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But after the number changes to 988 — a shift that involves upgrading telecom infrastructure and bringing more call centers online — use of the hotline is expected to grow exponentially over the next few years. (The current number is 800-273-8255.)

The only call center in South Carolina, for instance, until recently operated out of an old, dark basement, near a boiler room. The last remaining one in Louisiana has struggled to keep up with an influx of calls after another center closed and its replacement went offline during the pandemic. Minnesota and Wyoming have had periods with no centers at all. When local centers cannot pick up, calls are pushed to national backup centers, where counselors are less likely to be familiar with local resources and wait times can be too long for people in crisis.

As a teenager, she made dozens of late-night calls to the Lifeline. A volunteer named Chris, who worked the late shift, usually would pick up and talk her to safety. But during the last several years, she has found it increasingly difficult to reach a counselor. Several times, she said, she hung up and harmed herself.

A woman from Michigan, who said she waited twice for over an hour before hanging up, likened the experiences to calling airline customer service — except that she was seeking suggestions on “not killing myself.” A teenager from Mississippi recounted calling three times one night without getting through, and then overdosing.

For 988, such fees could also help pay for mobile response teams that can be dispatched to people in crisis, as well as for specialized triage centers — both significant, and costly, elements of what advocates see as a watershed opportunity to recast the delivery of mental health care.

“Our concern is very much about whether there will be someone to answer that call when someone is in crisis,” said Hannah Wesolowski, chief advocacy officer for the National Alliance on Mental Illness.

“There are thousands of users — many of whom may be in suicidal crisis — who seek assistance and are unable to get the lifesaving help they deserve,” the report said.

Paying for 988, and what comes with it, has emerged as a contentious issue for states. Some lawmakers are wary of adding what they see as a new tax. Others think 988 is redundant with other resources. And telecommunications lobbyists, while broadly supportive of 988, have pushed back on some proposed fees.

“It is just like the United States Congress, though, to send us something like this” — with instructions that “you are going to fund it,” he said.

“With all due respect, 988 is going to save the taxpayers a whole lot of money,” he said.

“The crisis centers are like, ‘You don’t get any of those other things if people aren’t here to answer the phone,’” said Ms. Battle, director of access at the Harris Center, which provides services for mental health issues and developmental disabilities.

One goal of 988 is to eventually answer 95 percent of all incoming calls within 20 seconds. The data analysis showed that only two states had Lifeline answer rates above 95 percent in the fourth quarter of last year. Thirty-three states had more than 15 percent of their calls abandoned.

“People call in their most dire state of need.”

West Virginia’s lone call center answering the Lifeline, First Choice Services, also answers more than 15 other numbers, including ones for gambling, tobacco and drug and alcohol addiction, most with volume rising during the pandemic.

“We have a very real fear that without funding our program in a substantial way,” she said, “our West Virginia callers will suddenly be facing what has been a problem nationally.”

As Kiev attempted to further consolidate its control domestically, Moscow delivered yet another blow to the fledgling government on Tuesday as Gazprom, the Russian state gas giant, said it would raise the price of natural gas sold in Ukraine by more than 40 percent.

Alexei Miller, the head of Gazprom, said that Russia would revoke a discount on gas prices granted as part of a financial lifeline granted to Mr. Yanukovych in December, raising the price to $385.50 per thousand cubic meters from $268.50 per thousand cubic meters.

What is clear is that, despite years of Western involvement and billions of dollars in humanitarian aid to Afghanistan, children’s health is not only still a problem, but also worsening, and the doctors bearing the brunt of the crisis are worried.

Nearly every potential lifeline is strained or broken here. Efforts to educate people about nutrition and health care are often stymied by conservative traditions that cloister women away from anyone outside the family. Agriculture and traditional local sources of social support have been disrupted by war and the widespread flight of refugees to the cities. And therapeutic feeding programs, complex operations even in countries with strong health care systems, have been compromised as the flow of aid and transportation have been derailed by political tensions or violence.

