.

# Medicaid’s role in Harlan County

> Almost half of people in Harlan County receive Medicaid, which is administered by the state of Kentucky but funded largely by the federal government. Those funds help pay for doctor visits and prescriptions, but Medicaid also subsidizes a burgeoning industry of rehabilitation facilities and treatment centers in a state that has one of the country’s highest rates of opioid abuse.

> “The substance abuse treatment industry in Eastern Kentucky employs more people than the coal mines ever thought about,” said the owner of one facility, who spoke on the condition of anonymity to avoid fraying professional relationships. “With Medicaid expansion, if you need help, you can get it now. You can get medication, you can get counseling, you can get therapy. Basically, you can get almost any service that you need, more services than you ever could have before.”

> Harlan County Judge Dan Mosley, the county’s chief executive, said Medicaid has helped countless people in his county recover from opioid abuse, transforming from repeat offenders who siphon finite resources to working taxpayers, including some who help others through addiction.

!ping SOCIAL-POLICY&RURAL

They need to pull themselves up by their bootstraps and say NO to drugs. Problem solved.

Am I supposed to sympathize with these people? Because I don’t.

They’re getting what they voted for, and I’m happy for them.

There’s no way to reign in spending to any noticeable degree while refusing to touch the 5 biggest items (I’m assuming they aren’t stupid enough to just stop paying interest) that make up like 80% of the federal budget. You can only cut food stamps or the payroll so much.