The labor and delivery unit where she used to work in this rural northeastern Georgia community is no longer open. So, she asked former co-workers to be on standby around her anticipated due date. She and her midwife mapped out emergency rooms along the more-than-50-mile trek to the hospital in Greenville, South Carolina, where she planned to give birth. And, to prepare for a worst-case scenario, she curated items to keep in the car in case she went into labor en route.

“That’s a horrible place to put a pregnant woman in,” said Holden, who on Oct. 11 made the painful, hourlong trip to Greenville Memorial Hospital to deliver her son Tucker.

Holden lives roughly midway between Athens and Greenville, two of the nearest cities with labor and delivery units. Owing partly to Medicaid cuts from President Donald Trump’s One Big Beautiful Bill Act, St. Mary’s Sacred Heart Hospital in Lavonia nearly a year ago. Its closure is part of a trend touching rural communities nationwide. From South Dakota to and from to , low Medicaid reimbursement and dwindling birth rates are pushing hospitals to shutter these services. Today, of rural hospitals offer labor and delivery services.

In Georgia, only 36% of rural hospitals have a labor and delivery unit, and four have closed since 2020, according to data from the .

To address the challenge the closings pose to patients seeking care, the state — which ranks among the for maternal health outcomes — has turned to federal money from the $50 billion . This fund was created by congressional Republicans to offset concerns about the outsize fallout Trump’s signature legislation would have in rural communities.

More than $12 million — out of the nearly $219 million approved for Georgia in the program’s first year — will be allocated toward placing obstetric carts in 43 rural hospitals without labor and delivery units. The carts will be outfitted with supplies needed for a birth or obstetric emergency. For example, they’ll have neonatal resuscitation tools, thermal blankets, and essential medications such as oxytocin, which stimulates contractions, and magnesium sulfate, used to treat seizures in pregnant people with high blood pressure.

The delivery carts sound fine, in theory, said Justin Peterson, an OB-GYN who practices in southern Georgia and has seen the pressures rural health institutions face providing maternal care.

Like Holden, Peterson worries that the carts, while helpful, will put supplies in the hands of ER doctors lacking extensive obstetric experience. Instead, he wants the state to fill coverage gaps by investing more to prevent the closure of labor and delivery units in rural areas.

“You’re putting a band-aid on a hemorrhage,” he said.

‘Can’t Practice Scared’

Brittany Mitchell was about seven months pregnant when Sacred Heart’s labor and delivery unit closed. She was reassigned to an OB-GYN in Athens, even though the nearly 50-mile drive from Lavonia was stressful and inconvenient.

That OB-GYN wanted to see Mitchell weekly after finding high levels of protein in her urine — a warning sign of preeclampsia, which can cause organ damage, seizures, and other complications. To make it to those prenatal appointments, she routinely gave up a day of work as a home health aide, a job she said already didn’t pay much.

But if Mitchell were to have another baby, she said, she’d still prefer to drive to Athens to see an OB-GYN than be treated by an ER doctor. When she had her first child nine years ago, the local OB-GYN had to act quickly when her daughter briefly lost oxygen.

“If they were in that situation,” she wondered of ER doctors, “would they know how to do all that?”

In written responses to ³Ô¹Ï²»´òìÈ, Lauren Williams, director of communications for the Georgia Department of Community Health, said that training ER medical staff is the main goal of the obstetric cart initiative. The rollout will include simulation drills, during which ER staff will practice high-risk procedures.

The Georgia Hospital Association will procure and distribute the carts. When exactly that will happen is unknown, but the grant funding must be spent by Sept. 30, 2027, said Anna Adams, the organization’s chief government relations officer.

The concept of obstetric carts is great, said Justin Law, an emergency doctor with SouthlandMD, a physician-owned and -operated healthcare management and staffing company. Most items planned for the carts are already available in ERs. But having them in one organized spot will be helpful, he said.

Still, while ER doctors are more frequently positioned at the front lines as labor and delivery closures persist, advocates argue that they shouldn’t be used as a stopgap in obstetric care.

