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Kevin Stansbury, the CEO of Lincoln Community Hospital in the 800-person town of Hugo, Colorado, is facing a classic Catch-22: He could boost his rural hospitals revenues by offering hip replacements and shoulder surgeries, but the 64-year-old hospital needs more money to be able to expand its operating room to do those procedures.

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I’ve got a surgeon that’s willing to do it. My facility isn’t big enough, Stansbury said. And urgent services like obstetrics I can’t do in my hospital, because my facility won’t meet code.

Besides securing additional revenue for the hospital, such an expansion could keep locals from having to drive the 100 miles to Denver for orthopedic surgeries or to deliver babies.

Rural hospitals throughout the nation are facing a similar conundrum. An increase in costs amid lower payments from insurance plans makes it harder for small hospitals to fund large capital improvement projects. And high inflation and rising interest rates coming out of the pandemic are making it tougher for aging facilities to qualify for loans or other types of financing to upgrade their facilities to meet the ever-changing standards of medical care.

Most of us are operating at very low margins, if any margin at all, Stansbury said. So, we’re struggling to find the money.

Aging hospital infrastructure, particularly in rural areas, is a growing concern. Data on the age of hospitals is hard to come by, because hospitals expand, upgrade, and refurbish different parts of their facilities over time. A 2017 analysis by the American Society for Health Care Engineering, a part of the American Hospital Association, found that the average age of hospitals in the U.S. increased from 8.6 years in 1994 to 11.5 years in 2015. That number has likely grown, industry insiders say, as many hospitals delayed capital improvement projects, particularly during the pandemic.

Research published in 2021 by the capital planning firm Facility Health Inc., now called Brightly, found that U.S. health care facilities had deferred about 41% of their maintenance and would need $243 billion to complete the backlog.

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Most of todays rural hospitals were opened with funding from the Hill-Burton Act, passed by Congress in 1946. That program was rolled into the Public Health Service Act in the 1970s and, by 1997, had funded the construction of nearly 7,000 hospitals and clinics. Now, many of those buildings, particularly those in rural areas, are in dire need of improvements.

Stansbury, who is also board chair of the Colorado Hospital Association, said at least a half-dozen rural hospitals in the state need significant capital investment.

Harold Miller, president and CEO of the Center for Healthcare Quality and Payment Reform, a think tank in Pittsburgh, said the major problem for small rural hospitals is that private insurance is no longer covering the full cost of providing care. Medicare Advantage, a program under which Medicare pays private plans to provide coverage for seniors and people with disabilities, is a major contributor to the problem, he said.

You’re basically taking patients away from what may be the best payer that the small hospital has, and pushing those patients onto a private insurance plan, which doesn’t pay the same way that traditional Medicare pays and ends up also using a variety of techniques to deny claims, Miller said.

Rural hospitals also must staff their emergency rooms with physicians round-the-clock, but the hospitals get paid only if someone comes in. The facility opened in 1959 after soldiers coming back from World War II decided that Lincoln County on the eastern Colorado plains needed a hospital. Now, management wants to expand it.(Lincoln Health)

Meanwhile, labor costs coming out of the pandemic have increased, and inflation has driven up the cost of supplies. Those financial headwinds will likely push more rural hospitals out of business. Hospital closures dropped during the pandemic, from a record 18 closures in 2020 to a combined eight closures in 2021 and 2022, according to the Cecil G. Sheps Center for Health Services Research at the University of North Carolina-Chapel Hill, as emergency relief funds kept them open. But that life support has ended, and at least nine more closed in 2023. Miller said closures are reverting to pre-pandemic rates.

That raises concerns that some hospitals might invest in new facilities and end up shutting down anyway. Miller said only a small portion of rural hospitals might be able to make a meaningful difference to their bottom lines by adding new services.

Lawmakers have tried to help. California, for example, has loan programs charging low to no interest that rural hospitals can participate in, and hospital representatives are urging Colorado legislators to approve similar support.

At the federal level, Rep. Yadira Caraveo, a Colorado Democrat, has introduced the bipartisan Rural Health Care Facilities Revitalization Act, which would help rural hospitals get more funding for capital projects through the U.S. Department of Agriculture. The USDA has been one of the largest funders of rural development through its Community Facilities Programs, providing over $3 billion in loans a year. In 2019, half of the more than $10 billion in outstanding loans through the program helped health care facilities.

