May 25 is Red Nose Day in the United States.

And millions of people are probably going, “huh, what?”

The short explanation: It’s a campaign to raise money to fight child poverty.

But how does buying a red foam nose at a drugstore for a buck help the cause? And does this charity with the silly name really do good work?

We did some reporting, and here’s what we learned.

The British charity Comic Relief started Red Nose Day in England in 1985 as a way to raise money to fight child poverty. Why Red Nose Day and not, say, Fight Child Poverty Day? It’s hard to get a definitive answer. But it appears the organizers wanted a symbol that would make people laugh. Everyone from the Spice Girls to Hugh Grant have put on red noses to promote the fundraising effort.

Red Nose Day is held every two years in the U.K. and has raised $1.4 billion, which is distributed to charities that fight child poverty.

Three years ago, the event crossed over to the U.S., where it’s become an annual event. Although it hasn’t yet become a household word. Last year, Comic Relief USA surveyed 1,000 Americans and found that “60 percent didn’t quite understand what we did,” says Janet Scardino, CEO of the group.

In the weeks leading up to Red Nose Day and on the day itself, money is raised in all sorts of ways. Of the dollar people pay to buy a red nose at Walgreens and Duane Reade drugstores, 50 cents goes to charity (the other half covers the cost of producing the nose). The public can also make direct donations on the Red Nose Day telethon airing Thursday night on NBC.

According to the organization’s 2015 tax filings, 85 percent of the proceeds go to a handful of charity partners that support children in need around the world. In the U.S., that includes multiyear grants to groups like Feeding America, the Boys & Girls Clubs of America, Save the Children and Gavi, the Vaccine Alliance.

The Bill & Melinda Gates Foundation, a supporter of NPR, is also backing Red Nose Day in the U.S. by matching donations to the cause made on Facebook up to total of $1 million.

Charity Navigator, which rates nonprofits using a four-star evaluation system, has found that most of Red Nose Day’s charity partners have a three or four-star rating.

But Comic Relief has been criticized in the past for its controversial investments. In the U.K, some funds raised by Red Nose Day are invested in various ways, with the returns going toward the cost of the campaign. In 2013, the BBC program “Panorama” reported that around $816,000 was invested in the arms company BAE Systems while $3.5 million was invested in tobacco companies.

A spokesperson from Comic Relief U.K. told NPR that the group stopped investing in those companies in 2014.

And then there’s the question of the goofiness of it all. Part of the appeal of Red Nose Day is that it makes people feel good, says David Bishai, a professor who specializes in economics and public health at Johns Hopkins University. “The red nose doesn’t drag you into the dark side of the poor, showing you children with swollen bellies. That’s not fun,” he says. “The [campaigners] say: We understand there’s terrible suffering in the world and we’re doing something about it.”

But it’s a tricky line to toe. This year’s BBC telethon for Red Nose Day in the U.K., on March 24, garnered 150 complaints for profanity and lewd comments from the celebrity entertainers. There was a skit showing a bounty of biscuits followed by footage of a starving infant in Liberia. One viewer tweeted: “Comic Relief … painful.” Asked to comment on the controversy, a spokesperson for Comic Relief U.K. did not address the issue specifically but told NPR: “The broadcast was a live studio event enjoyed by a peak audience of 7.6 million. The amazing British public yet again dug deep to raise over 73 million pounds [about $94 million] so far.”

U.S. campaigns haven’t brought in quite as much: more than $60 million in the first two years. Still,“that’s nothing to sneeze at,” says Sandra Miniutti of Charity Navigator.

But the name might be an obstacle, suggests Miniutti. “Stand Up For Cancer, I know I’m giving to cancer,” she says. “Red Nose Day doesn’t have that attribute.”

So on Red Nose Day the group devotes a lot of effort to explaining what kinds of projects it supports. Tonight, for example, Julia Roberts guest stars on a Red Nose Day episode of the TV series Running Wild with Bear Grylls. Grylls and Roberts head out to delivervaccines from Wamba Hospital in Kenya to children in the a remote community. The challenge? They must keep the vaccines cold the whole time — while avoiding crocodiles and hippos.

