By Tony Leys, KFF Health News

SPENCER, Iowa — This town’s hospital is a holdout on behalf of people going through mental health crises. The facility’s leaders have pledged not to shutter their inpatient psychiatric unit, as dozens of other U.S. hospitals have.

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Keeping that promise could soon get tougher if Congress slashes Medicaid funding. The joint federal-state health program covers an unusually large share of mental health patients, and hospital industry leaders say spending cuts could accelerate a decades-long wave of psychiatric unit closures.

At least eight other Iowa hospitals have stopped offering inpatient mental health care since 2007, forcing people in crisis to seek help in distant facilities. Spencer Hospital is one of the smallest in Iowa still offering the service.

CEO Brenda Tiefenthaler said 40% of her hospital’s psychiatric inpatients are covered by Medicaid, compared with about 12% of all inpatients. An additional 10% of the hospital’s psychiatric inpatients are uninsured. National experts say such disparities are common.

Tiefenthaler vows to keep her nonprofit hospital’s 14-bed psychiatric unit open, even though it loses $2 million per year. That’s a significant loss for an organization with an overall annual budget of about $120 million. But the people who use the psychiatric unit need medical care, “just like people who have chest pains,” Tiefenthaler said.

Medicaid covers health care for about 72 million Americans with low incomes or disabilities. Tiefenthaler predicts that if some of them are kicked off the program and left without insurance coverage, more people would delay treatment for mental health problems until their lives spin out of control.

“Then they’re going to enter through the emergency room when they’re in a crisis,” she said. “That’s not really a solution to what we have going on in our country.”

Republican congressional leaders have vowed to protect Medicaid for people who need it, but they also have called for billions of dollars in cuts to areas of the federal budget that include the program.

The U.S. already faces a deep shortage of inpatient mental health services, many of which were reduced or eliminated by private hospitals and public institutions, said Jennifer Snow, director of government relations and policy for the National Alliance on Mental Illness. At the same time, the number of people experiencing mental problems has climbed.

“I don’t even want to think about how much worse it could get,” she said.

The American Hospital Association estimates nearly 100 U.S. hospitals have shuttered their inpatient mental health services in the past decade.

Such closures are often attributed to mental health services being more likely to lose money than many other types of health care. “I’m not blaming the hospitals,” Snow said. “They need to keep their doors open.”

Medicaid generally pays hospitals lower rates for services than they receive from private insurance or from Medicare, the federal program that mostly covers people 65 or older. And Medicaid recipients are particularly likely to need mental health care. More than a third of nonelderly Medicaid enrollees have some sort of mental illness, according to a report from KFF, a nonprofit health policy organization that includes KFF Health News. Iowa has the highest rate of mental illness among nonelderly Medicaid recipients, at 51%.

As of February, just 20 of Iowa’s 116 community hospitals had inpatient psychiatric units, according to a state registry. Iowa also has four freestanding mental hospitals, including two run by the state.

Iowa, with 3.2 million residents, has a total of about 760 inpatient mental health beds that are staffed to care for patients, the state reports. The Treatment Advocacy Center, a national group seeking improved mental health care, says the “absolute minimum” of such beds would translate to about 960 for Iowa’s population, and the optimal number would be about 1,920.

Spencer Hospital is one of the smallest hospitals in Iowa still offering inpatient mental health care. ((Tony Leys/KFF Health News)/KFF Health News/TNS)

Most of Iowa’s psychiatric beds are in metro areas, and it can take several days for a slot to come open. In the meantime, patients routinely wait in emergency departments.

Sheriff’s deputies often are assigned to transport patients to available facilities when treatment is court-ordered.

“It’s not uncommon for us to drive five or six hours,” said Clay County Sheriff Chris Raveling, whose northwestern Iowa county includes Spencer, a city of 11,000 people.

He said Spencer Hospital’s mental health unit often is too full to accept new patients and, like many such facilities, it declines to take patients who are violent or charged with crimes.

The result is that people are held in jail on minor charges stemming from their mental illnesses or addictions, the sheriff said. “They really shouldn’t be in jail,” he said. “Did they commit a crime? Yes. But I don’t think they did it on purpose.”

Raveling said authorities in many cases decide to hold people in jail so they don’t hurt themselves or others while awaiting treatment. He has seen the problems worsen in his 25 years in law enforcement.

Most people with mental health issues can be treated as outpatients, but many of those services also depend heavily on Medicaid and could be vulnerable to budget cuts.

Jon Ulven, a psychologist who practices in Moorhead, Minnesota, and neighboring Fargo, North Dakota, said he’s particularly worried about patients who develop psychosis, which often begins in the teenage years or early adulthood. If they’re started right away on medication and therapy, “we can have a dramatic influence on that person for the rest of their life,” he said. But if treatment is delayed, their symptoms often become harder to reverse.

