The Trump administration’s efforts to cut federal spending is targeting a broad range of departments and agencies including the low-income health care program Medicaid. Republican lawmakers want work requirements in place for eligibility. But the scope of Medicaid programs goes beyond direct health care. Many people rely on Medicaid for treatment of substance use disorder and drug addiction. West Virginia has the nation's highest overdose numbers and the rate for African American people exceeds any other group. In this episode of Us & Them, host Trey Kay learns how Medicaid money supports the organizations that work in recovery and what that work looks like.

Home ownership in America is one of the most common ways to build wealth for future generations. But in Appalachia, West Virginia presents the complexities and nuances of that reality. The Mountain State has the nation’s highest homeownership rate but the second lowest personal income rate. And there’s another reality at work. Much of that housing is old and needs repair. In one West Virginia county, 67 percent of the homes are more than 80 years old and half rate below normal on standard quality measures. One estimate shows there are 500,000 people living in such conditions. This is a side of the housing crisis we don't often hear -- structures in disrepair without electricity, or running water, that people call home.

There’s a fresh slate of legislative agendas in the new year and some include efforts to chip away at reproductive rights and access to abortion, even in states that have recently passed constitutional abortion rights ballot measures. On this episode of Us & Them, host Trey Kay looks at what’s ahead after a record number of initiatives passed in November. There’s a lot that conservative legislatures and courts can do to limit the voter-approved amendments. While legal maneuvering continues, the number of abortions in the U.S. is at its highest level in more than a decade thanks to the increased use of abortion pills and travel across state lines. Abortion opponents want President Donald Trump to enforce a 19th Century law they say will stop abortion pills through the mail. Meanwhile, abortion-friendly states are using shield laws to protect their telehealth abortion providers from criminal prosecution for providing abortion pills to women in states with bans. The U.S.’s inconsistent abortion laws are pitting states against each other, and state governments against their citizens.

With the start of 2025, legislators in some states are determined to pass even tighter abortion restrictions. In the two years since the U.S. Supreme Court overturned Roe versus Wade, more than 40 states have passed abortion bans - some with very limited exceptions. Abortion rights advocates are equally determined to expand access to reproductive care — and some are looking at the lessons learned from half a century ago, before there was a right to legal abortion. On the next episode of Us & Them host Trey Kay hears from people who took on that work decades ago. We hear from supporters of reproductive rights who are ready for a new era of advocacy, while anti abortion advocates encourage a new Republican power center in Congress to tightly regulate medications and enact a federal abortion ban.

The headlines and issues front and center in 2024 have presented complex challenges. In this year end episode of Us & Them, host Trey Kay uses his cold water open swimming to launch an exploration of some of our most vexing questions. He leans into listening, challenging himself to understand more about those across the divide. Kay hears from some who celebrate a victory, as others fear the days ahead. And, he’s reminded that our nation proclaims fundamental rights and freedoms, while struggling to uphold them equitably. Living through history is how one person describes these divided times. In a splintered world, listening is one of the last bridges we have toward understanding.

There are people in the U.S. who break the law each day, simply by sleeping outside. This year, more states and local governments have passed laws banning public sleeping after a U.S. Supreme Court ruling that makes such laws constitutional. One sweeping state effort is the Safer Kentucky Act, a set of anti-crime laws that includes hardline provisions on gun crimes, fentanyl, and a three-strikes rule similar to the tough-on-crime laws of the 1990s. It also says public sleeping is illegal and because of the three-strikes rule, if you sleep outside enough, you can end up serving real time. Kentucky’s law originated as a response to crime and homelessness in Louisville. However some people say the law criminalizes homeless people and may put more of them behind bars.

Host Trey Kay brings together the Us & Them dinner party guests once again, this time for a candid post-election review. The group, representing a wide range of personal and political perspectives, shares the table for a potluck meal just days after President-elect Donald Trump’s election. Some of Kay’s dinner party guests are enthusiastic about Trump’s policies and plans for a second term, while others don’t have much of an appetite and are fearful as they reflect on the outcome of the election and their expectations for the future. As in many American households, there are raw feelings and honest emotions as some of the issues behind the political and social divides in our country are exposed. It’s a dinner table at which not everyone has much of an appetite.

West Virginia’s vaccination requirements for school children are what a lot of health experts call the gold standard. Only a medical exemption will get you out of school vaccine requirements. On this episode of Us & Them we look at a recent legislative proposal that would have changed that. It would have exempted homeschooled kids from vaccinations and let private and parochial schools set their own standards. The bill came from some parents who want relief from what they call the state’s oppressive compulsory vaccination laws. While the bill passed through the legislature, it did not become law after Gov. Jim Justice vetoed the measure. We’ll find out about this latest chapter in a state with one of the nation’s most robust vaccine histories.