Perhaps nowhere is the situation so obviously serious as in the malnutrition ward at Bost Hospital, which is admitting 200 children a month for severe, acute malnutrition — four times more than it did in January 2012, according to officials with Doctors Without Borders, known in French as Médecins Sans Frontières, which supports the Afghan-run hospital with financing and supplementary staff.

One patient, a 2-year-old named Ahmed Wali, is suffering from the protein deficiency condition kwashiorkor, with orange hair, a distended belly and swollen feet. An 8-month-old boy named Samiullah is suffering from marasmus, another form of advanced malnutrition in which the child’s face looks like that of a wrinkled old man because the skin hangs so loosely.

Médecins Sans Frontières helped Bost Hospital nearly double the number of beds in the pediatric wing at the end of last year, and there are still not enough — 40 to 50 children are usually being treated each day, mostly two to a bed because they are so small. Nearly 300 other children, less severely malnourished, are in an outpatient therapeutic feeding program.

“It’s quite an unusual situation, and it’s difficult to understand what’s going on,” said Wiet Vandormael, an M.S.F. official who has helped coordinate with Bost Hospital.

: “If the United States doesn’t stand for freedom, then who does? What were all those lives lost for?”

“Obama hasn’t talked about stopping the repression,” he said. “Not only that, but the prisoner swap tells any terrorist group around the world that they can capture an American and that he can be exchanged for any terrorist they want.” Next in U.S.

The need to bolster the Affordable Care Act will become even more urgent, the coalition says, if Texas and other states succeed in their lawsuit to invalidate the entire law.

Yet another Democratic proposal, allowing states to create a Medicaid buy-in program for all their residents, regardless of income, has won support from 23 senators, including Mr. Booker, Mr. Brown, Ms. Gillibrand, Ms. Harris, Ms. Klobuchar and Ms. Warren.

And “during the whole debate over the Affordable Care Act, we supported having a public option in the individual insurance market in every state,” said Robert B. Doherty, senior vice president of the college, which represents 154,000 doctors who specialize in internal medicine.

That’s the question behind the two main criticisms of “Girl.” One is that neither Dhont nor his co-writer, Angelo Tissens, nor the young actor who plays Lara, Victor Polster, are transgender

The other objection, the one that has prompted foes to label the film “traumatizing” and “sickening,” involves scenes near the end.

The outrage has played out ferociously online. The film critic Oliver Whitney wrote in The Hollywood Reporter that “Girl” is the “most dangerous movie about a trans character in years.” Whitney, who identifies as trans masculine, told me that seeing a trans girl mutilating herself suggests “it’s part of her survival, and that’s harmful.” He said he was most upset that the film “sends a damaging message to all audiences, but especially to trans folks suffering from dysphoria who may not have access to medical care or information about medical transitions.”

Three trans women who saw the film at a screening in Los Angeles said it was the film’s dark territory that made it compelling. Crystal Stull told me “Girl” was “the closest that cis people in society will ever get to understanding just how bad dysphoria can really get.

Ann Thomas, the founder of Transgender Talent, a talent listing service for trans people, chastised the campaign against it.“The message these arrogant trans activists are saying is that Nora doesn’t have the right to tell her story,” said Thomas, who also defended “Girl” in an opinion piece for The Advocate.

“We’re worried about harm reduction,” said Elena Rose Vera, the deputy executive director of Trans Lifeline, who has not seen the movie. “We just want to protect our community.”

Monsecour told me she hoped the trans community knew that “Girl” was a beginning, not an end.“I have a platform to speak with ‘Girl,’” she said. “Without ‘Girl,’ I wouldn’t have that. There’s a lot of work to do, but I’m confident that more trans people will tell their stories.”

Employees who are selected to make the switch can make $19 per hour, a $2 raise on top of the pay hike Amazon announced earlier this month.