Ulven, who helps oversee mental health services in his region for the multistate Sanford Health system, said he’s also concerned about people with other mental health challenges, including depression. He noted a study published in 2022 that showed suicide rates rose faster in states that declined to expand their Medicaid programs than in states that agreed to expand their programs to cover more low-income adults. If Medicaid rolls are reduced again, he said, more people would be uninsured and fewer services would be available. That could lead to more suicides.

Nationally, Medicaid covered nearly 41% of psychiatric inpatients cared for in 2024 by a sample of 680 hospitals, according to an analysis done for KFF Health News by the financial consulting company Strata. In contrast, just 13% of inpatients in those hospitals’ cancer programs and 9% of inpatients in their cardiac programs were covered by Medicaid.

If Medicaid participants have mental crises after losing their coverage, hospitals or clinics would have to treat many of them for little or no payment. “These are not wealthy people. They don’t have a lot of assets,” said Steve Wasson, Strata’s chief data and intelligence officer. Even though Medicaid pays hospitals relatively low rates, he said, “it’s better than nothing.”

Spencer Hospital CEO Brenda Tiefenthaler vows to maintain the facility’ s mental health services, with help from behavioral health services director Kerri Dandy, nursing director Jen Dau, and outreach navigator Jill Barr. ((Tony Leys/KFF Health News)/KFF Health News/TNS)

Birthing units, which also have been plagued by closures, face similar challenges. In the Strata sample, 37% of those units’ patients were on Medicaid in 2024.

Spencer Hospital, which has a total of 63 inpatient beds, has maintained both its birthing unit and its psychiatric unit, and its leaders plan to keep them open. Amid a critical shortage of mental health professionals, it employs two psychiatric nurse practitioners and two psychiatrists, including one providing care via video from North Carolina.

Local resident David Jacobsen appreciates the hospital’s efforts to preserve services. His son Alex was assisted by the facility’s mental health professionals during years of struggles before he died by suicide in 2020.

David Jacobsen knows how reliant such services are on Medicaid, and he worries that more hospitals will curtail mental health offerings if national leaders cut the program. “They’re hurting the people who need help the most,” he said.

People on Medicaid aren’t the only ones affected when hospitals reduce services or close treatment units. Everyone in the community loses access to care.

Alex Jacobsen’s family saw how common the need is. “If we can learn anything from my Alex,” one of his sisters wrote in his obituary, “it’s that mental illness is real, it doesn’t discriminate, and it takes some of the best people down in its ugly swirling drain.”

©2025 KFF Health News. Distributed by Tribune Content Agency, LLC.

By ELAINE KURTENBACH and MATT OTT, Associated Press Business Writers

U.S. markets edged lower before the opening bell Tuesday as the earnings season nears its end and the last major corporations post their quarterly performances.

Futures for the S&P 500 lost 0.2%, while futures for the Dow Jones Industrial Average were flat. Nasdaq futures are down 0.2%.

Home Depot rose more than 2% in premarket after the hardware store chain beat Wall Street sales targets and reaffirmed previous sales growth projections despite an ongoing housing market slump.

Target and Home Depot rival Lowe’s report their latest results on Wednesday.

Home Depot’s strong report comes even as many companies — particularly retailers — have lowered or pulled guidance due to uncertainty over President Donald Trump’s tariffs.

How Trump’s tariffs play out remains to be seen and uncertainty has been the prominent theme since he started rolling them out early this year. Many of the import taxes have been since been lowered or delayed, most recently with China. Markets soared last week after the the world’s two largest trading partners announced a 90-day pause on their tariff battle.

In comments at its annual investor conference on Monday, JPMorgan CEO Jamie Dimon suggested that geopolitical risks — presumably including trade wars — remain a major risk for the global and U.S. economies. Dimon said that stagflation — a recession with inflation — would be a worst-case scenario.

“I think the odds of that are probably two times of what the market thinks,” Dimon said.

Elsewhere, global markets rallied Tuesday after China cut key interest rates to help fend off an economic malaise worsened by trade friction with Washington.

China’s central bank made its first cut to its loan prime rates in seven months in a move welcomed by investors eager for more stimulus as the world’s second largest economy feels the pinch of Trump’s higher tariffs.

The People’s Bank of China cut the one-year loan prime rate, the reference rate for pricing all new loans and outstanding floating rate loans, to 3.00% from 3.1%. It cut the 5-year loan prime rate to 3.5% from 3.6%.