Tonight’s Red Nose Day TV marathon also features a reunion of the cast of the 2003 movie Love Actually.

It sounds gimmicky, but academics who study charitable giving don’t seem to mind. “I could have been holy about it — but they’re helping Americans think about those less well-off in other countries,” says Bishai. “Give them a break.”

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The Congressional Budget Office gave its projections Wednesday on the costs and impact of the version of the American Health Care Act passed by the House earlier this month.

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The proposed budget unveiled Tuesday by the Trump administration doubles down on major cuts to biomedical research; programs to fight infectious disease outbreaks; health care for the poor, elderly and disabled; and prevention of HIV/AIDS.

It restates the goals of the “skinny budget” the administration released in March, which was widely condemned by scientists and public health advocates.

Mick Mulvaney, director of the Office of Management and Budget, said Monday that the goal is to cut back on public assistance and instead put people back to work. “We are going to measure compassion and success by the number of people we help get off of those programs and get back in charge of their own lives.”

No one thinks the president’s budget will pass as proposed, since Congress has budget and spending authority. But it does provide a baseline from which negotiations may begin.

“The president is right to take a close look at spending,” says Sen. Chuck Grassley, R-Iowa. But “Congress has the power of the purse strings. I’ve never seen a president’s budget proposal not revised substantially.”

Here’s a rundown of the budget’s medical research and health care proposals.

Medicaid: The budget proposes cutting Medicaid and CHIP, the Children’s Health Insurance Program, by $616 billion over 10 years, with almost half the savings occurring in the last two years.

The joint federal-state programs provide health care and support services for 75 million low-income, elderly and disabled people, about half of whom are children. In 2015, federal and state spending on Medicaid was about $545 billion.

The budget mirrors the changes in Medicaid included in the health care overhaul bill passed by the House earlier this month. Rather than the federal government matching state spending based on beneficiaries’ health care needs, it would give states a fixed amount of money per enrollee or, alternatively, offer states a fixed block grant. That would cut the program’s growth over time and reduce services because health care costs grow faster than the broad economy.

Medicaid benefits for the elderly and disabled: Medicaid pays for services — including personal care, shopping or cooking for the elderly, and occupational therapy and work support for the disabled — that allow people to continue to live on their own.

Under the law, those services are considered optional. But Medicaid is required to pay for nursing home and institutional care.

“We’ll see a return to more people with disabilities and more older adults not having access to services that allow them to remain at home,” says Barbara Beckert, director of the Milwaukee office of Disability Rights Wisconsin. “Instead, we may see people forced into institutions, forced into nursing homes.”

Refugee benefits: The proposed budget makes the argument that the U.S. should reduce the number of refugees it brings into this country because those fleeing persecution in their home countries often end up using public assistance, including 50 percent who were on Medicaid in 2015. “The larger the number the United States admits for domestic resettlement, the fewer people the United States is able to help overall,” the budget document says.

National Institutes of Health: The NIH, which funds research into medical treatments and basic science, would see cuts of almost $6 billion, to about $26 billion. That would include a $575 million cut to the National Heart, Lung and Blood Institute and $838 million cut to the National Institute of Allergy and Infectious Diseases, which is involved in a wide range of diseases including AIDS and Zika. The National Institute of Diabetes and Digestive and Kidney Diseases would be cut by $355 million.

The proposed cuts drew immediate and harsh criticism.

The cuts would “cripple our nation’s scientific efforts, undermining our economic growth, public health and national security,” Mary Sue Coleman, president of the Association of American Universities, said in a statement. The cuts could “hobble our ability to provide tomorrow’s cures and technologies.”

Centers for Disease Control and Prevention: The administration proposes trimming the CDC, which helps states and other countries fight infectious disease outbreaks, by $1.3 billion — 17 percent. That could include a $186 million cut in programs at the CDC’s center on HIV/AIDS, hepatitis and other sexually transmitted diseases. The CDC’s chronic disease prevention programs, such as those for diabetes, heart disease, stroke and obesity, would be cut by $222 million.

The proposed cut to CDC “would be perilous for the health of the American people,” says John Auerbach, president and CEO of the Trust for America’s Health. “From Ebola to Zika to opioid misuse to diabetes to heart disease, the CDC is on the front lines keeping Americans healthy.”

