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Rural hospitals in the U.S. already operate on a razors edge, but new cuts to Medicaid in the Republican appropriations bill could tip many of them into failure. The Republican megabill that the House just passed in a 218-214 vote is a massive piece of kitchen sink legislation, extending Trumps tax cuts and allocating hundreds of billions for immigration enforcement, among the presidents priorities. To pay for all of that spending, the bill will slash programs that make up the federal safety net by the largest amount in decades, mostly through major cuts to Medicaid. Medicaid is the joint federal and state health insurance program that millions of low-income Americans rely on for healthcare coverage. As of March of this year, 71 million people in the U.S. were enrolled in Medicaid, which also extends coverage for pregnant people, elderly adults, and Americans with disabilities. An estimate from the Congressional Budget Office expects about 12 million people will lose their Medicaid coverage under the legislation. Among its major changes, the bill would cut $1 trillion in funding from Medicaid over the next decade and add new eligibility restrictions that require able-bodied adults up to age 65 to work 80 hours per month to qualify. Older Americans between ages 50 and 64 could be hit hardest by the new work requirements, according to analysis from the UC Berkeley Labor Center. That set of aging adults is too young to be eligible for Medicare but face the challenge of juggling work with chronic illness and disability, two factors that contribute to plunging employment numbers after age 50. Rural hospitals hit hardest Beyond shrinking the number of Americans covered by Medicaid, the bill would also place a cap and a gradual set of reductions on the taxes that states charge healthcare providers to pay for their share of Medicaid. Those taxes are a big piece of what makes the system work, and any changes risk destabilizing an already fragile healthcare system. Limits to state reimbursements are anticipated to further imperil hospital and clinic funding, particularly in rural areas where a larger share of the population relies on Medicaid. In those areas, an increased number of people without healthcare coverage and preventive care also means more patients showing up in emergency rooms. In Nebraska, nearly half of our rural hospitals are currently operating in the red, Nebraska Hospital Association president Jeremy Nordquist said. This change would pull the rug out from under them, leading to a loss of critical patient services and putting the health of our communities at risk. On Tuesday, Senate Republicans added more funding for rural hospitals to compensate for funding losses after a push from Maine Sen. Susan Collins, whose state stands to be slammed by the cuts due to a large rural population that relies on Medicaid. An earlier version of the bill allocated $25 billion to rural hospitals over five years, a number that was doubled to $50 billion in the final version. Whether the $50 billion fund will be enough to offset a rural healthcare crisis is about to become a live social experiment with steep stakes. At least one hospital that’s closing its doors in the state is already blaming Trumps signature legislation. Nebraskas Community Hospital just announced the closure of a clinic in the rural southwest Nebraska town of Curtis, which serves 900 people locally. Unfortunately, the current financial environment, driven by anticipated federal budget cuts to Medicaid, has made it impossible for us to continue operating all of our services, many of which have faced significant financial challenges for years, Community Hospital CEO Troy Bruntz said. Over a million could lose coverage According to the National Rural Health Association, the bill is expected to reduce Medicaid funding for rural hospitals by 21% while leaving more than a million rural residents without coverage. While the Senate Finance committee proposal has made some cuts deeper than the House-passed bill, both are certain to lead to more hospital closures and reduced access to care for rural residents, exacerbating economic hardship in communities where hospitals are major employers, the association wrote in a report exploring the rural impacts of the bill. An analysis by the Urban Institute and the Robert Wood Johnson Foundation found that hospitals would be down $321 billion over the next decade if changes in the less severe House version of the bill went into effect. On top of that, hospitals could be hit with $63 billion in additional costs from handling a larger base of uninsured patients, including those seeking emergency services. The cuts to Medicaid are controversial, even among some of the lawmakers that ultimately supported the bill, which the Senate approved on Tuesday. Do I like this bill? No, said Alaska Sen. Lisa Murkowski, who cast a decisive vote for the legislation after securing special carve-outs for her state. I know that in many parts of the country, there are Americans that are not going to be advantaged by this bill. House Minority Leader Hakeem Jeffries attempted to push back Republicans self-imposed July 4 deadline by filibustering the massive legislative package, speaking on the House floor for eight hours and 44 minutes. With Jeffries record-setting critique wrapped up, Democrats could no longer delay the inevitable vote on Trumps so-called One Big Beautiful Bill, which passed the House on Thursday afternoon.