“As we continue to see a significant increase in demand for grocery orders, we are offering temporary opportunities for associates across our fulfillment network to provide additional support,” an Amazon spokesperson said on late Friday, confirming the action.

Amazon has been doubling down on the grocery industry since its $13.7 billion acquisition of Whole Foods in 2017.

Since the outbreak, grocery delivery has become a lifeline for people to get household staples while trying to avoid stepping outside.

So far, coronavirus has spread to at least 17 Amazon warehouses in the U.S., prompting workers and lawmakers to question if enough safety measures have been taken to protect employees on the frontlines.

Grocery stores are competing for workers to fulfill online orders. Walmart, with a fast growing online grocery business, plans to hire 150,000 employees at stores, distribution and fulfillment centers through May.

He knows that he is privileged by virtue of his gender and his skin color, but in his heart he is sick of being reminded about it. Like lots of other white men in America, he is grappling with a growing sense that the term white man has become an epithet

The bedrock issue, though, is Rogan’s courting of a middle-bro audience that the cultural elite hold in particular contempt—guys who get barbed-wire tattoos and fill their fridge with Monster energy drinks and preordered their tickets to see Hobbs & Shaw. Joe loves these guys

Why is he connecting so deeply with so many men, for such long stretches of time, at a moment when no one else can seem to hold anyone’s attention for more than two minutes?

the irony is that so many of the men who demonstrate a level of intelligence and empathy worth aspiring to—they’ve pretty much all been on Joe Rogan’s podcast

The hard truth for some of Rogan’s critics in the media is that he is much better at captivating audiences than most of us, because he has the patience and the generosity to let his interviews be an experience rather than an inquisition.

how many mainstream entertainers routinely expose their audiences to Harvard biologists? Or climate-change experts? (The Uninhabitable Earth author David Wallace-Wells, episode No. 1259.) Or biosocial scientists? (The Yale professor Nicholas Christakis, episode No. 1274.) Or ethical-leadership lecturers? (The NYU Stern business-school professor Jonathan Haidt, episode No. 1221.)

“Learn, learn, learn, ladies and gentlemen,” Joe said at the start of one podcast episode this winter, wrapping up an ad read for the online education platform Skillshare. “That’s what I’m getting out of this. I think it’s very important to continue to challenge your mind.”

He’s right! It is! And don’t we want men thirsting for knowledge? Don’t we want them striving, setting goals, learning, learning, learning? Don’t we want more Joes?

Plenty of the role models that men choose for themselves draw eye rolls from everyone else, or dire warnings, or #cancel tweets

if we’re all going to make it through this era alive, men do need alternatives to look up to

There’s a tendency right now to make every single thing about Donald Trump, but if you don’t see the dotted line connecting the president to a wave of men who feel thwarted and besieged and sentenced to an endless apology tour, then you’re not paying attention.

Free speech and its consequences, particularly the deplatforming of right-wing political provocateurs, is a push-button subject for Rogan, and it’s where he gets himself into the most trouble.

the same core stimulus: a plunging sense of self-worth caused by a rapidly changing society.

that’s not why people are obsessed with him. In reality, it’s because Joe Rogan is a tireless optimist, a grab-life-by-the-throat-and-bite-out-its-esophagus kind of guy, and many, many men respond to that.

The competitive energy, the drive to succeed, the search for purpose, for self-respect. Get better every day. Master your domain. Total human optimization

It’s a tough message for a very rich guy like Joe Rogan to sell, but he pulls it off because he has never stopped coming across as stubbornly normal. He’s from a middle-class Boston suburb, he’s bald, and for God’s sake, his name is Joe.

Rogan seems like a regular Joe, but he’s not. He is driven, inexhaustible, and an honest-to-goodness autodidact.