Food and Drug Administration: A 31 percent proposed cut, from $2.7 billion to $1.89 billion, would be offset by $1.3 billion in proposed increased fees to be paid by drugmakers and device-makers.

The budget shows a basic misunderstanding of how these agencies function, says Ryan Hohman, vice president of public affairs at the group Friends of Cancer Research. “To further suggest that private sector industry make up for such a significant cut to the FDA as proposed by the president shows a lack of knowledge for how user fees can be used and the scope of the FDA’s pivotal role in assuring the safety of the daily lives of Americans.”

The budget doesn’t explicitly address high drug costs, though Trump has frequently inveighed against drug prices, telling Congress in February that it should “work to bring down the artificially high price of drugs and bring them down immediately.”

Planned Parenthood: The family-planning organization has been the target of efforts to cut funding for years because it provides about one-third of the nation’s abortions.

This budget would be the first to bar a specific provider, according to Planned Parenthood. And it would bar the organization not only from Medicaid funding but also from any other Health and Human Services program, including the Title X family planning program, maternal and child health, STD testing and treatment, and Zika prevention.

“From Day 1, President Trump has worked to keep his pro-life promises, including stopping taxpayers from being forced to fund abortion and abortion businesses,” says Marjorie Dannenfelser, president of the anti-abortion group Susan B. Anthony List. “Taxpayers should not have to prop up Planned Parenthood’s failing, abortion-centered business model.”

Planned Parenthood officials said Tuesday that many of their clients don’t have other places to get health care. “We’ve already seen the results of these sorts of policies in Texas, so we know what would happen,” says Kevin Griffis, vice president at Planned Parenthood Federation of America. “The heartbreaking truth is that if this budget were enacted, the results would be catastrophic for countless women and their families — cancers and diseases going undetected, higher maternal mortality and more unintended pregnancies.”

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Back in January, Republicans boasted they would deliver a “repeal and replace” bill for the Affordable Care Act to President Donald Trump’s desk by the end of the month.

In the interim, that bravado has faded as their efforts stalled and they found out how complicated undoing a major law can be. With summer just around the corner, and most of official Washington swept up in scandals surrounding Trump, the health overhaul delays are starting to back up the rest of the 2018 agenda.

One of the immediate casualties is the renewal of the Children’s Health Insurance Program. CHIP covers just under 9 million children in low- and moderate-income families, at a cost of about $15 billion a year.

Funding for CHIP does not technically end until Sept. 30, but it is already too late for states to plan their budgets effectively. They needed to know about future funding while their legislatures were still in session, but, according to the National Conference of State Legislatures, the local lawmakers have already adjourned for the year in more than half of the states.

“If [Congress] had wanted to do what states needed with respect to CHIP, it would be done already,” says Joan Alker of the Georgetown Center for Children and Families.

“Certainty and predictability [are] important,” agrees Matt Salo, executive director of the National Association of Medicaid Directors. “If we don’t know that the money is going to be there, we have to start planning to dismantle things early, and that has a real human toll.”

In a March letter urging prompt action, the Medicaid directors noted that while the end of September might seem far off, “as the program nears the end of its congressional funding, states will be required to notify current CHIP beneficiaries of the termination of their coverage. This process may be required to begin as early as July in some states.”

CHIP has long been a bipartisan program. One of its original sponsors is Sen. Orrin Hatch, R-Utah, who chairs the Finance Committee that oversees it. It was created in 1997, and last reauthorized in 2015, for two years. But a Finance hearing that was intended to launch the effort to renew the program was abruptly canceled this month, amid suggestions that Republicans might want to hold the program’s renewal hostage to force Democrats and moderate Republicans to make concessions on the bill to replace the Affordable Care Act.

“It’s a very difficult time with respect to children’s coverage,” says Alker. Not only is the future of CHIP in doubt, but also the House-passed health bill would make major cuts to the Medicaid program, and many states have chosen to roll CHIP into the Medicaid program.”

