President Trump just released his budget plan for the next fiscal year, which proposes some big changes in government spending. Here's a look at what agencies are helped and hurt by the proposal. (Jenny Starrs/The Washington Post)


Little by little, it is sinking in that President Trump’s agenda will hurt untold numbers of his voters, on multiple fronts. New reporting indicates that some voters in Appalachia worry that Trump will champion cuts to regional development and that some Rust Belt supporters now fear that the GOP replacement for Obamacare will deny them coverage. GOP senators such as Susan Collins (Maine) and Bill Cassidy (La.) are now suggesting that Trump-friendly demographics will be directly harmed.

Here’s another new example of this: Trump’s budget may wipe out a program that sends doctors into medically under-served rural counties throughout the Delta region, many of them in red states.

The program that Trump may eliminate is called Delta Doctors, and it is run by the Delta Regional Authority, a federal agency that sponsors infrastructure and manufacturing repairs and projects in the region around the lower Mississippi River. Trump’s budget would eliminate funding for the DRA, which theoretically means it would disappear. This latter fact has already drawn scrutiny: As The Post’s Jeff Guo reported, the elimination of the DRA’s $25 million in funding could deal a damaging setback to infrastructure and economic development in scores of counties that went overwhelmingly for Trump.

But the fact that this agency’s Delta Doctors program in particular could also be eliminated deserves more attention. That program connects foreign-born, U.S.-trained professional physicians with clinics and hospitals throughout eight states and scores of counties in the region, and in so doing seeks to fill a gaping regional health-care need created by the shortage of medical practitioners in rural areas. In exchange for the physicians’ service in filling this need, Delta Doctors recommends them for visa waivers. They are paid by the clinics and hospitals.

“The need is high here in the region,” Chris Masingill, the federal co-chair of the DRA, told me. “The health facilities in these communities have to prove that they cannot recruit an American-born physician. It’s extremely difficult to recruit physicians to the Delta region and to rural America. We need every tool in the tool chest to provide adequate health care. We are one of the primary vehicles for these physicians to be placed in rural America.”

We’re talking here about very unhealthy areas that need more adequate health care. “These are some of the highest places in the country for circulatory diseases, heart attacks, obesity — we suffer from significant chronic illnesses,” Masingill said.

The Delta Doctors program has placed more than 500 U.S.-trained, foreign-born physicians from many different parts of the world — Latin America, Asia, the Indian subcontinent — in clinics throughout the region, largely in red states such as Mississippi, Louisiana, Tennessee, Arkansas, Kentucky, Missouri and Alabama’s Black Belt, the group says. It has placed more than 80 in 2016 alone. One medical professional can go a long way.

The possibility that this program could be eliminated sits at the nexus of several subplots unfolding around the Trump presidency. The GOP health-care bill that Trump is championing would result in many millions losing coverage. But it would hit older, rural voters particularly hard, by driving up their premiums and potentially putting coverage out of reach; its phasing-out of the Medicaid expansion could also roll back coverage for a lot of Trump voters. Ending the Delta Doctors program could further complicate access to health care for many.

Meanwhile, top Trump advisers Stephen K. Bannon and Stephen Miller — the key architects of Trump’s immigration crackdown — have generally expressed skepticism about legal, high-skilled immigrant labor. But in these cases, the doctors are brought in to fill a serious need that is resulting from a confirmed inability to fill the slots with Americans.

“These physicians come in and they become part of their community for the time that they’re here,” Masingill said. “The communities constantly respond back to us about how thankful they are to have a physician.” But if Trump makes good on the elimination of the agency, Masingill said, this program will go along with it.

In a sense, the Trump budget represents a hybrid of the more conventional Paul Ryan-esque ideological zeal to downsize government and the Bannon-esque desire to “deconstruct the administrative state,” the shadowy bureaucracy that is supposedly disenfranchising U.S. workers through its allegedly unaccountable decision-making. The prospective elimination of programs such as this one illustrates what this would look like in the real world.