With China’s chief concern being deflation due to slack demand rather than inflation, economists have been expecting such a move. Data reported Monday showed the economy under pressure from Trump’s trade war, with retail sales and factory output slowing and property investment continuing to fall.

Tuesday’s cuts probably won’t be the last this year, Zichun Huang of Capital Economics said in a report.

“But modest rate cuts alone are unlikely to meaningfully boost loan demand or wider economic activity,” Huang said.

Shares in China’s CATL, the world’s largest maker of electric batteries, jumped 16.4% in its Hong Kong trading debut after it raised about $4.6 billion in the world’s largest IPO this year. Its shares traded in Shenzhen, mainland China’s smaller share market after Shanghai, gained 1.2% after dipping earlier in the day.

Hong Kong’s Hang Seng gained 1.5% to 23,681.48, while the Shanghai Composite index advanced 0.4% to 3,380.48.

In Tokyo, the Nikkei 225 inched up 0.1% to 37,529.49, while Australia’s S&P/ASX 200 rose 0.6% to 8,343.30.

South Korea’s Kospi lost 0.1% to 2,601.80, while the Taiex in Taiwan was nearly unchanged.

India’s Sensex lost 0.8%.

In midday European trading, Germany’s DAX and the CAC 40 in Paris each rose 0.4%. Britain’s FTSE 100 was up 0.6%.

The Reserve Bank of Australia reduced its benchmark interest rate by a quarter percentage for a second time this year, to 3.85%, judging inflation to be within its target range. The earlier reduction, in February, was Australia’s first rate cut since October 2020.

U.S. benchmark crude oil lost33 cents to $61.81 per barrel. Brent crude, the international standard, shed 36 cents to $65.18 per barrel.

The U.S. dollar fell to 144.60 Japanese yen from 144.86 yen. The euro ticked up to $1.1248 from $1.1244.

By DEVI SHASTRI and LAURA BARGFELD

MILWAUKEE (AP) — Feel like you can’t focus? Like you’ll never finish a book again? Like the only way to keep your mind and hands busy is to scroll on social media for hours?

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You’re far from alone. One body of decades-long research found the average person’s attention span for a single screen is 47 seconds, down from 2.5 minutes in 2004. The 24/7 news cycle, uncertainty about the state of the world and countless hours of screen time don’t help, experts say.

“When my patients talk to me about this stuff there is often a feeling of helplessness or powerlessness,” said Dr. Michael Ziffra, a psychiatrist at Northwestern Medicine. “But you can change these behaviors. You can improve your attention span.”

Here are ways to start that process. As you read, challenge yourself to set a 2.5 minute timer and stay on this article without looking at another device or clicking away.

How did we lose focus?

A shifting attention is an evolutionary feature, not a bug. Our brains are hardwired to quickly filter information and hone in on potential threats or changes in what’s happening around us.

What’s grabbing our attentions has changed. For our ancestors, it might have been a rustle in the bushes putting us on guard for a lurking tiger. Today, it could be a rash of breaking news alerts and phone notifications.

The COVID-19 pandemic warped many people’s sense of time and increased their screen usage like never before, said Stacey Nye, a clinical psychologist at the University of Wisconsin-Milwaukee.

Technology isn’t the only thing that influences our attention, experts say, but the effects of those pinging notifications or hours scrolling through 30-second long videos can build up over time.

“Our attention span has really been trained to only focus in those little, small blips and it interrupts our natural focus cycles,” she said.

Give your wandering mind ‘active breaks’

Experts say “active” breaks are among the best way to retrain your mind and your attention. They only take about 30 minutes, Nye said, and can be as simple as taking a walk while noticing things around you or moving to another room for lunch.

Don’t be afraid to get creative. Develop a list of alternative activities or randomly choose ideas out of a fish bowl. Try craft projects, a short meditation, fixing a quick meal or talking a walk outside. All the better if you can involve a friend as well.

The break needs to be a physical or mental activity — no passive phone-scrolling.

When the brain is understimulated and looking for change, it’ll usually grab onto the first thing it sees. The smartphone, an “ever-producing change machine,” is an enticing option, said Cindy Lustig, a cognitive neuroscientist at the University of Michigan.

Turn off unnecessary notifications and put that “do not disturb” mode to good use, especially before bedtime. Better yet, put your phone in a whole different room, Lustig said.

Say no to multitasking

Multitasking may make you feel like you’re getting more done, but brain experts recommend against it.

“Be a single tasker,” Nye said. “Work on one thing at a time, for a specified period of time and begin to work your way up.”

Lustig is a big fan of the “Pomodoro technique,” in which you set a timer and work on something for 25 or 30 minutes before taking a five-minute break.