“We’ve just achieved a historic level in coverage of kids,” she says, referring to a new report finding that more than 93 percent of eligible U.S. children now have health insurance under CHIP. “Now all three legs of that coverage stool — CHIP, Medicaid and ACA — are up for grabs.”

But it’s not just CHIP at risk due to the congested congressional calendar. Congress also can’t do the tax bill Republicans badly want until lawmakers wrap up the health bill.

That is because Republicans want to use the same budget procedure, called reconciliation, for both bills. That procedure forbids a filibuster in the Senate and allows passage with a simple majority.

There’s a catch, though. The health bill’s reconciliation instructions were part of the fiscal 2017 budget resolution, which Congress passed in January. Lawmakers would need to adopt a fiscal 2018 budget resolution in order to use the same fast-track procedures for their tax changes.

And they cannot do both at the same time. “Once Congress adopts a new budget resolution for fiscal year 2018,” says Ed Lorenzen, a budget-process expert at the Committee for a Responsible Federal Budget, that new resolution “supplants the fiscal year 2017 resolution and the reconciliation instructions in the fiscal year 2017 budget are moot.”

That would mean that if Congress wanted to continue with the health bill, it would need 60 votes in the Senate, not a simple majority.

There is, however, a loophole of sorts. Congress “can start the next budget resolution before they finish health care,” said Lorenzen. “They just can’t finish the new budget resolution until they finish health care.”

So the House and Senate could each pass its own separate budget blueprint, and even meet to come to a consensus on its final product. But they cannot take the last step of the process — with each approving a conference report or identical resolutions — until the health bill is done or given up for dead. They could also start work on a tax plan, although, again, they could not take the bill to the floor of the Senate until they finish health care and the new budget resolution.

At least that’s what most budget experts and lawmakers assume. “There’s no precedent to go on,” said Lorenzen, because no budget reconciliation bill has taken Congress this far into a fiscal year. “So nobody really knows.”

Kaiser Health News is an editorially independent part of the Kaiser Family Foundation.

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President Trump gave a eulogy on Thursday for the Affordable Care Act, also known as Obamacare.

“Obamacare is collapsing. It’s dead. It’s gone,” Trump said in a news conference with Colombian President Juan Manuel Santos.

“There’s nothing to compare it to because we don’t have health care in this country,” he went on.

That left some Obamacare customers scratching their heads — figuratively — on Twitter.

Doktor Zoom, for example, wondered why he’s still paying a premium.

In fact, we do have health care in this country — quite a lot of it. The U.S. spent about $3.2 trillion on health care in 2015, or nearly $10,000 per person. It accounts for 17.8 percent of GDP.

But the president wasn’t talking about health care per se. He was talking about Obamacare, which Republicans are trying to replace with legislation currently in the hands of the Senate.

Even the picture of the current health law isn’t as bad as Trump tried to paint it, though. In the years since the Affordable Care Act went into effect, the uninsured rate fell toabout 10 percent, the lowest level in U.S. history. About 10 million people have bought insurance through the exchanges created by the health care law. Another 10 million got coverage through the expansion of Medicaid.

That’s not to say the Obamacare marketplaces aren’t struggling. In some states insurers are pulling out of the markets because they’re losing money, as Trump pointed out.

“Aetna just pulled out. Other insurance companies are pulling out,” he said.

That’s true. Aetna pulled out of all the Obamacare exchanges. In some states — Tennessee and Iowa, for example — there are areas that risk having no insurer at all. And premiums have been rising across the country.

Still, the overall Obamacare picture isn’t so stark.

Standard & Poors, for example, said last month that insurance companies that offer health plans on the exchanges are losing less money than ever, and the markets are becoming more stable. The Kaiser Family Foundation says more than half the population has the choice of three or more insurers if it wants to buy a policy on the exchanges. And most people who get insurance through the Affordable Care Act receive subsidies to offset the rate increases.

Several insurance companies, however, have said the uncertainty caused by Republican efforts to repeal the law have led them to either pull out of the markets or raise their rates for next year.

So when Trump says, as he did today, “Obamacare is a fallacy. It’s dead,” that’s not exactly true.

But he hopes to help make it so.

