Nursing the Nation

The One Big Beautiful Bill Act cuts an estimated $137 billion in federal Medicaid funding from rural America over ten years. Congress answered with a $50 billion Rural Health Transformation Program. Does it close the gap?

In Part 3 of our OBBBA series, Jamie Bourgeois (MSN, APRN, PMHNP-BC, CNM) and Melissa Anne DuBois (PhD, RN) break down how the program works, why an "equal" split leaves a Texas resident with about $66 and a Rhode Island resident with over $6,000, and why the rules limit what struggling hospitals can spend on.

We look at who gets hit hardest: pregnant people facing longer drives as birthing units close, and people with mental illness and substance use disorders facing new work requirements and a narrower exemption. We cover what supporters and critics say, where nursing organizations stand, and our nursing take on why a one-time grant can't replace coverage.

Full show notes and sources: nursingthenation.substack.com

The views and opinions expressed on Nursing the Nation are our own and do not represent those of our employers, academic institutions, or any organization we're affiliated with.

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By January 1, 2027, adults on Medicaid expansion will have to prove 80 hours a month of work, school, volunteering, or job training to keep their coverage. In Part 2 of our One Big Beautiful Bill Act series, Jamie and Melissa explain who Medicaid expansion covers, how the work requirement operates, now six-month verifications, and the reason states can't opt out. They also cover the "medically frail" exemption, which has no clear definition.

Through a hypothetical patient with well-controlled multiple sclerosis, we show how a 12-month claims lookback for proof of medical frailty can mistake stability for wellness. We then go through who opposes the rule and who supports it, and end with the nurses' take: social determinants of health, the cost of uncompensated care, and how we're all in the same storm but not the same boat.

Read more and join the conversation: nursingthenation.substack.com

The views and opinions expressed on Nursing the Nation are our own and do not represent those of our employers, academic institutions, or any organization we're affiliated with.

Episode image made with Adobe Firefly.

"It doesn't cut anyone's benefits."

That's the talking point — and it's technically true. In the launch of our latest six-part series on the One Big Beautiful Bill Act (OBBBA, now Public Law 119-21), Jamie and Melissa explain how a law that cuts no covered service is still projected to leave ten million more people uninsured, and why the savings depend on people losing coverage they're still eligible for.

We start with the basics then map the four changes that have already landed as of fall 2026: the ACA marketplace subsidy cliff and soaring premiums, sweeping SNAP changes, a health system cutting provider rates and closing rural units preemptively, and the states enforcing work requirements early. Nebraska and Montana are the canaries in the coal mine for how the Medicaid Expansion work requirement will pan out.

We make it human — four everyday people already caught in the gears of this law. We close with our nurse take on "administrative burden," the quiet act of rationing care through paperwork.

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The views and opinions expressed on Nursing the Nation are our own and do not represent those of our employers, academic institutions, or any organization we're affiliated with.

Episode image made with Adobe Firefly.

It's the first Shout Out Saturday of Season Two, and Jamie and Melissa Anne spotlight nurse practitioner and epidemiologist Dena Bushman. A CDC-trained medical epidemiologist and lieutenant commander in the U.S. Public Health Service, Bushman built her career inside federal public health—until she was rostered to deploy to an ICE detention facility in Texas, with Guantánamo Bay to follow. In January 2026, she resigned publicly and spoke out, knowing it could end her federal career for good.

Jamie and Melissa Anne unpack the moral distress at the heart of her decision: detained people genuinely need care, yet staffing these facilities helps sustain their operation and pulls scarce public health resources away from real outbreaks. With context on record-high detention numbers (roughly 71,000 people across ~225 facilities per early-2026 data), this episode is about ethics, advocacy, and the courage to name a trap out loud.

Know a nurse going above and beyond who deserves a shout out? Reach out to us on our Substack.

The views and opinions expressed on Nursing the Nation are our own and do not represent those of our employers, academic institutions, or any organization we're affiliated with.

A professional nursing organization recently drew a line between policy and politics, and said nurses belong on one side of it. We disagree, and this replay explains why.

In this episode, Jamie and Melissa Anne provide an update to the conversation that started the show: what led each of us into nursing, and why nursing knowledge belongs in the public square. Jamie makes the case that politics is a reflection of values, values are a reflection of ethics, and nurses already practice from a code that obligates them to engage in the democratic process and to speak against policy that undermines health equity.

Melissa Anne brings the view from nursing education, where she now teaches students in a direct-entry master's program. We get into the real drivers of the nursing shortage, which is not a shortage of applicants but of faculty, clinical placements, and newer nurses not making it past year three of practice. And we push back hard on resilience training as the profession's default answer to moral distress. You can prepare a nurse for grief. You cannot prepare a nurse to be prevented from practicing ethically. That requires systemic change, not a tougher workforce.