In the decade he’s worked across rural Georgia, Law said, he’s never delivered a baby in the ER even though he’s trained in emergency obstetrics and has experience delivering babies as a paramedic. When a mother needs an emergency cesarean section or has another high-risk complication, she would likely be transferred to a hospital with labor and delivery capabilities, Law said.

Holden, the former obstetric nurse, said familiarity with obstetric delivery practices and procedures is essential because some complications can’t wait for a transfer. “You’re not going to save anybody’s life just because you got access to some equipment,” she said.

Adams understands the concerns and acknowledged that the ER is not the ideal location for delivering a baby. “But sometimes things happen that are outside of our control,” she said. “And when it does, we want to make sure those hospitals are prepared.”

Robin Clyatt, maternal health community outreach coordinator for , said ER doctors have vast knowledge. But they might see someone with a major maternal health complication, such as a hemorrhage, only a few times a year, and therefore may lack the skills to act immediately, she said.

“You can’t practice scared when it comes to obstetrics,” Clyatt said. “And that’s important, because when you practice scared, you do stupid things.”

Ways To Keep Access

The labor and delivery unit at the Coffee Regional Medical Center in Douglas serves six counties in southern Georgia. The number of live births there increased from to , which shows the impact when nearby facilities close, said Peterson, who practices at the Coffee Regional Hospital Women’s Center.

While he understands that hospitals must consider their bottom lines, business decisions in recent years have often taken precedence over patient care, he said.

“They just say, ‘Oh, you know, the numbers aren’t there. We’re closing,’” he said, adding that when rural labor and delivery units shutter, the chance they’ll reopen is small.

Mark Ralston, public relations manager for St. Mary’s Health Care System, which owns Sacred Heart, did not respond to multiple requests to further discuss the unit’s closure. But in its announcement, the system said the decision followed “an extensive 18-month discernment process that included intensive efforts to recruit additional physicians, create new partnerships, and pursue incremental funding sources.”

Nationwide, states are attempting to narrow gaps in maternal healthcare using federal funds. will establish maternal health hubs to determine where resources are needed and help mothers navigate the health system. in rural communities.

In its proposal for federal rural transformation money, Georgia included incentives such as funding 75 new residency slots in various specialties and creating a grant program that would reimburse physicians up to $250,000 in relocation fees if they chose to practice in rural areas.

State legislators could incentivize doctors to stay in rural areas, offer higher reimbursement rates for hospitals, and provide loan forgiveness for physicians, Peterson said. Communities should also look to incorporate certified midwives and community health workers, Holden and Clyatt said, though for both groups to practice. Currently, certified nurse midwives are allowed to practice only in partnership with a physician, which maternal health advocates argue creates a .

Holden had the ability to send her vitals to her doctor and meet with them virtually for prenatal care.

As she adorned bookshelves in baby Tucker’s cozy, sage-green nursery with vintage trinkets and family heirlooms, she said she thought of less-resourced mothers in the area, who may be on Medicaid or not have the luxury to travel an hour for a prenatal appointment.

Holden worries that without prenatal care, conditions like preeclampsia could go undiagnosed more often. “They don’t make it, and their baby doesn’t make it, because they never got that diagnosed and managed,” she said.

People like to remain optimistic that everything will go as planned, but “there are so many things that can go wrong,” she said. “And they can go wrong really quick.”

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She and her husband have not had health coverage for the past two years, Bates said, because their employment is unsteady and they earn too much to qualify for Medicaid, the public health insurance for those with disabilities or low incomes.

When the GOP-led Congress allowed enhanced Affordable Care Act subsidies — which helped lower the cost of plans sold on the marketplace — to expire at the end of last year, Bates’ mother-in-law dropped her plan, too.

Bates and her husband have a 2-year-old son. The mother-in-law also cares for a son who has autism. They all live together in a trailer home, spending about a third of their family income on prescription medications and opting for trips to the emergency room — often their main destination for medical care, since they aren’t billed up front.

It’s stressful, Bates said. Yet despite their situation, she said she remains “all in” for President Donald Trump. But she also said she’s recognizing flaws in his leadership.

“He’s trying,” Bates said. “It’s just a lot more other things have his attention.”