His brain is wicked absorbent, like Neo in The Matrix, uploading knowledge through a hot spear jammed into the back of his skull. He’s a freak of nature, and most of his fans cannot, in fact, be just like him.

a key thing Joe and his fans tend to have in common is a deficit of empathy. He seems unable to process how his tolerance for monsters like Alex Jones plays a role in the wounding of people who don’t deserve it.

At the very least, he shows too much compassion for bad actors, and not enough for people on the receiving end of their attacks.

In order to get at the truth of Joe’s beliefs, you have to ignore what he says and watch what he does. Rogan likes to say that he’s voted for a Democrat in every presidential election—aside from a brief ill-advised fling with Gary Johnson—and that he despises Trump.

More revealing is who he invites onto his podcast, and what subjects he chooses to feast on in his stand-up specials. And if you cast a wide enough net, clear patterns emerge. If there’s a woman or a person of color (or both) on Joe’s podcast, the odds are high that person is a fighter or an entertainer, and not a public intellectual.

if you look past the jokes themselves and focus on the targets he’s choosing, the same patterns emerge. Hillary, the #MeToo movement, why it sucks that he can’t call things “gay,” vegan bullies,

All the same, because of their core DNA and their comfort with getting booed, comedians still tend to be at the forefront of so many of these debates over language and identity, touching those electrical wires in ways other people wouldn’t dare. Joe touches them all the time

like lots of other men in America, not just the white ones, he’s reckoning out loud with a fear that the word masculinity has become, by definition, toxic

Joe likes Jack. He likes Milo Yiannopoulos. He likes Alex Jones. He wants you to know that he doesn’t agree with much of what they say, but he also wants you to know that off camera they’re the nicest guys. If we all have fatal flaws, this is Joe’s: his insistence on seeing value in people even when he shouldn’t, even when they’ve forfeited any right to it, even when the harm outweighs the good.

It comes from a generous place, but it amounts to careless cruelty. He just won’t write people off, and then he compounds the sin by throwing them a lifeline at the moment when they least deserve it.

His invitation to Jones was indefensible, and his defense was even worse. I had assumed going in that Rogan would explain himself at the top, similar to what he’d done after booting the Jack Dorsey interview. But he didn’t. He went the other way. He promised a “fun” interview with Jones, as if it was a joyful, long-awaited reunion rather than offensive for even existing, and he assured his listeners that “you’re gonna love it.”

I’m glad, though, that the men of America have Joe Rogan to motivate and inspire and educate them in limitless ways, including how to recognize a moron

And yet I came away more comfortable with Joe’s vision of manhood—and more determined to do the exact opposite.

My Joe Rogan experience ended because he wore me out. He never shuts up. He talks and talks and talks. He doesn’t seem to grasp that not every thought inside his brain needs to be said out loud. It doesn’t occur to him to consider whether his contributions have value. He just speaks his mind. He just whips it out and drops it on the table.

Rogan’s podcast gushes like a mighty river of content—approximately three episodes a week, usually more than two hours per episode, consisting of one marathon conversation with a subject of his choosing. Over the course of about 1,400 episodes and counting, his roster of guests can be divided roughly three ways: (1) comedians, (2) fighters, and (3) “thinkers,”

The restaurant delivery person interacts with fewer people, lessening his or her individual risk, and the money you pay for the food goes toward keeping a restaurant’s staff employed through a crisis. In Wuhan, local delivery drivers were the city’s lifeline during a lockdown that made venturing out for fresh food difficult.

“Crowded stores would have a greater risk of infection, simply because of numbers of people and density,” Morse, the epidemiologist, explained. Shoppers can avoid some of this risk by dropping in at odd hours or patronizing less popular stores.

“We’re so connected to each other and reliant on people working in the background, but we don’t even see who keeps the shelves restocked, or who brings things” to us, he says. “People only become visible to us in the perception that they could harm us, as opposed to becoming visible to us in the fact that they’re taking a risk to their health by being helpful to us.”

But after weeks of work, administration officials have closed in on the final version of what will be the second half of Mr. Biden’s sweeping economic agenda, which also includes the $2.3 trillion American Jobs Plan the president described last month.

