You Think Trump Cares His Voters Are Suffering From Opioid Addiction?
I know it’s a bad look and not very Christian of me, but when I read about MAGA voters suffering from MAGA policies, I don’t feel badly. Stories of their disillusionment and regret go well with a steaming cup of morning turmeric tea. Cleve Wootson had one such story yesterday in Harlan County, Kentucky. A little context about Harlan County. In 2016, Bernie beat Hillary there, of course. But that day Bernie also beat Trump— and by a lot:
Bernie- 1,092 votes
Señor Trumpanzyy- 189 votes
In the general election Trump slaughtered Hillary in Harlan County, and across Kentucky (62.5% to 32.7%). He beat her in working class Harlan Co. 85% to 13%! This last cycle, after voters have had a chance to get to know Trump, he beat Kamala 88% to 12%. Wootson’s piece was called A Trump county worries Medicaid cuts could throw them back into opioid spiral. Harland Co, slam up against the border with West Virginia, has a lot of people who have had opioid problems. Other than in campaign bullshit, Trump ignored them when he was president. Biden did a lot to help turn their nightmare around with Medicaid-funded treatment programs. “Almost 90 percent of voters in this Appalachian county,” wrote Wootson, “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. 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.”
The intensifying debate hangs over Harlan County and illustrates a disconnect— even a contradiction— in Trump’s efforts to remake the federal government. He has vowed to reduce waste, fraud and abuse, and to extend a suite of tax cuts he signed into law in 2017. But reducing federal funding, particularly in places with large percentages of Medicaid users like Harlan, can threaten the livelihoods and even the lives of some of Trump’s most ardent supporters.
Containing the opioid epidemic has featured prominently in the political rhetoric of the Trump administration. Trump justified high tariffs on Mexico, Canada and China by saying the three countries didn’t do enough to stem the flow of opioids, particularly fentanyl, across American borders. “They’ve allowed fentanyl to come into our country at levels never seen before,” he said during his address to a joint session of Congress, “killing hundreds of thousands of our citizens and many very young, beautiful people destroying families.”
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.
“I have seen firsthand the people behind those statistics who have went and rehabilitated their bodies and their lives and are now productive members of society, and I worry what would have become of them had they not had Medicaid,” said Mosley, a Republican who voted for Trump in 2024 and thinks congressional Republicans will deliver a plan that cuts waste but also helps his community stay afloat, even if it includes tweaks to Medicaid or other entitlements.
“Medicaid in that arena has enabled us to return people to a productive workforce setting and make them a taxpayer again,” he said.
The state of Kentucky has seen similar strides. In 2023, drug overdose deaths in the state fell almost 10 percent, marking a second straight year of declines in the fight against the addiction epidemic. In an interview with the Washington Post, Democratic Gov. Andy Beshear said he worries what Medicaid cuts would do to people in his state, framing his fears in humanistic and economic terms.
“Any substantial impact to either [Medicaid reimbursement] rates or the overall amount coming in to the state will have a significant impact that no state in the country would be able to escape,” Beshear said. Further reductions could mean some rural hospitals would have to reduce services and staff, or even close. “If these cuts go too deep, it’s a risk to every piece of progress we’ve made in the last 10 years.”
From its very creation in 1965, the Republican Party— and conservative Democrats— have opposed Medicaid ferociously. It was voted out of the House Ways and Means Committee, 17-8, all 8 Republicans voting against it. It passed the House on April 8, 115 conservatives, mostly Republicans, opposing it. 313 Members of the House voted for it. It passed the Senate on July 9, 1965, 70-24, two dozen conservatives, mostly Republicans (and Democrats who later switched parties) in opposition. Nothing’s changed: conservatives still want to end it.
Wootson wrote that “Last month, Harlan residents were reminded of what those cuts could look like. Harlan’s hospital, a branch of Appalachian Regional Healthcare, announced that it was closing its labor and delivery unit. That means people giving birth in Harlan have to drive 40 miles to Middlesboro, Tennessee, or 50 miles to Whitesburg, Kentucky, or else give birth in the hospital’s emergency department. In announcing the reduction in services, the hospital said not enough women had opted to give birth at the hospital, and keeping the labor and delivery unit open was not economically feasible. Local leaders worry it’s the first of a cascade of closures for an area sorely in need of health care. ‘We have a lot of unhealthy people here, and the statistics show that we have high rates of cancer, high rates of obesity, high rates of diabetes, high rates of heart disease,’ Mosley said. ‘Kentucky was one of the least healthy states in the nation, and Harlan County was listed as one of the least healthy counties in the state. We’re trying to reverse that cycle.’ But despite Democratic warnings about what, exactly, could happen to Medicaid, some in Harlan don’t think Trump and Congress will whittle too much of the program away, said Paul Browning, one of the magistrates for Harlan County. He said many of his constituents never considered that Medicaid would be on the chopping block— some still don’t.”
Yeah, so don’t expect too many tears for them at DWT. “Little has been released about how much, exactly, would be cut,” wrote Wootson. “The Republican House budget resolution instructs a key U.S. House committee to cut $880 billion in spending over the decade, something that will help extend the Trump tax cuts. The vast majority of funds are in the Medicare and Medicaid buckets, and Republicans have said that Medicare is off the table. House Speaker Mike Johnson (R-LA) has not ruled out the cuts. Others have been more explicit: ‘Let me tell you, we cannot get to where we need to go without Medicaid,’ Rep. Keith Self (R-TX) said recently on Fox Business.”
In an interview with Politico last week, Paul Dans, chief architect of Project 2025, “Dans effectively confirmed what Democrats were saying all along and Trump himself denied: There really is almost no difference between Project 2025 and what Trump was planning all along and is now implementing. ‘It’s actually way beyond my wildest dreams,’ Dans said. ‘It’s not going to be the easiest road to hoe going forward. The deep state is going to get its breath back. But the way that they’ve been able to move and upset the orthodoxy, and at the same time really capture the imagination of the people, I think portends a great four years.’” Yeah, big surprise; trump was lying.
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