Otherwise, facilities would have to go to private lenders, said Carrie Cochran-McClain, chief policy officer for the National Rural Health Association. More from the Mountain States

Rural hospitals might not be very attractive to private lenders because of their financial constraints, and thus may have to pay higher interest rates or meet additional requirements to get those loans, she said.

Caraveos bill would also allow hospitals that already have loans to refinance at lower interest rates, and would cover more categories of medical equipment, such as devices and technology used for telehealth.

We need to keep these places open, even not just for emergencies, but to deliver babies, to have your cardiology appointment, said Caraveo, who is also a pediatrician. You shouldn’t have to drive two, three hours to get it.

Kristin Juliar, a capital resources consultant for the National Organization of State Offices of Rural Health, has been studying the challenges rural hospitals face in borrowing money and planning big projects.

Theyre trying to do this while they’re doing their regular jobs running a hospital, Juliar said. A lot of times when there are funding opportunities, for example, the timing may be just too tight for them to put together a project.

Some funding is contingent on the hospital raising matching funds, which may be difficult in distressed rural communities. And most projects require hospitals to cobble together funding from multiple sources, adding complexity. And since these projects often take a long time to put together, rural hospital CEOs or board members sometimes leave before they come to fruition.

You get going at something and then key people disappear, and then you feel like you’re starting all over again, she said. Expansion of Lincoln Community Hospital could keep locals from having to drive the 100 miles to Denver for orthopedic surgeries or to deliver babies.(Lincoln Health)

The hospital in Hugo opened in 1959 after soldiers coming back from World War II decided that Lincoln County on the eastern Colorado plains needed a hospital. They donated money, materials, land, and labor to build it. The hospital has added four family practice clinics, an attached skilled nursing facility, and an off-site assisted living center. It brings in specialists from Denver and Colorado Springs.

Stansbury wold like to build a new hospital roughly double the size of the current 45,000-square-foot facility. With inflation easing and interest rates likely to go down this year, Stansbury hopes to get financing lined up in 2024 and to break ground in 2025.

The problem is, every day I wake up, it gets more expensive, Stansbury said.

When hospital officials first contemplated building a new hospital three years ago, they estimated a total project cost of about $65 million. But inflation skyrocketed and now interest rates have gone up, pushing the total cost to $75 million.

If we have to wait another couple of years, we may be pushing up closer to $80 million, Stansbury said. But we’ve got to do it. I can’t wait five years and think the costs of construction are going to go down.

Markian Hawryluk: MarkianH@kff.org, @MarkianHawryluk Related Topics Health Industry Rural Health States California Colorado Hospitals Contact Us Submit a Story Tip

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RFK Jr chosen as Donald Trump’s health secretary – as president-elect says he will do ‘unbelievable things’

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RFK Jr chosen as Donald Trump's health secretary - as president-elect says he will do 'unbelievable things'

Donald Trump has chosen vaccine sceptic Robert F Kennedy Jr as his new health secretary and said he will do “unbelievable things”.

The news was announced by Donald Trump Jr on X, before the president-elect confirmed the appointment just moments later.

Former Democrat RFK Jr, the nephew of former president John F Kennedy, had been running as an independent presidential candidate but dropped out of the race and endorsed Mr Trump in August.

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From August: Kennedy family criticises RFK Jr after Trump endorsement

In return for Mr Kennedy’s support during the election, president-elect Trump pledged to give him a “big role” – and RFK Jr’s preference for the health position was widely reported.

Mr Trump spoke on Thursday night at a gala, hosted at his Mar-a-Lago retreat in Florida, which included tech billionaire Elon Musk and actor Sylvester Stallone.

Directly addressing RFK Jr, who was in the audience, Mr Trump said: “We want you to come up with things… and ideas… and what you’ve been talking about for a long time. I think you’re going to do some unbelievable things. Nobody’s going to be able to do it like you.”

The health and human services (HHS) department includes the Food and Drug Administration, the Centers for Disease Control and Prevention, Medicare, Medicaid and the National Institutes of Health.

RFK Jr will “restore these Agencies to the traditions of Gold Standard Scientific Research, and beacons of Transparency, to end the Chronic Disease epidemic, and to Make America Great and Healthy Again,” the president-elect wrote on X.