She tells herself: “I can do anything for this amount of time,” and the world will still be waiting for her at the end.

Start with something you actually like and set a goal

It’s not enough to just have a hobby, Lustig said. It helps to choose hobbies that include deliberate practice and a goal to strive toward, whether it’s playing guitar for an audience or improving in a sport.

It helps to pick something that you enjoy as well.

“You don’t want to start with the heavy nonfiction or like ‘War and Peace,’” Lustig said. “If you need to start with the romance novel, then start with the romance novel. You can work your way up.”

It’s also important to be kind to yourself. Everyone has good and bad days, and attention needs are different — and even vary from task to task.

The key is to make an intentional effort, experts say.

“It is in many ways similar to a muscle in the sense that we can build it up with practice and exercises,” Ziffra said. “Conversely, it can weaken if we’re not exercising it.”

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.

By JENNIFER McDERMOTT, Associated Press

For the first time in the United States, a utility is asking federal regulators for a permit to build a small nuclear reactor.

The nation’s largest public power company, the Tennessee Valley Authority, announced Tuesday it submitted a construction permit application to the U.S. Nuclear Regulatory Commission for a small, modular nuclear reactor. It wants to develop next-generation nuclear power in Oak Ridge, Tennessee, at its Clinch River site.

TVA President and CEO Don Moul said that by going first, they can show other utilities a way to accelerate the development of small nuclear reactors.

“Nuclear is very reliable, very resilient. It is carbon free,” he told The Associated Press in an exclusive interview Monday. “It is, what I would consider, one of the highest quality generating sources we have. And so starting a path forward not only helps others in America follow, but it can also help America lead the world in the new technology.”

The federally owned utility provides electricity to seven states and operates three traditional, large nuclear power plants, which provide 40% of the Tennessee Valley’s power. The region’s population is growing, industries are replacing fossil fuels with electric alternatives and there’s more manufacturing. The TVA is planning for the demand for electricity to increase by up to 26 gigawatts by 2035, which is enough to power roughly 15 million homes.

Its board launched a program in 2022 to develop and fund small modular nuclear reactors as part of its strategy to dramatically reduce planet-warming greenhouse gas emissions, and has provided $350 million for it so far.

U.S. electric utilities have been reluctant to invest in new nuclear construction because of large cost overruns and delays in Georgia, as Georgia Power Co.’s Plant Vogtle was expanded from two of the traditional large reactors to four, said Jacopo Buongiorno, professor of nuclear science and engineering at the Massachusetts Institute of Technology. The TVA decision is meaningful because it may be the start of a trend, Buongiorno added.

The United States does not have any next-generation reactors operating commercially. The NRC is currently reviewing applications from companies that want to build these reactors to begin providing power in the early 2030s. A project to build the first was terminated in 2023, as costs increased and not enough local power providers signed up to be part of it.

This month, the power company in Ontario, Canada, began building the first of four small nuclear reactors. Ontario Power Generation chose the same reactor the TVA wants to build, GE Hitachi’s design for a small modular reactor that uses light water like all large U.S. commercial reactors.

In Ontario, they’re expecting the first to cost $6.1 billion, along with $1.6 billion for equipment to build all four. The cost is expected to decline with each subsequent reactor. TVA’s cost estimates are in the same range, Moul said, but he declined to give specifics and said the utility is looking for partners to help with the initial costs.

The nonprofit Environmental Working Group says far cheaper, safer and cleaner electricity can be delivered much faster through investments in proven renewable sources like solar rooftops, battery storage and wind power. There’s “no bigger example of a money pit than the fantasy of small modular reactors” as a viable source of energy in the U.S., said Alex Formuzis, spokesperson for the research and advocacy organization.

The Biden administration announced a $900 million investment in these reactors last year. The Trump administration also supports building small modular reactors for flexible, reliable power for energy-intensive sectors like industry and data centers as electricity demand soars. Energy Secretary Chris Wright said in March that the $900 million would be awarded, but applicants had to submit new proposals to be judged solely on technical merit, without consideration for past diversity, equity and inclusion practices.

The TVA and its industry partners applied for $800 million in federal funding, which they say will help speed up the development of the technology by about two years.

The NRC has already said the Clinch River site is suitable for a new nuclear plant. There’s enough room for a total of four small reactors. If the NRC and the TVA board approve the plans to build the first reactor there, it could begin operating around 2032, providing 300 megawatts of power, which is enough for about 175,000 homes.

The Associated Press’ climate and environmental coverage receives financial support from multiple private foundations. AP is solely responsible for all content. Find AP’s standards for working with philanthropies, a list of supporters and funded coverage areas at AP.org.