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Common blood tests for lead can give falsely-low results in certain cases, according to a new warning from the Food and Drug Administration.

The tests, manufactured by Magellan Diagnostics, are commonly used in doctors’ offices and clinics, and on its website the company calls itself “the most trusted name in lead testing.” But the FDA now says that its tests can give inaccurate results when used to test blood drawn from a vein.

The majority of lead tests are not conducted with that kind of blood sample, but rather blood from a heel or finger prick, says Dr. Jeffrey Shuren, director of the FDA’s Center for Devices and Radiological Health.

“We have no evidence that Magellan’s tests, when used with blood obtained from a finger or heel stick, are impacted,” says Shuren. “We believe most people will not be affected by this issue.”

For example, in 2016, the Centers for Disease Control and Prevention recommended that all children under the age 6 years in Flint, Mich., get re-tested as part of the response to the crisis there. Patrick Breysse, director of the CDC’s National Center for Environmental health, says they have a lot of information about that testing, and have determined that “less than one percent, perhaps, might be at risk for being under-estimated because they were a venous draw that were tested on the Magellan system.”

Officials are recommending retesting for certain children, pregnant women and nursing mothers who did get tested using blood from a vein.

And the FDA says it’s aggressively investigating why these tests can give inaccurate results.

Officials say the company first became aware of a potential problem through complaints received in the fall of 2014, and developed a mitigation plan, which was to basically just delay processing of the sample for 24 hours.

“And that completely resolved the problem. They communicated with their customers, their customers acknowledged receipt, and that was it,” says Shuren.

But earlier this year, when FDA officials became aware of the problem, Shuren says the agency believed that the company had underestimated the risk to the public, and that the data supporting the mitigation plan wasn’t sufficient.

Between the beginning of 2014 to today, officials say, an estimated 8 million blood lead tests have been run using the Magellan systems, and the majority of those were for capillary blood from finger or heel sticks.

“From a coverage perspective, particularly for those kids on Medicaid, we would expect that the Medicaid programs in those states would be covering and paying for the retesting,” says Timothy Hill, the Acting Director for the Center for Medicaid and CHIP Services, which is part of the Centers for Medicare and Medicaid Services. “For those who are covered privately, we would encourage folks to consult with their health plan.”

Asked why taxpayers or insurance companies should have to pay for retesting, Hill said the first priority is to get kids retested if they need retesting, and officials do not want reimbursement to hold that up.

“It’s my understanding that the, sort of, conversations with Magellan are ongoing,” says Hill. “Speaking as to whether or not Magellan has liability or not is not something I can speak to.”

In response to NPR’s inquiries, a spokesperson with Magellan pointed to a letter to its customers that the company published this morning.

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Many Democrats are hoping the GOP health care bill that narrowly passed the U.S. House of Representatives is going to push political momentum their way, and result in big gains in the 2018 midterm elections. A special election next week in Montana may be an early test for this theory.

President Trump won Montana by 20 points in the November 2016 election, and the May 25 special election is being held to replace the state’s only congressman, Rep. Ryan Zinke, whom Trump nominated to be interior secretary.

Montana resident Jim Lynch plans to vote for the Republican candidate, Greg Gianforte. Lynch is a member of the Glacier Country Pachyderm Club and members get together once a month in Kalispell, Mont., to talk about advancing Republican values.

Lynch says health care is a top issue for him. He hates the Affordable Care Act. He’s 63 and says he maintained good health insurance coverage throughout the Obama administration. But, he says, “There’s a lot of people in my shoes who aren’t that lucky. I do know, personally, that they’ve seen huge increases in health care costs, to the point that they don’t even have it anymore.”

Indeed, people who are 55 to 64 can be charged as much as three times what a younger person can be charged for health insurance. Subsidies are available based on income, but older people may earn more than young people just starting their careers.

Under the GOP bill that’s now before the Senate, however, older people can be charged five times as much as younger people, and the subsidies are decreasing in aggregate.

Lynch says he doesn’t think the House health care bill is perfect, but he’s confident that, as President Trump shepherds it through Congress, it will be modified into something much better than the Affordable Care Act.