Donald Trump and Robert F Kennedy Jr in October during the presidential campaign. Pic: Reuters
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Donald Trump and Robert F Kennedy Jr in October during the presidential campaign. Pic: Reuters

Mr Trump added: “For too long, Americans have been crushed by the industrial food complex and drug companies who have engaged in deception, misinformation, and disinformation when it comes to Public Health.

“The Safety and Health of all Americans is the most important role of any Administration.”

Mr Kennedy is a known vaccine sceptic who has repeated misinformation on multiple occasions, including the discredited theory that childhood immunisations cause autism.

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The RFK Jr-led health department will “play a big role in helping ensure that everybody will be protected from harmful chemicals, pollutants, pesticides, pharmaceutical products, and food additives that have contributed to the overwhelming Health Crisis in this Country,” the president-elect added.

Earlier, his son Donald Trump Jr was the first to confirm the appointment, writing on X: “Robert F Kennedy Jr will be The Secretary of Health and Human Services! Promises Made Promises Kept.”

Read more:
Who’s in and who’s out of Trump’s top team?
Who is Robert F Kennedy Jr?

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When Trump met Obama and Biden

RFK Jr’s position will need to be confirmed with a Senate vote – but even with the chamber under Republican control, his appointment may face opposition because of his views on health issues.

Before Mr Trump announced his choice, Mr Kennedy had already claimed the new president would push to remove fluoride from drinking water on his first day in office. The addition of the compound has been cited as helping to improve dental health.

The department RKF Jr is hoping to oversee has more than 80,000 employees across the United States.

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Donald Trump picks controversial MAGA loyalist Matt Gaetz to be his attorney general

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Donald Trump picks controversial MAGA loyalist Matt Gaetz to be his attorney general

Donald Trump has picked fiery Florida congressman Matt Gaetz to be his attorney general – a man who was under investigation over sex trafficking just days ago.

Democrats have described the MAGA loyalist as “a gonzo agent of chaos” and his appointment a “red alert moment for our democracy”, while some Republican senators have also raised doubts about his suitability for the role.

It comes as Mr Trump won control of the House of Representatives, giving him full control of the government, and continues to fill out his top team.

Mr Gaetz, 42, has been under investigation by the House of Representatives’ ethics committee over allegations he was part of a scheme that led to the sex trafficking of a 17-year-old girl.

But after he resigned from Congress on Wednesday following being named as Mr Trump’s pick for attorney general, that probe has ended – without the publication of any findings.

Despite the cloud over his character – Mr Gaetz denies all allegations – he has repeatedly shown his loyalty to the president-elect, attending his hush money trial in Manhattan and vociferously calling out prosecutors.

The MAGA firebrand in the past has spread the conspiracy theory that the January 6 riots were actually orchestrated by the left-leaning group Antifa.

If he’s going to lead the Department of Justice, the Florida politician needs to be confirmed by a Senate vote like other cabinet positions. That’s where it could get difficult for him.

Donald Trump and Matt Gaetz at a rally
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The nomination is seen by some as a reward for his loyalty to Donald Trump. Pic: AP

What have Republicans said?

“I don’t think it’s a serious nomination for the attorney general,” Republican senator Lisa Murkowski said. “This one was not on my bingo card.”

Senator Susan Collins said she was “shocked” by the pick and said there would be “an awful lot of questions being asked in this case”.

Both Ms Murkowski and Ms Collins have been vocal Trump critics (the latter vowed to write fellow Republican Nikki Haley’s name on her ballot) and will be under the spotlight next year as their party retakes control of the Senate.

“I think it’s a little bit of a test,” said Republican senator Kevin Cramer.

He said he sees Mr Gaetz as a disruptive force in the House and has concerns about the “serious allegations” against him – but stopped short of saying he would not vote for him.

“It will take a lot of political capital to get him across,” he added.

Rep. Matt Gaetz, R-Fla., speaks before Republican presidential nominee former President Donald Trump speaks at a campaign rally at Lee's Family Forum, Thursday, Oct. 31, 2024, in Henderson, Nev. (AP Photo/Evan Vucci)
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Mr Gaetz will need to be confirmed by a Senate vote. Pic: AP

Read more:
Who is Marco Rubio, the next US Secretary of State?
How will Trump 2.0 be different to first presidency?