It also seeks to extend through 2025 an expanded tax credit for parents — which is essentially a monthly payment from the government for most families — that was created on a temporary basis by the $1.9 trillion economic aid package Mr. Biden signed into law last month.

Democrats on Capitol Hill have urged Mr. Biden to instead make permanent that credit, which analysts say will drastically cut child poverty this year.

“Expansion of the child tax credit is the most significant policy to come out of Washington in generations, and Congress has an historic opportunity to provide a lifeline to the middle class and to cut child poverty in half on a permanent basis,” the lawmakers said this week in a joint statement.

The president will also propose eliminating a provision of the tax code that reduces taxes for wealthy heirs who sell assets they inherit, like art or property, that have gained value over time.

All of the tax provisions would keep with Mr. Biden’s campaign promise not to raise taxes on individuals or households earning less than $400,000 a year.

Mr. Biden’s team was under pressure from Senator Bernie Sanders, independent of Vermont and the chairman of the Budget Committee, to instead focus his health care efforts on a plan to expand Medicare.

Mr. Sanders has pushed the administration to lower Medicare’s eligibility age and expand it to cover vision, dental and hearing services.

The “replacement” demagoguery seeks to exploit fears rooted in reaction to a truism: Immigrants have increased as a share of the U.S. population since national origins quotas were ended in the 1960s.

But as Brownstein notes, the further “browning” of America will be caused not primarily by new immigration, but rather the higher reproduction rates of immigrants already here and their descendants, relative to slower reproduction among Whites.

That means restricting immigration, even severely, cannot halt the transition to a majority-minority country by 2060. But it would mean a smaller workforce relative to the aging population.

To fully appreciate what a despicable scam this is, however, we need to look at the darker implications of the “replacement” narrative.

The argument isn’t just that liberals want more immigration to win future elections. It’s also that elites are deliberately importing more immigrants to threaten aging Whites’ long term survival.

Prominent Republicans who have echoed Carlson’s line in a deceptively softer form also trade on this idea. They have said liberals want more immigration to “permanently transform” our “political landscape” and to “remake the demographics of America” to “stay in power forever.”

What’s unmistakable, again and again, is the dark invocation of permanent erasure and elimination

There’s an audience for this: A recent survey by GOP pollster Kristen Soltis Anderson found that nearly half of Republican respondents believe politics is about “ensuring the country’s survival as we know it.” As Anderson told Ezra Klein, there is a “real sense in the Republican coalition today that they are under siege.”

As Ed Kilgore writes, this intimation of an “overclass-underclass alliance” that feasts parasitically on the authentic “producerist” majority of “hard-working Americans” is a decades-old right wing populist trope that trades in “paranoia” of “uncommon power.”

Phelps is from one of the 80% to 90% of households expected to receive a stimulus payment from the government. And to the delight of many, that money is coming sooner than anticipated.

Most individuals can expect to receive up to $1,400, couples up to $2,800, and those with children and adult dependents can expect $1,400 for each one. Payments start tapering off for individuals making $75,000 per year, or married couples making $150,000. And unlike the earlier stimulus checks, the maximum cutoff is lower: Individuals no longer qualify once they make $80,000 a year ($160,000 for couples).

According to the U.S. Treasury, payments to eligible Americans will continue through the next several weeks on a rolling basis. Most people who are eligible will automatically receive those payments — no action required.

The IRS says it will automatically calculate the amount that people receive, based on their latest processed tax return.

Payments will go out in batches. The first batch will go to taxpayers who provided direct deposit information on their 2019 or 2020 tax returns. That will be followed by a second batch to taxpayers for whom the IRS already has payment info. For them, the payments could come in the form of checks or prepaid debit cards in the mail.People who receive Social Security or other federal benefits will receive the payment in the same way as their regular benefits. The IRS has not yet announced a payment date for this group, but says it will do so shortly.