Georgia’s 14th District is the . It’s the district Marjorie Taylor Greene, who rose to prominence as one of Trump’s most vocal and loyal supporters, represented from 2021 to January 2026.

Greene made a notable pivot from the president last year when she publicly bashed Republicans’ handling of the enhanced ACA subsidies, which helped — along with her own adult children, she said — afford healthcare.

The following month, after Greene Trump of focusing too much on “foreign wars” and ignoring Americans’ economic struggles, the president attacked Greene and said he would no longer support her. Soon after, she announced that from Congress.

Still, many others in this semirural, exurban district, like Bates, remain loyal to Trump, even as more people go uninsured and face rising costs as a result.

Bates isn’t alone in feeling the pinch of healthcare costs this year. Nationally, 37% of Republican voters surveyed in June for said healthcare costs were “extremely important.” More than half of Republicans and Republican-leaning independents who support the Make America Great Again movement said that Congress did the wrong thing by letting the enhanced subsidies expire, according to released in March. And 62% of ACA marketplace enrollees put the most blame for the expiration on Republicans (30%) or Trump (32%).

But, as the November midterm elections approach, policy experts don’t anticipate the issue of healthcare costs will lead to a major shift in how people vote in deeply conservative areas like Georgia’s 14th District, even as policies that once benefited them are rolled back.

“They’re willing to stick with the party line,” said , a professor of political science at the University of Georgia. “As long as Donald Trump and other Republicans are saying Obamacare is bad, they’re going to continue to buy into that idea,” Bullock said, “even when it’s against their economic self-interest.”

Obamacare Still a ‘Dirty Word’

When the ACA was passed in 2010, voted for it. Now, 16 years later, Obamacare is still a “dirty word” for many conservatives, said , a professor of social medicine at the University of North Carolina-Chapel Hill.

While previously the GOP’s goal was to “repeal and replace” the ACA, the current political strategy is “effectively rolling back some of the coverage gains,” he said.

According to a dashboard from NYU Langone Health’s Department of Population Health, of people younger than 65 living in Georgia’s 14th District were uninsured in 2024, which is higher than the . And in 2023, relied on Medicaid or the Children’s Health Insurance Program, known as CHIP, according to Georgetown University’s Center for Children and Families.

Last summer, Congress passed the One Big Beautiful Bill Act, which restricted ACA enrollment periods, added monthly fees, and imposed new documentation requirements for enrollees. The Congressional Budget Office estimated that the number of uninsured people in the U.S. would increase by about 15 million people over 10 years as a result of the new law, the expiration of the ACA subsidies, and other ACA changes. With the enhanced subsidies expiring at the end of 2025, ACA enrollment fell by this year. In Georgia, enrollment dropped by .

Greene’s not a fan of the ACA. She said her family’s health insurance premiums skyrocketed after it became law in 2010. But last year she surprised those on both sides of the aisle when she openly criticized her Republican colleagues over the subsidies.

“I’m going to go against everyone on this issue,” she wrote in an , “because when the tax credits expire this year my own adult children’s insurance premiums for 2026 are going to DOUBLE, along with all the wonderful families and hard-working people in my district.”

In a June interview with ³Ô¹Ï²»´òìÈ in Cumming, Georgia, Greene described the end of the subsidies as “catastrophic.”

“All over the country, people are constantly outraged over the cost of health insurance,” she said.

Like Greene, Bates has also wavered in her support for Trump. In addition to her frustration about the ACA subsidies expiring, she said the Iran war and inflation have also hit her wallet.

“I just don’t feel like he’s doing the best he could,” she said. “He did great his first term. But this term, it’s just not OK.”

While Republicans’ policies have made it more difficult for people to qualify for Medicaid and led to the end of the subsidies that made ACA marketplace plans more affordable, a clear plan to improve the U.S. healthcare system hasn’t emerged, Greene and policy experts say.

In December, House Speaker the Lower Health Care Premiums for All Americans Act. Touted as an alternative to extending ACA subsidies, was intended to lower premiums and increase healthcare access.

But the Congressional Budget Office found the bill would people by 100,000 a year from 2027 to 2035. While the House passed the measure in December, nearly nine months later the Senate hasn’t voted on it.