“I’ve known Matt for a very long time, we’re friends,” said Florida senator Marco Rubio, who was nominated for secretary of state on Wednesday. “I think he would do a very good job for the president.”

Some Republican senators were reluctant to publicly criticise the incoming president’s pick to lead the justice department but did not endorse him either.

Senator John Cornyn, a member of the judiciary panel, said he did not know Mr Gaetz “other than his public persona”, and said he will not “prejudge any of these” nominations.

“I’ve got nothing for you,” said senator Katie Britt when asked by reporters. “We’ll see,” said senator Ron Johnson, when asked if he is voting for Mr Gaetz.

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Difference between Trump meeting Obama and Biden

What have Democrats said?

Unsurprisingly, Democrats in Congress have been less restrained with their reactions to Mr Gaetz’s nomination.

Veteran senator Chris Murphy declared the announcement to be “a red alert moment for our democracy”.

Representative Jim Himes meanwhile, who sits on the House Intelligence Committee, told CNN the role of attorney general requires “care, prudency, a deep respect for the rule of law… Matt Gaetz is the opposite of all of those things, he is a gonzo agent of chaos”.

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Senator Richard Blumenthal, who sits on the Senate’s judiciary panel, said the nomination was the “first test of whether Republicans are willing to stand up to Donald Trump and go with conscience and conviction as opposed to just politics”.

New Mexico senator Martin Heinrich was even more blunt, posting on X: “People voted for cheaper eggs, not whatever the f@#€ this is.”

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Trump hands out top jobs: Who is in, who is out and who are the leading contenders?

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Trump hands out top jobs: Who is in, who is out and who are the leading contenders?

As the dust settles on Donald Trump’s US election win, the president-elect has begun choosing who will be in his administration for his second stint in the White House.

During the campaign, Mr Trump avoided directly confirming any appointments but frequently dropped hints about who he would like in his top team.

Nominees must be questioned by members of the Senate before it votes on their appointment. Even with the Republicans in control some of the picks are very controversial and could be blocked.

So who is in, who is out and who are the leading contenders for jobs?

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Who is in?

Susie Wiles

Susie Wiles is a veteran Republican campaign manager – having helped Ronald Reagan and Ron DeSantis get elected as well as Donald Trump in 2016 and 2024. She is the first member of his team to be announced – and becomes the first female chief-of-staff in American history.

The 67-year-old, who lives in Florida, has a political career that spans decades but has largely kept out of the limelight and rarely given interviews.

She is the daughter of late American footballer Pat Summerall and one of her first jobs in politics was as an assistant to one of his former New York Giants teammates when he became a Republican representative.

Outside politics, she has worked in the private sector as a lobbyist, for both Ballard Partners, whose clients include Amazon, Google, and the MLB (Major League Baseball), and then Mercury, which works with Elon Musk’s SpaceX and the embassy of Qatar.

This time around, Mr Trump credited her with his “best-run” presidential campaign, describing her as “incredible” at a Milwaukee rally earlier this year, and an “ice maiden” in his victory speech.

Matt Gaetz

Mr Trump has chosen Matt Gaetz, a man who once faced a federal sex trafficking probe, to be the nation’s top prosecutor.

The investigation, carried out by the Justice Department he will now lead, ended without charges.

However, it is just one of a number of reasons why his appointment as attorney general has raised concerns in Washington.

Mr Gaetz had also been under scrutiny by the House Ethics Committee over wider allegations including sexual misconduct, illicit drug use and accepting improper gifts.

The inquiry was dropped on Wednesday 13 November when Mr Gaetz left Congress – the only forum where the committee has jurisdiction.

The 42-year-old is a fierce Trump supporter who has regularly attacked both the Justice Department and the FBI, and even called for the FBI to be defunded and abolished.

He was particularly critical of the Justice Department’s investigation into the January 6 attack on the Capitol in 2021 – which resulted in charges against more than 1,500 Trump supporters and hundreds of convictions.

Veteran Democratic senator Chris Murphy declared his appointment as attorney general as “a red alert moment for our democracy”.

Another senior Democrat described Mr Gaetz as a “gonzo agent of chaos”.

Steve Bannon, Trump’s former adviser told NBC news: “President Trump is going to hit the Justice Department with a blowtorch, and Matt Gaetz is that torch.”