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An interstellar object called 3I/ATLAS is passing through our solar system this year, NASA announced yesterday. Today at 6 p.m. ET, you can see it for yourself, thanks to a livestream from the Virtual Telescope Project. 3I/ATLAS is the third interstellar object ever detected within our solar system, following Oumuamua in 2017 and 2I/Borisov in 2019. These objects moved quickly through our solar system, giving astronomers limited time to study themjust two weeks in Oumuamuas case. However, scientists currently expect 3I/ATLAS to continue getting brighter and more visible until September 2025, giving astronomers and interested nonscientists more chances to see it themselves. This is a tremendous step forward and a tremendous opportunity, says Teddy Kareta, a postdoctoral researcher at Lowell Observatory in Arizona and press officer at the American Astronomical Societys division for planetary science, tells Fast Company. And if the public is excited about it, the astronomers are twice as excited. It’s a really big deal. ‘The building blocks of planets’ The object was discovered by the Asteroid Terrestrial-impact Last Alert System (ATLAS). One of the observatories affiliated with this NASA-funded system, El Sauce Observatory in Chile, first spotted it in photos taken July 1. So far, astronomers think its a comet, an icy body that appears to have a tail due to gas and dust trailing behind it. Comet movements are largely predictable, and NASA is confident the object is merely passing by us. The comet poses no threat to Earth and will remain at a distance of at least 1.6 astronomical units (about 150 million miles or 240 million kilometers), NASA wrote in a statement about the objects discovery. Scientists study interstellar objects the same way they study the comets and asteroids that form closer to home, asking what the objects are made of and how they formed. But for interstellar objects, the answers to these questions yield answers about what the universe is like outside our solar system, ultimately giving us a better idea of whether our solar system is rare in some way and if intelligent life on Earth is alone in the universe. These [interstellar objects] are the building blocks of planets from other planetary systems, Kareta says. That lets us ask really fundamental questions about why our solar system looks the way it does. How and when to see the object as it zips by Beyond the philosophical questions this object lets us ask, it is also an opportunity to see something truly out of this world. The Virtual Telescope Projects livestream will show imagery from telescopes in Italy starting at 6 p.m. ET today (Thursday, July 3). You can watch from the VTP’s website or on YouTube. And even if you miss the livestream, it wont be your last chance to see the object. Scientists predict even amateur astronomers might be able to see the object with their telescopes as the object gets closer to the sun and brighter. It might require you getting up early or staying up late, Kareta says. But youre seeing light reflected off of something that formed around another star . . . What a wild experience. Because these objects are so rarely detected and such a recent area of study, astronomers from different disciplinessuch as those who study exoplanets and those who study comets or asteroidscome together to study them. Thats where the best and most interesting science gets done and when you can push the envelope in a way that doesnt just matter to me and my research group, but to tons of people across the world, Kareta says.
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The $297 collectors edition of Grace Given has shimmering gilded edges, a simulated white antique leather cover, lush full-color illustrations on heavy coated stock, and a flocked slipcase with extensive gold-foil detailing. Such elaborate, ornate bookmaking is the purview of a handful of passionate and obsessive publishersmost notably among them The Folio Society. But whereas The Folio Society is known for its luxe editions of classic and contemporary works, Grace Given is, against all odds, about a video game. Of course, its not just about any video game: its about the mythology of Elden Ring, FromSoftwares 2022 Game of the Year winner. The game just crossed the $30 million mark in sales, putting it in the company of Call of Duty titles, Super Mario Odyssey, and Diablo III. [Photo: Tune & Fairweather] Video game books tend to be flimsy, mass-produced affairs. But publisher Jason Killingsworth believes in the staying power of FromSoftwares cult-fave games, which launched the Soulsborne genre with titles like Demons Souls, Bloodborne and the Dark Souls series. So the Dublin-based creative launched a publishing company, Tune & Fairweather, that celebrates their rich worldsand the obsessive fan bases they command. Five years in, he says the enterprise has crossed the 10 million ($11.7 million USD) mark, and made around 3.5 million ($4.1 million USD) last year alone. In the process, Tune & Fairweathers books are perhaps doing something else via their elaborate form factors: elevating the art form of video games at large. And the runaway success of Elden Ring gave them an opportunity to take it all to an unprecedented level, creating perhaps the most opulent video game book ever made. You’re hoping for that project thats just going to let you throw everything you’ve ever learned [at something], use every tool in the toolbeltand Grace Given just seemed like the perfect project to take that kitchen-sink approach, Killingsworth says. [Photo: Tune & Fairweather] LEVELING UP Killingsworth was born in Ireland to Christian missionaries, but found himself drawn to the demons of scripture over the angels; he just saw them as more textured and interesting. He also loved role-playing video games, so after working as an editor at Paste in its heyday (where he launched its video game coverage), he got a gig at the U.K.