Although 2023 is a relatively light election year, the attention rural health care is receiving in a handful of gubernatorial and legislative races could signal the issue’s importance in the much more consequential 2024 election season.
In Kentucky, Louisiana and Mississippi, gubernatorial candidates are squaring off over whether to expand Medicaid or roll it back, and how Medicaid enrollment will affect rural hospitals.
Michael Shepherd, assistant professor in the Department of Government and the Health and Society program at the University of Texas, Austin, said in an interview with the Daily Yonder that having access to and affording health care are important to rural voters.
“Rural voters care a lot about health care and they talk about it quite often,” he said. “I think accessibility has increasingly come to reach parity with costs over time… Ten or 15 years ago, the conversation would have entirely been about costs. Accessibility is much more of an issue now in rural areas.”
Health care is popping up in ads as part of the Kentucky governor’s race. An ad from the Democratic Governors’ Association this year criticizes gubernatorial candidate Attorney General Daniel Cameron’s plan to change the requirements for Medicaid. The plan would leave an estimated 95,000 people without health care, the ad suggests, and lead to the closing of rural hospitals across the state.
Emma O’Brien, Democratic Governors’ Association press secretary, said rural health care and hospital closures are issues rural voters are focusing on. In governor’s races in Mississippi and Louisiana, candidates are running on Medicaid expansion, rural hospital payments and ensuring voters have access to healthcare coverage.
“Too many rural Americans already have to drive for miles to get the health care they need, or are one hospital closure away from being unable to get lifesaving treatment,” O’Brien said. “Hospitals are the lifeblood for rural communities across the country, not only for the care they provide, but the jobs they support. Refusing to expand Medicaid or ripping health care away from hundreds of thousands of Americans puts the health of rural communities at risk.”
Candidates in Kentucky have said it’s something they’ve been meeting with rural hospitals about.
In a forum before the Kentucky Chamber of Commerce in September, 2023, candidate Cameron said he would not roll back Medicaid expansion, but would seek to implement a work requirement for “able-bodied individuals” in order to keep benefits.
“When I talked to our health care providers, the expansion of Medicaid was important, particularly for our rural providers; I understand that,” Cameron said during the forum. “But what I don’t understand is if you expand Medicaid coverage to able-bodied individuals, why we didn’t condition that on some sort of work requirement.”
In contrast, Kentucky Governor Andy Beshear said he would expand Medicaid further in order to address workforce challenges.
“We have to get more of our people healthy,” he said during the forum. “It’s why I expanded Medicaid for vision, hearing and dental because if someone’s out of the workforce and we want them to go to a job, they’ve got to be able to see well enough to drive to the job. A pair of glasses isn’t that expensive, let’s get them for them.”
In Mississippi, Governor Tate Reeves recently announced his health care plan that would inject nearly $700 million into the state’s hospitals through two payment initiatives. The first would provide direct payment to hospitals to bring their reimbursement rates up, and the second would supplement Medicaid base payment rates. Reeves’ announcement comes as his opponent, Democrat Brandon Presley has focused his campaign on expanding Medicaid.
“Mississippi is a largely rural state, so rural healthcare is integral to any healthcare policy making. According to the National Rural Health Association, 64% of our rural hospitals are operating on a negative margin. As with any business, operations don’t continue long on negative margins,” Chad Netterville, director of the Mississippi Rural Hospital Alliance and the Mississippi Hospital Association’s Center for Rural Health said in an email interview with the Daily Yonder.
“The Mississippi Hospital Association has put forth many proposals over the past 10 years to increase healthcare access and coverage and improve healthcare outcomes in our state. The recent attention on healthcare in Mississippi is a welcomed change.”
And in Louisiana, Governor John Bel Edwards expanded Medicaid on his first day in office in 2016. In this year’s election, during a candidate forum in April, six of the seven gubernatorial candidates said they would keep the expansion with one, Louisiana Treasurer John Schroder, saying “maybe.”
Professor Shepherd said rural health and rural hospitals will likely continue to be campaign issues next year during the presidential campaign. It has been before, he said. In 2016, health care as a campaign issue also centered around Medicaid expansion.
“In 2016, it was a bragging point of Republicans who were running for president if they rejected Medicaid expansion in their states,” he said. “People like Bobby Jindal and Scott Walker, their claim to fame when they were trying to become president in 2016 was that they rejected Medicaid expansion and they fought off the federal government and the Democrats.”
That’s likely to be the case again in 2024, he said.
“In 2024, a lot of (the campaign issues) will be a function of the Republican primary candidates emphasizing their battles against Obamacare,” he said. “On the Democratic side is going to be an attempt to focus on the policy successes and differences between the two… I do think the recovery from Covid-19 will end up being a huge portion of what gets discussed and whether or not there’s been unequal recovery.”
However, he said, many times the inclusion of an issue like rural health doesn’t come from the voters, but from the politicians themselves.
“There does seem to be quite a lot of discussion of these things on the campaign trail,” he said. “Political scientists think that most of the time when voters tell you some particular issue is important or some particular issue is on their minds, it’s because the politicians themselves are talking about it. They play a critical role in helping to find for voters what are the politically relevant things for them to consider.”