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The views and opinions expressed on Nursing the Nation are our own and do not represent those of our employers, academic institutions, or any organization we're affiliated with.

We're taking a short hiatus — and using it to bring back the episode where we talk about how it all started.

We've had a lot happen since we launched Nursing the Nation. Melissa Anne defended her dissertation in August and started a full-time assistant professor position a week later. Jamie has entered the dissertation phase — plus several academic writing projects, clinical presentation preparation, and a full house renovation currently in demolition. Something had to give, so the show is taking a brief pause.

We also preview what's coming: a multi-episode series on the Medicare, Medicaid, and ACA marketplace changes under the One Big Beautiful Bill Act; an episode on midwifery and doula care; and the mental health policy fights they're tracking, including the ongoing litigation over roughly $1 billion in school-based mental health grants and the still-unrestored "Press 3" service on the 988 Suicide and Crisis Lifeline, which Congress funded at $33.1 million for fiscal year 2026.

Plus: two stories from the bedside that neither Jamie nor Melissa Anne will ever forget.

Make sure to follow us on our Substack. If you have a topic idea or a nurse who deserves a shout-out, email [email protected].

On July 15, 2026, Secretary of Defense Pete Hegseth announced — in a video captioned "The High-T Department of War" — that all active-duty service members thirty and older will be screened annually for testosterone deficiency, with testosterone replacement therapy offered to those who screen low. The stated goal: keeping troops at the "leading edge of lethality."

This week, Melissa Anne and Jamie cover what Total Force Fitness actually is and why a genuinely good, whole-person, family-inclusive readiness framework is being reduced to a single serum draw. We dig into the Operator Syndrome research Hegseth incorrectly attributes as evidence: a six-year study of about fifty highly symptomatic special operations members that never examined treatment at all. We walk through the Endocrine Society's response, why a testosterone level is not a diagnosis, why the same blood sample can read low at one lab and normal at another, and what a real hypogonadism workup requires.

Update: the Pentagon's new testosterone screening program for troops 30+ was published September 2nd and rescinded within a day. Stick around for the update at the end of the episode.

Head over to our Substack to join the conversation.

The views and opinions expressed on Nursing the Nation are our own and do not represent those of our employers, academic institutions, or any organization we're affiliated with.

Episode image made with CanvaAI.

Dolly Parton has died at 80, and the tributes have poured in from every corner of American life — country music, film, business, Appalachia. We wanted to write a different kind of tribute. As nurse scientists, Jamie and Melissa Anne dig into not just what made Dolly's philanthropy extraordinary, but why it worked.

From the 1988 Dollywood Foundation's Buddy Program (which cut participating-class dropout rates from 35% to 6%) to the Imagination Library's monthly books for children from birth to age five, to the Dolly Parton Birthing Unit that helped close a maternity care desert in rural Appalachia, to the $1 million that seeded the research behind the Moderna COVID-19 vaccine — we walk through the return on investment and the evidence base behind each one.

Dolly said she had no strategy and just gave from the heart. The research suggests she was doing upstream public health the whole time.

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The views and opinions expressed on Nursing the Nation are our own and do not represent those of our employers, academic institutions, or any organization we're affiliated with.

Cyclospora. Salmonella. Listeria. E. coli. It has felt like a relentless summer of foodborne illness headlines. So Jamie and Melissa Anne went looking for the actual data.

In this episode, we trace how an outbreak is actually discovered. We break down which federal agency picks up which food (USDA for meat, FDA for produce and packaged goods), and we hit the fact that shocked us: nearly all food recalls in this country are voluntary. USDA cannot order contaminated meat off the shelf. It can only ask.

We also examine what's happened to the response infrastructure. You won't be surprised by the reasons why.

Head over to our Substack to join the conversation.

The views and opinions expressed on Nursing the Nation are our own and do not represent those of our employers, academic institutions, or any organization we're affiliated with.

Episode image made with CanvaAI.

This week, Dr. Victoria Soltis-Jarrett returns to Nursing the Nation to explain integrated behavioral health care — what it actually is, what it isn't, and why "we'll refer you two doors down" doesn't count. Dr. Soltis-Jarrett is the Carol Morde Ross Distinguished Professor of Psychiatric Mental Health Nursing at the University of North Carolina at Chapel Hill and a newly inducted inaugural Fellow of the International Society of Psychiatric-Mental Health Nurses, with thirty-five years of clinical practice, education, and scholarship behind her.

Dr. Soltis-Jarrett walks us through TANDEM3-PC- the rural primary care integration model she built from the ground up after the off-the-shelf models didn't fit- and the Carolina Behavioral Health Integration Scholar traineeship, which has now educated more than two hundred nurse practitioners.

Head over to our Substack to join the conversation.

The views and opinions expressed on Nursing the Nation are our own and do not represent those of our employers, academic institutions, or any organization we're affiliated with.