Rural voters put Trump in office. Now he’s screwing them over.

As always, the loyalty only flows one way.

In 2024, rural voters swung to Donald Trump two-to-one, with 69 percent supporting him. These blowout numbers were a key factor in putting him back in office, and an improvement on Trump’s 59 percent in 2016 and 65 percent in 2020. Now, Trump is repaying rural voters by stripping them of their healthcare and potentially costing them their livelihoods, and even their lives.

The American Hospital Association estimates that 1.8 million citizens in rural communities will lose their Medicaid coverage by 2034 as a result of Trump’s One Big Beautiful Bill Act. This won’t just affect the individuals who lose their health care; many hospitals will, and already have had to, limit their operations as well. While some hospitals may not need to completely close, they will have to shut down entire departments.

The first casualty is usually the maternity ward. This is because they are the least cost-efficient part of the hospital, though arguably some of the most important. More than 40 percent of all births in the US are covered by Medicaid, which typically only reimburses hospitals 88 cents for every dollar spent. Even before Trump took office, hospitals all over rural America were being forced to eliminate maternity departments due to pre-existing financial strains. Now, even more hospitals and care centers will have to close.

Approximately 2.3 million women live in maternity care deserts—counties with no birthing hospitals, birth centers, or obstetric providers. Unlike urban areas where patients can often find alternative facilities within reasonable distance, rural women facing obstetric emergencies or labor complications have nowhere else to go. When the nearest hospital is hours away, women are forced to give birth in ambulances, and may forgo essential prenatal and postpartum care.

Residing in these healthcare wastelands leads to significantly higher rates of maternal and infant mortality. On the campaign trail, Trump promised he would be “great for women and their reproductive rights,” even angering some of his own allies. Instead, his signature legislative achievement endangers women and mothers needlessly by cutting back their access to critical care.

Other kinds of patients will suffer as well. From 2010 through 2022, rural adults between the ages of 25 and 64 experienced a 21 percent jump in deaths related to heart attacks. Stroke mortality in 2020 was 30 percent higher in rural communities than urban ones. In these cases, rendering immediate care is a life-or-death matter.

But an article published in the Journal of the American Medical Association estimates that one in 10 rural Americans will wait more than 30 minutes for life-saving treatment. And that was before an estimated 700 rural hospitals faced potential closures due to Trump’s cuts. For rural residents, hospital closures don’t just mean longer drives—they can mean the difference between life and death.

As a result of the law, rural hospitals specifically will lose nearly $70 billion in Medicaid funding over the next 10 years. In addition to cutbacks in care, good-paying jobs will disappear as hospitals close their doors or scale back. In many rural communities, hospital systems are the beating heart of the local economy, employing people from high-skilled clinicians to service staff who keep these facilities running. One study found that rural healthcare facilities employed almost 10 percent of the people in communities in which they resided. It is not an exaggeration to say that Trump’s law threatens to collapse the economic backbone of rural America.

Despite being a lifelong New Yorker and transplant to Palm Beach, Trump has spent years talking about how much he loves rural America—or “real America,” to use his preferred phrase. In turn, rural voters have rewarded him with staggering electoral margins in three straight presidential elections. It’s telling that Trump has chosen to repay their support by gutting their access to health care while dismantling their local economies.

As with everything Trump does, the loyalty only flows one way.

Home of the Brave is an initiative dedicated to exposing this administration’s corruption, cruelty, and lawlessness.