“It’s a Republican-controlled House, Republican-controlled Senate, Republican-controlled White House,” Greene said. “If Republicans had a plan, this was the perfect scenario to get it passed. You should have all the votes — get it done. And they’re not doing anything.”

Sticking to the Party Line

Despite such criticisms of Republicans for lacking a healthcare plan, voters in deeply conservative areas such as Georgia’s 14th District are sticking with Trump and his allies.

In April, the district elected Trump-backed Clay Fuller to replace Greene, though he won with than she had. He’s up for election again in November for a full congressional term. The University of Georgia’s Bullock said flipping the district from red to blue is unlikely.

Fuller’s office did not respond to interview requests for this report. But in a Q&A with the ahead of his April runoff with Democrat Shawn Harris, Fuller said that the expanded ACA subsidies, introduced under the Biden administration during the covid pandemic, were not a “a long-term solution.” Lowering healthcare costs would come from increasing competition and reducing federal overreach, he said.

Harris, who’s facing off with Fuller again in November, told ³Ô¹Ï²»´òìÈ that the GOP strategy for the midterms is to continue to play off Republicans’ long-standing negative perceptions about Obamacare.

When people in the community are asked whether they support Obamacare, “they’re probably going to say no,” Harris said. But when asked about the Affordable Care Act, people tend to say, “‘Oh, yes, I need to have that,’” he said.

“They don’t realize it’s one in the same,” Harris said, adding that Republicans “sold everybody a bill of goods.”

As candidates campaign, they need to be in tune with their constituents, Greene said.

“That’s where I think they’re completely missing the mark,” she said. “They’re totally tone deaf to what Americans’ needs really are. And we need a serious solution.”

Bates considers healthcare among her top concerns. She said she doesn’t think anybody, including Trump, can make healthcare more affordable. But she hopes politicians will talk with people like her to better understand the burdens that consumers face.

“I honestly wish Congress would actually spend time in the life that we live,” she said. “They just sit behind their desks, and they don’t know what’s really going on in life, because they make so much money.”

Are you struggling to afford your health insurance? Have you decided to forgo coverage? Click here to contact ³Ô¹Ï²»´òìÈ and share your story.

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Homes that once belonged to friends, family, and neighbors had siding covered in mold. Some were boarded up. Others had holes in their roofs.

Black churches once used Oquina Creek, which runs along the border of the neighborhood, to baptize their congregants. Today, fecal bacteria and other contaminants have made the water unsafe due to an aging wastewater system.

“Sometimes you get the feeling like you’re in a Third World country,” Williams said. After three decades in Washington, D.C., he returned four years ago with a mission to revitalize communities such as Dewey City, which he said are “part of what makes Thomasville, Thomasville.”

A $19.8 million Community Change Grant from the Environmental Protection Agency was supposed to shift the tides of the neighborhood Williams grew up in.

The city and the , where Williams formerly served as community development director, applied for the grant in 2024. It was part of a $2 billion effort to help disadvantaged communities address environmental health risks and create clean energy and climate resiliency projects.

But three months after winning the grant, Thomasville became one of across the country — from to to — to see the funding stripped as priorities shifted in Donald Trump’s second presidency.

On the first day of his second term, Trump signed an executive order titled “.” It stated that the Biden administration “forced illegal and immoral discrimination” through diversity, equity, and inclusion programs.

In an emailed statement, EPA spokesperson Mike Bastasch said the administration is “fully committed to being a great steward of taxpayer dollars.” He added that the “radical agenda” of DEI and environmental justice “preferencing” are not within the agency’s core mission of protecting human health and the environment.

Environmental health advocates argue, though, that the decision to cut the grants was not rooted in science. They say that equating environmental justice to DEI is an act of bad faith and that withholding the money forces disenfranchised communities to delay long-overdue updates needed to protect public health for marginalized populations.

“I unfortunately believe we’re going to see a reversal in the health profile of this country,” said , an associate professor at the University of Michigan who served in the Biden administration as the first federal chief environmental justice officer.

“This current federal regime has decided that humanity and public health and justice don’t mean anything,” she said.

‘Why Us?’