The Treasury says it will provide more information in the coming days for people who don't have a bank account, or whose address has recently changed. People will soon be able to check the status of their stimulus check at the IRS website.For Phelps of GenDrop, the deposit is already "pending" in his bank account, and should be available within days.

any early childhood programs pay for themselves when aimed at the most disadvantaged, notes the Nobel-winning economist James Heckman, because they reduce spending on criminal justice, special education, health care and other services. One study by Heckman found that programs for vulnerable young children generated a 13 percent annual rate of return.

Deaton and the economist Anne Case, who is also his wife, coined the term “deaths of despair” to describe the surge of mortality from alcohol, drugs and suicide.

“The meaningfulness of the working-class life seems to have evaporated,” Angus Deaton, the Nobel Prize-winning economist, told us. “The economy just seems to have stopped delivering for these people.”

Only in America has life expectancy now fallen three years in a row, for the first time in a century, because of “deaths of despair.”

“I’m a capitalist, and even I think capitalism is broken,” says Ray Dalio, the founder of Bridgewater, the world’s largest hedge fund.

The suffering was invisible to affluent Americans, but the consequences are now evident to all: The survivors mostly voted for Trump, some in hopes that he would rescue them

The stock market is near record highs, but working-class Americans (often defined as those without college degrees) continue to struggle. If you’re only a high school graduate, or worse, a dropout, work no longer pays.

If the federal minimum wage in 1968 had kept up with inflation and productivity, it would now be $22 an hour. Instead, it’s $7.25.

we would return to the Kristof family farm in Yamhill and see a humanitarian crisis unfolding in a community we loved — and a similar unraveling was happening in towns across the country. This was not one town’s problem, but a crisis in the American system.

Even in this presidential campaign, the unraveling of working-class communities receives little attention. There is talk about the middle class, but very little about the working class

One consequence is that the bottom end of America’s labor force is not very productive, in ways that reduce our country’s competitiveness

we discuss college access but not the one in seven children who don’t graduate from high school.

“We have to stop being obsessed over impeachment and start actually digging in and solving the problems that got Donald Trump elected in the first place,”

We have to treat America’s cancer.

the situation is worsening, because families have imploded under the pressure of drug and alcohol abuse, and children are growing up in desperate circumstances

In the 1970s and ’80s it was common to hear derogatory suggestions that the forces ripping apart African-American communities were rooted in “black culture.” The idea was that “deadbeat dads,” self-destructive drug abuse and family breakdown were the fundamental causes, and that all people needed to do was show “personal responsibility.

A Harvard sociologist, William Julius Wilson, countered that the true underlying problem was lost jobs, and he turned out to be right. When good jobs left white towns like Yamhill a couple of decades later because of globalization and automation, the same pathologies unfolded there.

Men in particular felt the loss not only of income but also of dignity that accompanied a good job. Lonely and troubled, they self-medicated with alcohol or drugs, and they accumulated criminal records that left them less employable and less marriageable.

Family structure collapsed.

The problems are also rooted in disastrous policy choices over 50 years

The United States wrested power from labor and gave it to business, and it suppressed wages and cut taxes rather than invest in human capital, as our peer countries did.

The kids on the No. 6 bus rode into a cataclysm as working-class communities disintegrated across America because of lost jobs, broken families, gloom — and failed policies.

Americans also bought into a misconceived “personal responsibility” narrative that blamed people for being poor.

It’s true, of course, that personal responsibility matters: People we spoke to often acknowledged engaging in self-destructive behaviors.

But when you can predict wretched outcomes based on the ZIP code where a child is born, the problem is not bad choices the infant is making.

If we’re going to obsess about personal responsibility, let’s also have a conversation about social responsibility.

Why did deaths of despair claim Farlan, Zealan, Nathan, Rogena and so many others?

First, well-paying jobs disappeared

Second, there was an explosion of drugs

Third, the war on drugs sent fathers and mothers to jail, shattering families.