About a hundred miles south in Missoula, Mont., restaurant owner Molly Galusha dreads the idea of Obamacare being repealed. She says the current health care law’s subsidies have made it possible for her employees to afford health coverage on the wages she can afford to pay them.

Galusha is 62 and gets her health coverage through her husband’s job. She says she doesn’t know what they’d do if their insurance went away.

“We’re old and broken,” she laughs.

The Affordable Care Act’s protections for people with pre-existing conditions are also likely to affect older people, because the likelihood of having a pre-existing condition increases with age.

“We are uninsurable as a couple, so we’re very grateful,” Galusha says.

Republican candidate Gianforte says he won’t vote for a health care bill that doesn’t work for Montana.

“I need to know that, in fact, it’ll bring premiums down, preserve rural access and protect people with pre-existing conditions,” he says.

He also says he would have voted against the House health care bill, because there wasn’t enough time to read and understand it before the House voted.

Democrats, however, accuse Gianforte of being disingenuous. They point to a recording of a phone call he had with lobbyists on the day the House bill passed, which was leaked to The New York Times. On the tape he can be heard saying, “Sounds like we just passed a health care thing, which I’m thankful for, that we’re starting to repeal and replace.”

Democratic candidate Rob Quist pounced on those words. Quist needs Republican votes to win, so he’s trying to convince Republicans that their candidate will sell out the state’s interests on health care.

“Montanans want a Congressman who’ll shoot straight, not a dishonest politician who says one thing to Montanans and another to the millionaires behind closed doors,” he says. Quist says he wants to build on the ACA and thinks the country should eventually move to a single-payer health insurance system.

This story is part of a reporting partnership with NPR, Montana Public Radio and Kaiser Health News.

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The Greek poet Archilochus wrote, “the fox knows many things, but the hedgehog knows one big thing.”

There are many different interpretations of this parable, but psychologist Phil Tetlock argues it’s a way of understanding two cognitive styles: Foxes have different strategies for different problems. They are comfortable with nuance, they can live with contradictions. Hedgehogs, on the other hand, focus on the big picture. They reduce every problem to one organizing principle.

“The hedgehogs are more the big idea people, more decisive. In most MBA programs, they’d probably be viewed as better leadership material,” Tetlock says.

This week, we have the story of a hedgehog by the name of Don Laub: a young surgeon who was eager to make his mark. In his words, he wanted to “do a big thing, and help a lot of people.”

One day, Don got his chance when a colleague asked him if he could help with a surgery. The patient was a child from Mexico with a cleft lip and palate, and the surgery was simple. Don says it gave the child, who had been ostracized in his community, a real chance in life.

The experience inspired him to organize trips for surgeons to travel to Mexico and help other children with similar injuries. “Everybody jumped on it,” he said. “I had to hide when I would go into the hospital because people wanted to get in on this.”

His story is one of many triumphs — and a tragedy that he continues to dwell on many decades later. This week on Hidden Brain, we explore his story, and what it can tell us about how we view our roles in the world.

The Hidden Brain Podcast is hosted by Shankar Vedantam and produced by Maggie Penman, Jennifer Schmidt, Renee Klahr, and Rhaina Cohen. Our supervising producer is Tara Boyle. Follow us on Twitter @hiddenbrain, and listen for our stories each week on your local public radio station.

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In rural Alaska, providing health care means overcoming a lot of hurdles.

Fickle weather that can leave patients stranded, for one.

Also: complicated geography. Many Alaskan villages have no roads connecting them with hospitals or specialists, so people depend on local clinics and a cadre of devoted primary care doctors.

I followed one young family physician, Dr. Adam McMahan, on his regular weekly visit to the clinic in the village of Klukwan.

It’s a speck of a town alongside the Chilkat River in Southeast Alaska, framed by snowy mountains that loom in the distance.

The clinic staff drives up to Klukwan twice a week from the bigger town of Haines, 22 miles to the south.

On our drive, McMahan points out the clouds of dust blowing off sandbars along the river: “Likely today we’ll see somebody with a lung issue because of the sand coming off the river.”

Klukwan is populated mostly by Alaska Natives of the Tlingit tribe, fewer than 100 people in all, with a few hundred more people in the surrounding area.