-based game magazine Edge, where he discovered Demons Souls. He was entranced by FromSoftwares strange immersive worlds where every detail felt considered and intentional, and went further down the rabbit holeeventually writing a book about Dark Souls in 2016 with video game journalist Keza MacDonald, dubbed You Died. Named after the screen that pops up in the notoriously difficult Soulsborne titles when you, well, die (a lot), the book explored the game from a variety of angles, from its creation to the psychology behind its popularity to its fandom (which includes director Alex Garland). The thing was, the book was released by a small publisher, and I had been cajoling and sort of begging them to do this really exalted fetish object of a book that I knew that Souls fans would revel inand it just wasn’t what they wanted to make, Killingsworth says. So they released the book at a low price (and the production specs to match), and that was that. Until it wasnt, when Killingsworth bought the hardcover rights to the project. There was this unfinished quest line with You Died, where there was an ideal version of that book in my mind that hadn’t been created, and it was still sitting in there like a little splinter, he says. He formally launched Tune & Fairweather in 2019 when he announced a Kickstarter campaign for an updated, expanded, and, most importantly, richly produced volume, from the art to the paper stock and the hardcover bindings (one tier even involved an etched pine coffin box for the book at $347). [Photo: Tune & Fairweather] Because of their high level of difficulty, FromSoftware games can be a punishing experience for casual gamers who are not expecting to die dozens upon dozens of times before learning the right moves to conquer a given foe. As such, they are polarizingand they yield either enraged naysayers, or rabid obsessives. Would the latter be willing to support the ultimate book tie-in, not to mention the price it would command? I had a really strong, strong hunch, Killingsworth says. Gaming is, after all, a largely intangible experienceand when you have a physical object that deepens that experience, not unlike music fandom and a vinyl record box set, you might have exactly what a devoted fan would want. And Killingsworth would know. Its what he wanted. I just knew that video game fans were some of the most collector-minded audiences on the planet, he says. Moreover, with Kickstarter, there really was no risk in probing the concept (save embarrassment, he notes with a laugh). It went on to provide compelling proof of concept when it made 126,346 on a 50,000 goal. But the true watrshed moment came when Tune & Fairweather Kickstarted Soul Arts in 2021, a book featuring a range of work from YouTuber Michael VaatiVidya Samuels Soulsborne fan art competitions. It was funded in one hour, and made $2.15 million on a $58,880 goal. At the time, Killingsworth had been laid off from Riot Games, where he had been working, and was coasting on (the last of) his severance. The Kickstarter came at a critical moment: It really was those first minutes of the Soul Arts campaign where I had the realization that I was going to be able to do Tune & Fairweather full-time, he says. (Curious about the IP legalities of all this? Killingsworth notes that FromSoftware doesnt interfere, and similar to fans who make YouTube videos about the companys games, Tune & Fairweather is essentially doing the same thing in print, providing original analysis and art.) [Photo: Tune & Fairweather] A DESIGN FREE-FOR-ALL The publisher has since scaled up to making three to four books a year, and moved from Kickstarter to an internal sales system. Its worth noting that not all of its output is Soulsborne books. While those remain Tune & Fairweathers bread and butter, they allow Killingsworth the space to explore other projects, like this years typographic/visual novel Process. Its most ambitious book so far is Grace Given: The Mythology of Elden Ring. When it came to the production, Killingsworth drew inspiration from a few critical placesnotably Italy, where all of Tune & Fairweathers books are printed. When he ventures over for each production run, he tacks on a few days for explorationand that can be immediately seen on the cover, which was designed by Elliott Wells (whose double gatefold also dominates the middle of the book). The debossed demigod faces that frame the cover echo, say, the carvings in the Golden Staircase of the Doge’s Palace in Venice. The weathered marble throughout Italy finds its way into the faux antique white leather, and the gilded edges are synonymous with so much ornamentation in the country. Another key influence is the Chester Beatty Library in Dublin, and its permanent Arts of the Book exhibit featuring elaborate tomes of the ancient world, where Killingsworth often finds inspiration, as in the case of the overall color palette or the fabric spine labels that made their way to Grace Given. Ultimately, We used almost every design technique that you could think of, Killingsworth says. It was just an absolute free-for-all. It was so fun and so indulgent. The book showcases more than 20 illustrations by the popular artist Shimhaq and more than 100 spot illustrations by MenasLGboth regarded for their takes on the genre. The core text detailing Elden Rings mythology, meanwhile, comes from Geoff SmoughTown Truscott, who maintains a popular YouTube channel where he explores game lore. [Photo: Tune & Fairweather] Tune & Fairweather printed 5,000 copies of the collectors edition, which have been shipping, and Killingsworth says theyre nearly sold out. While the collectors edition is limited to just one run, a $144 deluxe edition with downgraded (but still impressive) specs is on its way in the coming months, as is a $42 softcover. Like the games that Killingsworth documents, the high-tier pricing can polarizeand he has weathered his share of commenters online who arent thrilled about it. It’s just such an expensive enterprise. Never mind the price of the materials and the production costs, which themselves are eye-watering, he says. I just made a conscious decision that even if there was some blowback, I felt like I had built up enough trust with our audience where I could say, ‘Trust me. I will make this worth your while.’ And hey, when it comes to that price tag, if theres one group thats used to really grinding for what they want, its a Souls fan.
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