His nomination, which must be ratified by Congress, could be blocked unless Republicans unite around him.

Elon Musk

Tech billionaire Elon Musk became one of Mr Trump’s staunchest supporters in the months leading up to the election and spent at least $119m (£92m) canvassing for him in the seven battleground states.

Awarding his loyalty, Mr Trump announced Mr Musk will co-lead the new Department of Government Efficiency (DOGE) alongside former Republican presidential candidate Vivek Ramaswamy.

In a statement on Tuesday, the president-elect said Mr Musk and Mr Ramaswamy “will pave the way for my administration to dismantle government bureaucracy, slash excess regulations, cut wasteful expenditures, and restructure federal agencies”.

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Musk to co-run ‘efficiency’ dept

Despite its name, the DOGE is not a government agency and is instead set to provide “advice and guidance” from the outside of government.

The statement released by Mr Trump said it will partner with the office of management and budget to “drive large-scale structural reform, and create an entrepreneurial approach to government never seen before”.

The department has been given a deadline of 4 July 2026 to conclude its work.

Vivek Ramaswamy

Vivek Ramaswamy speaks to reporters in the spin room before the  presidential debate.
Pic: AP
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Vivek Ramaswamy. Pic: AP

Former Republican presidential candidate Vivek Ramaswamy will join Elon Musk in leading DOGE.

Mr Ramaswamy, the founder of a pharmaceutical company, suspended his campaign in January to support Mr Trump.

In his 2021 bestseller book Woke, Inc, Mr Ramaswamy criticised the decisions of some big companies to base business strategy around social justice and climate change concerns.

Pete Hegseth

Fox News commentator and National Guard veteran Pete Hegseth has been picked as Mr Trump’s defence secretary.

In a statement, the president-elect described the 44-year-old as “tough, smart and a true believer in America First”.

He said: “With Pete at the helm, America’s enemies are on notice – our military will be great again, and America will never back down.”

If confirmed by the Senate, Mr Hegseth could make good on Mr Trump’s campaign promises to rid the US military of
generals who he accuses of pursuing progressive policies on diversity in the ranks that conservatives have rallied against.

In the past Mr Hegseth has expressed disdain for the so-called “woke” policies of Pentagon leaders including its top military officer.

He has also railed against NATO allies for being weak and claimed China is on the verge of dominating its neighbours.

Mr Hegseth has pushed for making the US military more lethal and argued allowing women to serve in combat hurts that effort.

“Everything about men and women serving together makes the situation more complicated, and complication in combat, that means casualties are worse,” he said in an interview on The Shawn Ryan Show podcast.

Though he said diversity in the military is a strength, he said that was because minority and white men “can perform similarly” but the same is not true for women.

Critics have pointed to Mr Hegseth’s lack of experience with some suggesting he could be defence secretary in name only as the Trump White House runs the department.

“There is reason for concern that this is not a person who is a serious enough policymaker, serious enough policy implementer, to do a successful job,” said Adam Smith, the ranking Democrat on the House Armed Services Committee.

Robert F Kennedy Jr

Independent presidential candidate Robert F. Kennedy Jr. speaks as he endorses Republican presidential nominee former President Donald Trump at a campaign rally at the Desert Diamond Arena, Friday, Aug. 23, 2024, in Glendale, Ariz. (AP Photo/Evan Vucci)
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Robert F Kennedy Jr. Pic: AP

Mr Trump has confirmed vaccine sceptic Robert F Kennedy Jr as his pick for health secretary – meaning he’ll oversee a huge department that includes the Food and Drug Administration, the Centers for Disease Control and Prevention, and Medicare.

The president-elect wrote on X that RFK Jr will “restore these Agencies to the traditions of Gold Standard Scientific Research, and beacons of Transparency, to end the Chronic Disease epidemic, and to Make America Great and Healthy Again”.

RFK Jr abandoned his independent presidential campaign to back Mr Trump in August.

It was a move that saw RFK Jr condemned by many members of his family, but as with Musk, his public support has been rewarded.

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From August: Kennedy family criticises RFK Jr

Mr Kennedy – the son of politician Robert F Kennedy and the nephew of assassinated president John F Kennedymade a name for himself as a vaccine sceptic during the COVID-19 pandemic and has frequently repeated debunked claims, including linking vaccines to autism in children.

