Beatrice Hall is waiting for word that her husband is out of surgery and his colostomy has gone well. It is the latest in umpteen procedures, check-ups and tests he has been forced to ensure since being diagnosed with colon cancer.

“I don’t know what we would do without this hospital,” she says, standing in the 33C heat outside the Kentucky River Medical Centre.

Yet that is a very real prospect facing this poverty-riddled corner of Kentucky as a consequence of the passage of Donald Trump’s “one, big, beautiful bill”.

The bill will slash trillions of dollars from the Medicaid budget – dollars that pay for healthcare for those who cannot otherwise afford it. Without those patients and that money, some 300 hospitals across the country may struggle to survive, according to a study by the University of North Carolina, including 35 in Kentucky alone.

The hospital outside which Mrs Hall, 60, is waiting in the shade is “Hillbilly Elegy” territory.

It is the place where JD Vance rose to prominence with a memoir detailing the poverty and hopelessness of Breathitt County, a book that became a cipher for understanding the forgotten parts of America that elected Donald Trump.

And Mr Vance has been tasked with selling the legislation to the country. On Wednesday, he was in a blue-collar corner of Pennsylvania, describing how it would give $1,000 to every newborn and banish taxes on overtime pay.

“So what I ask every single person to do is take what I’ve said… go and talk to your neighbours, go and talk to your friends about what this bill does for American citizens,” he said.