Pemiscot County, Missouri, lost its Walmart. Now it may lose its only hospital.

This deeply conservative corner of rural America is getting a front-row education in what it means when Republicans say they want to “run government like a business.”

Businesses exist to make money. And they don’t waste their time in poverty-stricken Pemiscot County, home to less than 16,000 residents who have a median household income that barely clears $40,000. It’s Missouri’s poorest county. Why would any profit-driven, efficiency-minded system waste a dime here?

The Guardian paints a grim picture: “Three stories of brown brick just off Interstate 55 in the town of Hayti, the 115-bed hospital has kept its doors open even after the county’s only Walmart closed, the ranks of boarded-up gas stations along the freeway exit grew, and the population of the surrounding towns dwindled, thanks in no small part to the destruction done by tornadoes.”

This is one of those rural counties I’ve written about: dependent on the federal government they hate.

Now, thanks to President Donald Trump and his Medicaid-gutting budget law, Pemiscot Memorial Hospital is hanging by a thread.

“If Medicaid drops, are we going to be even collecting what we’re collecting now?” Jonna Green, the chair of the hospital’s board, asked the Guardian. With roughly 80 percent of the hospital’s revenue coming from Medicaid and Medicare, any cuts to a hospital already on the edge of insolvency is a death sentence. “We need some hope,” she added.

She doesn’t need hope. She and her neighbors need to stop voting for Republicans.

Trump won 74 percent of the vote in the county last year. Rep. Jason Smith, their Republican congressman, did even better, winning with 76 percent of the vote. And Smith was thrilled to support the law that could shutter this hospital, saying in a statement, “The One, Big, Beautiful Bill is nothing short of the greatest piece of working-class tax relief in a generation. President Trump didn’t just sign a bill into law—he unleashed America’s Golden Age.”

Sure. If “Golden Age” means no hospital.

Republican Sen. Josh Hawley won 73 percent of the county. He had warned that Trump’s tax bill would devastate rural hospitals—and then he voted for it anyway.

However, just days after that vote, he tried to reverse course, introducing a bill to “protect” the same rural-hospital funding he had just voted to gut.

“I’m completely opposed to cutting rural hospitals period,” Hawley told NBC News. “I haven’t changed my view on that one iota.”

Except … he already had.

Last week at an Axios forum, Hawley doubled down, warning against “experiment[ing]” with the “vitally important” federal funding that keeps rural hospitals afloat.

But when it mattered—when it came time to vote on a major bill—he chose instead to cut rich people’s taxes. He had a choice between Missouri hospitals and billionaire handouts, and he picked the billionaires.

And here’s the kicker: that “vitally important” funding he says he wants to protect? It doesn’t even come from Missouri. Missouri is a moocher state, propped up by federal dollars primarily from blue states like California, Illinois, and New York. Hawley’s constituents hate the federal government, but they sure love its money.

As for Pemiscot County, they wanted a smaller government to cut waste, fraud, and abuse. In fact, many voices quoted in that Guardian story insisted what Republicans did was okay because they knew that one guy. Not even kidding—check out this passage:

“We got a guy around here, I guess he’s still around. He’s legally blind but he goes deer hunting every year,” Baughn Merideth, a county commissioner, told The Guardian. “There’s just so much fraud … it sounds like we’re right in the middle of it.”

So this one “guy” in Pemiscot County—if he’s “still around”—is so full of fraud that it’s acceptable for the county to lose its only hospital. (Also, “legally blind” doesn’t mean can’t-see-anything blind. In fact, Iowa’s Department for the Blind says that only about 18% of legally blind people are totally blind.)

Trump supporters will bend themselves into knots to avoid blaming those enabling the crises they face.

Whatever fraud may exist in Pemiscot County, it pales in comparison to the waste of maintaining a critical medical facility in a county where the population has plunged from nearly 47,000 in the 1940s to under 16,000 today. When the hospital closes, more people will leave. The area’s death spiral will accelerate.

“This is our home, born and raised, and you would never want to leave it. But I have a nine-year-old with cardiac problems. I would not feel safe living here without a hospital that I could take her to know if something happened,” Brittany Osborne, Pemiscot Memorial’s interim CEO, told The Guardian.

Meanwhile, Green—the hospital board chair worried about cuts—follows a Facebook group that recently posted a meme of Trump with the caption “Isn’t it great having a real president again?”

She says she needs “some hope”?

Hard to think of a worse place to go looking for it.

Markos Moulitsas is founder and editor of the blogging website Daily Kos and author of three books.