Both political parties embraced mass incarceration and the war on drugs, which was particularly devastating for black Americans, and ignored an education system that often consigned the poor — especially children of color — to failing schools

Since 1988, American schools have become increasingly segregated by race, and kids in poor districts perform on average four grade levels behind those in rich districts.

Yet it’s not hopeless. America is polarized with ferocious arguments about social issues, but we should be able to agree on what doesn’t work: neglect and underinvestment in children. Here’s what does work.

ob training and retraining give people dignity as well as an economic lifeline. Such jobs programs are common in other countries.

For instance, autoworkers were laid off during the 2008-9 economic crisis both in Detroit and across the Canadian border in nearby Windsor, Ontario. As the scholar Victor Tan Chen has showed, the two countries responded differently

The United States focused on money, providing extended unemployment benefits. Canada emphasized job retraining, rapidly steering workers into new jobs in fields like health care, and Canadian workers also did not have to worry about losing health insurance.

The focus on job placement meant that Canadian workers were ushered more quickly back into workaday society and thus today seem less entangled in drugs and family breakdown.

Another successful strategy is investing not just in prisons but also in human capital to keep people out of prisons.

We attended a thrilling graduation in Tulsa, Okla., for 17 women completing an impressive local drug treatment program called Women in Recovery.

The graduates had an average of 15 years of addiction each, and all were on probation after committing crimes. Yet they had quit drugs and started jobs

Women in Recovery has a recidivism rate after three years of only 4 percent, and consequently has saved Oklahoma $70 million in prison spending,

Bravo for philanthropy, but the United States would never build interstate highways through volunteers and donations, and we can’t build a national preschool program or a national drug recovery program with private money.

For individuals trying to break an addiction, a first step is to face up to the problem — and that’s what America should do as well

Trump outperformed Mitt Romney, the 2012 Republican nominee, in rural parts of Arizona like Mohave County, where Golden Valley is located. Mr. Trump won 58,282 votes in the county, compared to 47,901 for Mr. Romney, though Mr. Romney carried the state by a much bigger vote margin.

Arizona will be a key battleground state in 2020: Democrats already flipped a Senate seat and a Tucson-based congressional district from red to blue in 2018. For Mr. Trump, big turnout from white voters in areas like Mohave County — and in rural parts of other battlegrounds like Florida, Michigan, Minnesota and Georgia — could be a lifeline in a tight election.

Grass-roots gatherings play a critical role in the modern culture of political organizing, firing up ardent supporters and cementing new ones. Small circles of Trump-supporting conservatives, often organized online and outside the traditional Republican Party apparatus, engage in more decentralized — and explicit — versions of the chest-beating that happens at Mr. Trump’s closely watched political rallies.

They described Mr. Trump as an inspirational figure who is undoing Mr. Obama’s legacy and beating back the perceived threat of Muslim and Latino immigrants, whom they denounced in prejudiced terms.

The Trumpstock speakers pushed even further, tying Mr. Obama’s middle name to a false belief that he is a foreign-born Muslim

“There is no difference between the democratic socialists and the National Socialists,” said Evan Sayet, a conservative writer who spoke at the event, referencing Nazi Germany. Democrats, he said, “are the heirs to Adolf Hitler.”

This blend of insider and outsider, of mainstream and conspiracy, is a feature of how Mr. Trump has reshaped the Republican Party in his image, and the core of his presidential origin story. Before Mr. Trump announced any firm plans to seek office, he was the national face of the “birther” conspiracy, which thrived in the Tea Party movement and had a significant amount of support from the Republican base, polls showed.

On Mr. Trump’s Twitter account, likely the most watched in the world, he has promoted white nationalists, anti-Muslim bigots, and believers in the QAnon conspiracy theory, which claims that top Democrats are worshiping the Devil and engaging in child sex trafficking.