* COMEY MAY DEBUNK TRUMP’S CHARGES ABOUT OBAMA: The House Intelligence Committee is holding a hearing today on Russian meddling, and ranking Democrat Adam Schiff (Calif.) expects James Comey to knock down Trump’s claim that Obama wiretapped his phones:

“I hope that we can put an end to this wild goose chase, because what the president said was just patently false,” the Democrat said. “It’s continuing to grow in terms of damage, and he needs to put an end to this.” Comey privately told lawmakers last week that there is no basis whatsoever for Trump’s claim. “It was a categorical denial,” said a U.S. official familiar with the matter.​ The FBI chief is expected to say so publicly on Monday.

It should be interesting to see whether Trump sticks to the claim in the face of a Comey denial of it. Maybe he’ll denounce Comey’s testimony as Fake News?

* REPUBLICANS KNOCK DOWN TRUMP’S CLAIMS: House Intelligence Committee chair Devin Nunes (R-Calif.) said yesterday that there’s no evidence of any wiretap of Trump or any warrant for such a wiretap. And here’s GOP senator Susan Collins on “Meet the Press“:

“I don’t know the basis for President Trump’s assertion. And that’s what I wish he would explain to us on the Intelligence Committee and to the American people. And I do believe he owes us that explanation.”

Yes, I’m sure the White House will get right on offering that “explanation.”

* HOW TO READ COMEY’S TESTIMONY TODAY: Another big question is how much Comey reveals at today’s hearing about the FBI’s reported investigation into possible collusion between the Trump campaign and Russia. Legal observer Benjamin Wittes offers up an interpretive guide:

If Comey says a lot … that will very likely be a sign that Comey has relatively little to protect in terms of investigative equities in the Russia matter and is thus free to vent. Conversely, a quiet, reserved Comey — one whose contrast with the relatively loquacious FBI director who talked at length about the Clinton email matters will infuriate a lot of liberals and frustrate those who want to know what’s going on with Russia — may well spell trouble for the President.

As Wittes notes, Comey would probably relish the chance to hit back at Trump, so if he is relatively quiet, this could mean he doesn’t want to compromise an ongoing probe that is going places.

* PAUL RYAN ADMITS HEALTH BILL WILL BE CHANGED: On “Fox News Sunday,” Ryan conceded the GOP repeal-and-replace bill will have to be changed to give more financial assistance to older people:

“We’re going to have more plans being offered, more choice and competition…the secretary of HHS will help bring market freedom and regulatory relief to the health insurance markets to dramatically lower the price of plans for those 50 and 60-year-olds. But even with that, we think that we should be offering even more assistance than what the bill currently does.”

Wait, so “more choice” and “market freedom” won’t magically make coverage affordable to older people? We’ll need more government spending, too? What a shocker!

* TRUMP TO APPROVE CHANGES TO SPECIAL OPS POLICY: The New York Times has a good report noting that Trump is largely following President Barack Obama’s playbook of training local forces abroad to fight terrorists, to minimize the American footprint, as Obama sought to do. But there’s this:

Trump is expected to soon approve a Pentagon proposal to remove constraints on Special Operations airstrikes and raids in parts of Somalia to target suspected militants with the Shabab, an extremist group linked to Al Qaeda. Critics say that the change — in one of the few rejections of President Barack Obama’s guidelines for the elite forces — would bypass rules that seek to prevent civilian deaths from drone attacks and commando operations.

So I guess this is what getting a whole lot tougher on terrorism than Obama was looks like.

* TRUMP’S APPROVAL SLIDES TO NEW LOW: His approval rating has plummeted to a new low of 37 percent in Gallup tracking, even as his disapproval has climbed to a new high of 58 percent. So much winning!

* THE DOCTRINE OF ‘TRUMP INFALLIBILITY’: Paul Krugman looks at numerous examples of the White House refusing to admit it when Trump got important things wrong or outright lied about them, and concludes:

This administration operates under the doctrine of Trumpal infallibility: Nothing the president says is wrong, whether it’s his false claim that he won the popular vote or his assertion that the historically low murder rate is at a record high … what’s going on with Mr. Trump and his inner circle seems to have less to do with ideology than with fragile egos. To admit having been wrong about anything, they seem to imagine, would brand them as losers and make them look small.

Indeed. And Trump’s lies and distortions and inventions must be endlessly humored at all costs, even to the degree that they damage our democracy in the process.


This appears to be a preemptive strike at today’s Comey hearings. By the way, a recent Fox News poll found that 63 percent want a congressional probe of possible connections between Russia and the Trump campaign. Fox News = Real News, no?