He has claimed Mr Trump will push to remove fluoride from drinking water on his first day in office. The addition of the compound has been cited as helping to improve dental health.

RFK Jr’s controversial views could see him struggle to land enough votes to have his role confirmed, even in a Republican-controlled Senate.

Marco Rubio

Donald Trump has named Marco Rubio as his secretary of state, making him the first Latino member of the president-elect’s top team.

Mr Rubio, a Florida senator, unsuccessfully ran against Mr Trump to be the Republican presidential candidate in 2016.

In the past, the 53-year-old has advocated for muscular foreign policy with respect to the US’s geopolitical rivals, including China, Iran and Cuba.

However, over the last several years he has softened some of his stances to align more closely with Mr Trump’s views.

He was a contender to be his 2024 running mate before JD Vance landed the role.

Elise Stefanik

According to US network CNN, Mr Trump has offered fierce ally Elise Stefanik the job as US ambassador to the UN.

Citing two anonymous sources, CNN confirms rumours the Republican – who represents New York in the House – was lined up for the role.

Ms Stefanik has built up a national profile as an unwavering ally of the president-elect, shedding her early reputation as a moderate – having worked on Mitt Romney’s 2012 campaign – to become the highest-ranking woman in the House Republican leadership.

Sky News’ US partner network NBC News reported in January this year she was being considered as Mr Trump’s pick for vice president.

Mr Trump reportedly described her as a “killer”.

Tom Homan

Mr Trump said late on Sunday that Tom Homan will return to government to be in charge of US borders and the deportation of illegal immigrants.

Announcing the news on Truth Social, the president-elect said “there is nobody better at policing and controlling our Borders” than his new “border czar”.

Mr Homan served as former acting director of Immigration and Customs Enforcement (ICE) during Mr Trump’s first term, and was an early backer of the president’s “zero tolerance” policy – which NBC News reported led to at least 5,500 families being separated at the southern border in 2018.

Earlier this year, he told a conservative conference he would “run the biggest deportation force this country has ever seen,” per NBC.

Mr Homan was also a contributor to Project 2025’s Mandate for Leadership book.

Mike Waltz

Trump loyalist Mike Waltz is the president-elect’s national security adviser – a powerful role which does not require confirmation from the Senate.

The 50-year-old, who served in the National Guard, will be responsible for briefing Mr Trump on key national security issues and coordinating with different agencies.

Having praised Mr Trump’s foreign policy views, Mr Waltz is a leading critic of China, and has spoken out about the country’s activity in the Asia-Pacific, claiming the US needs to be ready for a potential conflict in the region.

Kristi Noem

Republican presidential nominee former U.S. President Donald Trump gestures next to South Dakota Governor Kristi Noem during a town hall campaign event in Oaks, Pennsylvania, U.S., October 14, 2024. REUTERS/David Muse
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Kristi Noem with Mr Trump in Pennsylvania. Pic: Reuters

South Dakota governor Kristi Noem has been picked to serve as the next homeland security secretary.

Once seen as a possible running mate for the president-elect, Ms Noem is currently serving her second four-year term as South Dakota’s governor, having risen to prominence after refusing to impose a statewide mask order during the COVID-19 pandemic.

As head of homeland security, she will be responsible for everything from border protection and immigration to disaster response and the US Secret Service.

In a statement on Tuesday, Mr Trump said: “Kristi has been very strong on border security. She was the first governor to send National Guard soldiers to help Texas fight the Biden border crisis, and they were sent a total of eight times.”

He said Ms Noem would work closely with his “border czar,” Mr Homan.

Stephen Miller

Mr Trump has named Stephen Miller, an immigration hardliner, to be his deputy chief of staff for policy and homeland security adviser.

Mr Miller was a vocal spokesperson during the presidential campaign for Mr Trump’s priority of mass deportations.

The 39-year-old previously served as a senior adviser during Mr Trump’s first administration.

Mr Miller has been a central figure in some of Mr Trump’s policy decisions, notably his move to separate thousands of immigrant families.

John Ratcliffe

Former director of national intelligence John Ratcliffe has been picked by Mr Trump to serve as director of the
Central Intelligence Agency (CIA).