Thomasville, near Georgia’s southwestern border, is home to just over 18,600 people.

The city had hoped to improve health outcomes in neighborhoods on its southern and western sides where, according to the grant proposal, “historical redlining created a legacy of disinvestment.”

Those areas have a deep history: Dewey City, for example, was the first neighborhood in the city where Blacks could build homes after the Civil War. It’s also home to the closed Douglass High School — the first public school for Blacks in Thomasville, established in 1902.

“This place has been neglected,” said Williams, who occasionally hosts historical walks through the community. “But it’s worth bringing it back online.”

The proposed “Restoring Resiliency” project featured a plan to remove toxic substances such as mold, lead paint, and asbestos from homes, repair a nearly 82-year-old wastewater system, and convert part of a shuttered high school band room into a health clinic.

“This was a long and storied attempt to bend the arc of justice closer,” said Jeremy Rich, a Thomas County commissioner and the pastor at First Missionary Baptist Church. “Justice in healthcare. Justice in environmental impact.”

Having a clinic in the community would be a “game changer,” Rich said. During the covid pandemic, he said, older residents who rely on public transit were reluctant to go to the nearby hospital or the county health department to get vaccinated. When his church offered shots from Black nurses, he said, vaccination rates improved.

Many residents don’t have the financial means to remove mold, lead paint, and other toxic materials, said Thomasville Mayor Pro Tem Lucinda Brown. “They just have money to live with every day. That’s it,” she said. “If they can make that happen.”

The grant meant hope, and its reversal left many asking, “Why us?” Williams said.

In the EPA’s May 2025 letter announcing the grant termination, it said Thomasville’s project promoted “initiatives that conflict with the Agency’s policy of prioritizing merit, fairness, and excellence.” The grant was “inconsistent with, and no longer effectuates, Agency priorities,” the letter said.

Environmental justice projects are rooted in science, not DEI, said Jillian Blanchard, the senior vice president of climate change and environmental justice at , a national nonprofit that provides pro bono legal assistance in focus areas such as health equity, immigration, and environmental health.

“Where is the water dirty? Where is the air unclean?” she said. “That is where the money should go.”

In June of last year, nearly two dozen communities and organizations around the country filed a to get the Community Change Grants reinstated. The lawsuit argued that the projects — such as efforts to create energy-efficient housing in Kalamazoo, Michigan, and empower Houston residents in the pollution permitting process — were vital.

The case was dismissed by a federal district judge in 2025 but is being appealed.

Thomasville was not named in that lawsuit. But the city did appeal the EPA’s decision on its project with the support of Blanchard’s group. The city and the EPA continue to dispute the issue.

This March, the EPA’s deputy inspector general, which serves as an independent watchdog for the agency, concluding that the process for determining the awardees was fair.

Such federal funding is needed because large-scale change is difficult for small municipalities to achieve without getting stuck with high-interest loans, Blanchard said.

“It’s next to impossible,” she said. “That’s one of the reasons the things haven’t been done.”

‘It’s Not Over’

The city of Thomasville has found other ways to make some improvements in the meantime. With the help of a nearly $3 million federal Community Development Block Grant from the Department of Housing and Urban Development, it made repairs to portions of Dewey City’s sewer, water, and drainage systems.

The Thomasville Community Development Corp. has begun building affordable housing in Dewey City and intends to convert a portion of the closed Douglass school into apartments for seniors.

The corporation has also applied for $764,000 in through the office of Sen. Jon Ossoff (D-Ga.) that it hopes to use to construct a community health clinic in Dewey City. Decisions on these funding requests will be made this fall.

“It’s not over,” said Williams, whose legacy in Thomasville runs deep. At the center of what locals call The Bottom — a two-block stretch of downtown where independent Black and other minority-owned businesses once thrived — is a plaque honoring his father, Earl Williams Jr., the city’s first Black mayor.

As he peered at his father’s memorial on a muggy afternoon, he reaffirmed his intentions.

“There’s more work to be done, and I’m able,” he said. “I like pouring into the community.”

But he has little hope the initial grant will be restored under the current administration.

“That was our shot. We didn’t do anything to miss it,” he said. “We just did it during the wrong period of time.”

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