When 77 million Americans cast their ballots for Donald Trump for president last year, many of them were voting for exactly the kind of disruptive, government-gutting change Trump has delivered. They probably never imagined that the price of Trump’s cost-cutting would soon hit their own communities, often with devastating economic and public health effects.
Trump’s decision to end billions of dollars in federal grants to a wide variety of state and local nonprofits has crippled the delivery of critical public services in small towns across the country. Some of the hardest hit communities are located in red states like West Virginia, Alabama, North Carolina, and Louisiana, where voters backed Trump in 2016, 2020, and 2024. Now some of Trump’s most fervent supporters are left wondering whether anything will be left of their communities in four years.
Related | West Virginians love Trump—and he's screwing them anyway
With Capitol Hill gearing up to pass a Trump budget that will slash federal domestic spending to its lowest level in modern history, many of the nonprofits that keep red states running are preparing to shutter operations. That will leave millions of Americans without access to basic medical and dental care, early childhood education, senior support services, and free mental health services for at-risk populations like veterans.
Trump pledged to foster a new golden age of economic prosperity. Instead, he’s presiding over more collapsing small towns than at any time since the Great Depression.
Locals in Pine Ridge, South Dakota, have seen the aftermath of Trump’s reckless federal cuts which have stripped the Red Cloud Indian School of its AmeriCorps teachers. The organization, which operates two elementary schools, a middle school, and a high school on the Pine Ridge Reservation, received $400,000 annually in AmeriCorps grant money. Without those funds, Lakota youth in the area will lose their access to education.
Children will be directly impacted by the Trump cuts when it comes to education and resources around schools.
Trump carried Mississippi, with nearly 61% of the vote in 2024. It took him less than a year to bring the city to the brink of a public health crisis. Trump’s decision to gut federal funding for HIV prevention is a bomb blast to communities across the south, where more than half of all new HIV infections occur. Prior to Trump’s cuts, the Centers for Disease Control provided roughly 90 cents of every dollar spent on HIV prevention. Now, communities are on their own.
The loss of community health services may be the biggest blow to red states that were already reeling from a slow response to COVID-19. Federal HIV prevention programs have been hugely successful across the south, reducing infection rates by 21% between 2017-2022. That didn’t just save lives, it meant a healthier and more economically productive population for red states. Now progress hasn’t just halted—Trump’s cuts have thrown efforts into full reverse.
Trump’s sweeping cuts are also complicating life for state Republican parties who are now facing hordes of angry constituents at town hall meetings. That’s been the case in Virginia, where the state GOP is locked in a close race for control of the governor’s mansion against popular Democratic Rep. Abigail Spanberger. There, Trump’s cuts weigh like an anchor on a state Republican Party that finds itself on the defensive in what were once deep red communities.
As the Trump-supporting Virginians across the state’s southwest region quickly realized, most of their local services are provided by nonprofits funded through federal grants. In fact, nearly all of Virginia’s most federally dependent communities are located in MAGA country, where killing “wasteful” federal grants was one of Trump’s most popular proposals. Now those communities are on the verge of losing their community centers and child care services.
Still, many of those small-town Americans continue to support Trump even as he actively rips them off. In one grim example Markos Moulitsas highlighted on March 23, West Virginians have remained unwavering in their love for Trump even as his policies lead to sweeping layoffs across the state’s coal mining industry. Those West Virginians are actively getting poorer and sicker because of Trump’s cuts, but their cheering has only grown louder. How can anyone save communities that don’t seem to want to save themselves?
If the courts allow Trump’s vast government spending cuts to move forward, the result will be a series of stacked crises unfolding across red state America. The south’s fragile public health infrastructure will collapse, leading to a health care crisis concentrated in rural communities that depend completely on now-shuttered nonprofit health services.
That will in turn spark an economic crisis as those rural communities exert more and more drag on state balance sheets. States will appeal for federal aid at the very moment Trump and congressional Republicans are slashing what little remains of that from the budget. The costs will compound the longer the situation remains unresolved.
And that will lead to a migration crisis—that is if people can even afford to move—as rural residents across the nation abandon their quite literally crumbling communities in favor of urban centers with medical care, education, and clean water. Oh yeah, Trump also plans to cut funding for clean water infrastructure as part of his looming Environmental Protection Agency budget.
Red state cities aren’t ready for the instability Trump’s cuts will unleash. Many red states barely have enough service infrastructure to meet current levels of need. Adding a surge of new arrivals, many of whom will likely be in poor health, would push those municipalities over the financial cliff. Just like that, a public health crisis becomes a nationwide economic catastrophe.
Trump’s crowds are still cheering. As his funding cuts start to bite into his voters’ health, how much longer will that be true?
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