A former congressman and prosecutor, Mr Ratcliffe is seen as a Trump loyalist who is likely to win Senate confirmation.

Tulsi Gabbard

Tulsi Gabbard, a former Democratic member of Congress and presidential candidate, has been chosen to serve as director of national intelligence.

“As a former Candidate for the Democrat Presidential Nomination, she has broad support in both Parties – She is now a proud Republican!” Mr Trump said.

“I know Tulsi will bring the fearless spirit that has defined her illustrious career to our Intelligence Community, championing our Constitutional Rights, and securing Peace through Strength. Tulsi will make us all proud!”

She has been accused of amplifying Russian propaganda and would come to the job having never worked in the intelligence world or served on a congressional intelligence committee.

Two years ago it was claimed she echoed Russian propaganda by posting a video saying there were bio labs across Ukraine funded by the US.

Who is out?

Nikki Haley

Former Republican presidential contender Nikki Haley takes the stage on Day 2 of the Republican National Convention (RNC), at the Fiserv Forum in Milwaukee, Wisconsin, U.S., July 16, 2024. REUTERS/Mike Segar
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Nikki Haley. Pic: Reuters

Nikki Haley was once Mr Trump’s main rival during his run for the Republican presidential nomination.

Despite losing the contest, she proved her popularity with parts of the GOP and previously served in his first presidential cabinet as the US ambassador to the United Nations.

The 51-year-old also served as governor of South Carolina but news of her not being involved this time around was broken by the president-elect on his own social media platform, Truth Social.

In a short statement, Mr Trump said he would not be inviting either her or former secretary of state Mike Pompeo back but thanked them for their service.

@realDonaldTrump/Truth Social
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@realDonaldTrump/Truth Social

In response, Ms Haley, who eventually endorsed Mr Trump despite harshly criticising him in the party primaries, said: “I was proud to work with President Trump defending America at the United Nations.

“I wish him, and all who serve, great success in moving us forward to a stronger, safer America over the next four years.”

Mike Pompeo

Mike Pompeo also served as the director of the CIA under Mr Trump and had been mentioned in some reports as a possible defence secretary or in relation to another role linked to national security, intelligence or diplomacy.

Former Sec. of State Mike Pompeo speaks during the Republican National Convention on Thursday, July 18, 2024, in Milwaukee. (AP Photo/J. Scott Applewhite)
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Former secretary of state Mike Pompeo. Pic: AP

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Mr Trump confirmed Mr Pompeo would not be returning to his cabinet in the same post that he ruled out Ms Haley.

Previously among Mr Trump’s closest allies, Mr Pompeo is one of the fiercest US defenders of Ukraine.

Who is yet to be decided?

Don Jr, Eric and Lara Trump

Donald Trump Jr. speaks to the news media, as Lara and Eric Trump stand nearby, across the street from former President Donald Trump's criminal trial in New York, Tuesday, May 28, 2024. Pic: AP
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Don Jr, flanked by Eric and Lara, defending his father outside his hush money trial in May. Pic: AP

Mr Trump’s daughter and son-in-law, Ivanka Trump and Jared Kushner, were among his senior advisers during his first term. But will the businessman once again keep any family members close when he is in the Oval Office?

In June 2023, Mr Trump said he did not want his children to serve in a second administration, saying it was “too painful for the family”.

More from Sky News:
Trump still faces criminal charges – here’s what happens next
US talk show host on verge of tears after Trump win
Why Harris lost a key state

Nevertheless, while Ms Trump and Mr Kushner have stayed away from politics since, two of Mr Trump’s other sons – Don Jr and Eric – have played prominent roles on the campaign trail.

Eric’s wife, Lara Trump, already has a significant role in US politics, as she serves as co-chair of the Republican Party.

Larry Kudlow

White House chief economic adviser Larry Kudlow speaks before a television interview at the White House, Friday, Oct. 23, 2020, in Washington. Pic: AP
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Larry Kudlow hosts shows on Fox News and Fox Business. Pic: AP

Fox News personality Larry Kudlow served as director of the National Economic Council for much of Mr Trump’s first term and is said to have an outside shot at becoming his treasury secretary this time.

Other names being linked to the post include John Paulson – a billionaire hedge fund manager and donor, who hosted a fundraiser that raked in more than $50m (£38m) for the former president.

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