Even mainstream conservative media figures have embraced QAnon as a way to dismiss Mr. Trump’s political enemies. The Fox News host Jesse Watters, during a recent segment dedicated to the conspiracy, linked it to Mr. Trump’s Washington enemies. “Isn’t it also about the Trump fight with the deep state in terms of the illegal surveillance of the campaign, the inside hit jobs that he’s sustained?” he asked.

Leaders of fledgling political groups with names like JEXIT: Jews Exit The Democratic Party, Latinos for Trump and Deplorable Pride, a right-wing L.G.B.T. organization, told the overwhelmingly white audience they were not anti-Semitic, anti-immigrant, homophobic or racist. In fact, the speakers insisted, people who used those terms were more guilty of bigotry than the people they accused.

Trumpstock attendees say they are used to being denounced, another quality they feel they share with the president. It’s part of why they are protective of him, to the point that they refuse to acknowledge the possibility of a Trump loss in 2020.

Mark Villalta said he had been stockpiling firearms, in case Mr. Trump’s re-election is not successful. “Nothing less than a civil war would happen,” Mr. Villalta said, his right hand reaching for a holstered handgun. “I don’t believe in violence, but I’ll do what I got to do.”

mong other measures, the new legislation caps loans at $2 million and makes them available only to borrowers with fewer than 300 employees that experienced at least a 25 percent drop in sales from a year earlier in at least one quarter. The agreement also sets aside $12 billion specifically for minority-owned businesses.

Clearing a longstanding legislative impasse, the deal will also help millions of Americans avoid unexpected — and often exorbitant — medical bills that can spawn from visits to hospitals.

Overall, the legislation provides $13 billion for increased nutrition assistance, $400 million of which will support food banks and food pantries. An additional $175 million is earmarked for nutrition programs under the Older Americans Act, such as Meals on Wheels.

“If a patient comes to the urgent care clinic but is in need of emergency care, they will be stabilized and transferred to an emergency department at another facility for appropriate care,” he said.

The pandemic has exacerbated the Indian Health Service’s decades-long weaknesses and has contributed to disproportionately high infections and death rates among Native Americans. The Albuquerque service area has a seven-day rolling positivity rate of about 14 percent, compared with 7 percent for New Mexico and about 8 percent nationwide.

The office in the Albuquerque area is one of I.H.S.’s 12 service regions and serves 20 Pueblos, two Apache bands, three Navajo chapters and two Ute tribes across four southwest states. There are five hospitals, 11 health centers and 12 field clinics serving the residents of the area.Wendy Sarracino, 57, a community health representative for the Acoma people, said that when her son broke his leg, she had to stop at two hospitals before he could receive the care he needed.

“That was kind of our lifeline,” Ms. Sarracino said of the hospital. “We didn’t have to go very far for health care. An awareness needs to be made that people do live in rural New Mexico and we need health care.”

Dr. Thomas said the agency requested an extension of the removal of the tribe’s financial shares in the hospital given the pandemic but Laguna denied that request. “We’re doing everything we can to maintain all services for the tribal communities,” he said. “We take it very seriously and want to make sure we’re there for the patients.”

It has always been difficult for I.H.S. to attract doctors and nurses to its facilities, many of which are in isolated areas. In the Albuquerque area, the overall job vacancy rate of the health system is 25 percent for doctors and 38 percent for nurses.

“There’s already so much loss that we have to deal with in term of the unavailability of goods and services because we live on the reservation,” she said, “so basically we are fighting to keep whatever we can because at this point the health of our community isn’t great enough to sustain itself on it own.”

Democrats, who have long advocated increasing the amount of financial relief distributed across the country, plan to hold a vote on Monday to approve a stand-alone bill that would increase the payments to $2,000. It is unclear whether that legislation will stand a chance in the Senate, where Republicans have long been resistant to spending more than $1 trillion on pandemic relief.

the president was “posturing to make himself, to bring himself back as the hero of the American people”