Over the three years that he’s been practicing medicine in Klukwan, McMahan has come to know his patients well, and that becomes clear as he begins the day’s consultations.

With patient Lani Hotch, along with reviewing her cholesterol and blood sugar levels, McMahan remembers that she has a new dog. “What type of puppy did you get?” he asks her. (A yellow Lab.)

With fisherman Henry Chatoney, he wonders, “Hey, did you find a deckhand?”

And knowing that Everett Simons grows great potatoes and has been put on a low-starch diet for his diabetes, the doctor joshes, “How often are you sneaking a potato?”

This is the kind of intimate, full-spectrum family medicine the 34-year-old doctor loves.

“I know that Everett, he’s an amazing potato farmer,” he says. “I know that Henry is full of adventures and has fished Bristol Bay for longer than I’ve been alive. You get to know your patients as human.”

McMahan can trace his inspiration to become a physician back to a striking series of black-and-white photographs he saw in a magazine when he was a teenager. His grandfather was a pediatrician and had a 1948 issue of Life magazine on a shelf in his office. The photo essay by W. Eugene Smith, “Country Doctor,” shows a dedicated general practitioner tending to his patients in rural Colorado: making house calls, taping up broken ribs, stitching wounds.

“Those stills were really captivating,” McMahan says. “I was looking at those the other day and they’re not that different than what we do now here in Alaska.”

The Klukwan clinic is open on Tuesdays and Thursdays. It’s part of the Southeast Alaska Regional Health Consortium, or SEARHC.

The clinic has two exam rooms, a dental suite and a small lab for basic diagnostics.

“A lot of it is doing the best we can in the moment with limited resources,” McMahan says. “I can’t send you down the street to go see a cardiologist. I can’t get a CT [scan] done in 10 minutes.”

On the day we visit, McMahan is seeing mostly elderly patients, including one, a Tlingit elder named Evelyn Hotch, who is confined to her bed after a stroke.

So with stethoscope looped around his neck, McMahan walks down the road to pay her a house call.

Once we’re inside her home, the first thing Evelyn Hotch does is offer all of us a snack: dried red seaweed. “You came to an Indian house,” she says, “and this is what Indians like to eat!”

It’s only after McMahan has shared her seaweed and inquired about the grandchildren whose photos cover just about every inch of her walls that he turns to her medical issues, asking about pain and what supplies she needs. “We’ll see you next week, OK?” he says as he heads out.

The goal with regular primary care like this is to keep people out of the emergency room. But in such a small, remote town, what happens in an emergency? There’s a volunteer ambulance squad that will drive up from Haines, about a half hour away.

Haines doesn’t have a hospital, though, so critically ill or injured patients might need to be medevacked by Coast Guard helicopter from Haines to Juneau.

“The vibratory effect of that, when your heart rate’s beating fast and you’ve got a really sick patient, hearing the helicopter, hearing the blades, is such a relief,” McMahan says.

Once a patient makes it to Juneau, he or she might still need to be flown by air ambulance to bigger hospitals in Anchorage or Seattle, hundreds of miles away.

“The Rubik’s Cube of resource coordination and transport is probably one of our biggest challenges,” McMahan says.

In part because of these complicated logistics, Alaska has some of the highest health care costs in the country.

For people who don’t have health insurance, “it’s often cause for catastrophe, financially,” McMahan says.

But, he adds, since Alaska expanded its Medicaid program in September 2015 under the Affordable Care Act, he is able to treat patients now who had gone for years without access to primary care.

More than 32,000 Alaskans have gained health coverage through Medicaid expansion.

McMahan worries about what might happen to his patients if the ACA is repealed and replaced by Congress: “I think if the Medicaid expansion is undercut, people will go without care,” he tells me. “They’re not going to be able to afford it.”

Even though the current health care debate is taking place thousands of miles away from his clinic, it hits home.

“It’s amazing how politics impact my day-to-day life when it comes to just getting somebody basic, basic care,” he says.

For now, though, Dr. McMahan turns to his immediate concerns: He has more patients to see, and more stories to hear.

The “Our Land” series is produced by Elissa Nadworny.

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