The World Health Organization says that “health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”
Republican speakers and administration officials at the National Rural Health Association’s 31st Rural Health Policy Institute in Washington, DC. seemed to agree.
U.S. Senator Todd Young (R-Indiana) spoke about the issue of prohibitive costs of healthcare, pointing out that 80 percent of those costs are not associated with healthcare delivery.
“It’s other factors, it’s socio-economic factors, environmental factors, access for reliable transportation, access to stable housing,” Young told the audience.
Eric Hargan, deputy secretary of Health and Human Services, presented a laundry list of health care issues and approaches that the administration wants to tackle. The top four priorities were prevention, sustainable financing, technology to address these issues, and workforce solutions.
“These areas are going to drive a lot of action from HHS and were identified as strategic priorities in the annual budget by President Trump,” said Hargan.
Young and Hargan spoke one day after the Trump administration released its proposed spending plan for the coming fiscal year. The budget proposes cuts for the Department of Health and Human Services by 9 percent. Part of that cost-saving will come from reductions of $2 billion over the next 10 years in a program designed to improve access to rural healthcare.
Hargan addressed programs targeting the opioid epidemic and expanding telehealth solutions. He did not give details on how the federal government might address the closure of rural hospitals. He did discuss mergers of hospitals and health centers.
“We also need to think broadly about how rural health care may look … in the future. The right sustainable model for healthcare may not always be the traditional kind of 20th century hospital model,” he added.
Beyond cuts to HHS, the White House proposed an 8 percent cut to USDA’s budget, 15 percent cut to the Department of Housing and Urban Development and a 13 percent cut to the Department of Transportation, as well as almost 27 percent reductions to the EPA’s budget.
Combined, these cuts may become a serious roadblock on the path to advancing rural health
Hargan and Young addressed the National Rural Health Association conference on the day New Hampshire voters headed to the polls in the first presidential primary of the 2020 election. While rural health issues like hospital closures have captured some headlines, health policy may not be top of mind for voters in rural communities.
In another different panel at the conference, Abby Vesoulis with TIME Magazine, Marilyn Serafini with Bipartisan Policy Center and Dee Davis, the president of the Center for Rural Strategies discussed rural vote in 2020 and the perceived impacts of healthcare policy in deciding the presidency this coming November. (DISCLOSURE: The Center for Rural Strategies publishes the Daily Yonder.)
Vesoulis visited rural areas and learned that policy may not be the top of mind.
“When we’re talking about rural voters and 2020, we keep saying ‘Medicare for all,’ Medicare for all who want it. But that’s not what a lot of rural voters are concerned about. They’re concerned about, ‘do I have a doctor that I can drive to in case of an emergency?” she said.
Serafini said the Bipartisan Policy Center’s research did confirm that a lot of voters across different demographics find rural healthcare one of the most important issues. However, that doesn’t necessarily translate into a vote.
“Very few go to the pole on anything, whether it be healthcare or politically charged issues like abortion,” she said. “They could feel very strongly about that but we know that most people, even if they say that healthcare or rural healthcare is very important to them, that there are a lot of other things that that will come into play during the election.”
Davis said he thinks rural people vote primarily on culture, story, or identity and not necessarily specific policies or economic programs..
“They may be,” Davis said. “But they go as hard for their own identity. And in a country where more and more affinity takes on more and more importance that really suffuses the whole electoral process.”
The ability to tell a compelling story about rural identity may have been President Trump’s biggest appeal to rural voters in 2016. “Trump was very good at elevating the story of coal miners, of loggers, of farmers, of bringing those jobs and those communities into prominence,” Davis said
People in less affluent, rural counties don’t necessarily vote policy first. “Their self interest isn’t all about the economy,” he added.
It’s not a coincidence that the Democrats are waking up to the concept of the narrative as well. Vesoulis identified that issues go beyond healthcare in rural areas: “If we’re looking at rural areas, we need to look at what’s happening in farmland.”
Farmland pushed back hard against the 2020 budget proposal. National Family Farm Coalition, Missouri Rural Crisis Center and One Country Project were among organizations that responded with strong criticism. So did the Housing Assistance Council.
Vesoulis said that during her time traveling the country she could “see candidates on the field really honing in on their origin story.” Vesoulis thinks Democrats, to some degree, are trying to make amends for ostracising rural voters, while Trump told stories that recognized the culture of rural voters.
Davis pointed out the collective assumption that the vast majority of rural voters uncritically supports Trump.
“The reality is that in the 2018 midterm elections, the biggest flip from Republican to Democrat happened in rural areas,” he said. “Eighty-nine percent of [that] change was people flipping from voting Republican in 2016 and voting for a Democrat [in 2018].”
CORRECTION: An earlier version of this story misquoted Abby Vesoulis. “Medicare for all compliant” should have been “Medicare for all who want it.” The complete, corrected quote is as follows. “When we’re talking about rural voters and 2020, we keep saying ‘Medicare for all,’ Medicare for all who want it. But that’s not what a lot of rural voters are concerned about. They’re concerned about, ‘do I have a doctor that I can drive to in case of an emergency?” The Daily Yonder regrets the error.
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