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Five Reasons the Trump Administration Must “Go Big” on Rural Health

Rural health care should obviously be a focus for the new Administration. In his first address to Congress, President Trump called on Congress to work together “to repeal and replace Obamacare with reforms that expand choice, increase access, lower costs, and at the same time, provide better health care.”

The National Rural Health Association urges the Administration and Congress to make health care work in rural America. A large policy initiative on rural health care means:

1.) Jobs.  In most rural communities, rural health care represents the largest, or second largest, employer in the community.  If you are bringing jobs back to the middle class, an investment in solving the chronic workforce shortages plaguing rural America is a no-brainer. During the Great Recession, rural counties were shedding 200,000 jobs per year and rural unemployment stood at nearly 10 percent.  Economic recovery hasn’t returned to rural America.  In fact, 95% of the jobs that have returned after the Great Recession have been to urban, not rural areas.

2.) Investment in infrastructure.  Rural hospitals are closing across the U.S. at an alarming rate. Already 80 rural hospitals have closed and right now, 673 additional facilities are vulnerable and could close—this represents more than 1/3 of rural hospitals. Many of these facilities are dated – built in the 1950s – and were designed for care from a bygone age.  A new program for improved access to broadband, technology grants, and access to capital, seems like a solid way to achieve the stated goal of rebuilding our aging infrastructure.

3.) Low costs – high returns. Rural Medicare payments represents a rather small portion of the overall Federal health care budget.  By stopping devastating Medicare cuts and proposing targeted Medicare increases for rural providers, the new Administration can point to an immediate improvement in access to care for rural America. A January 2017 CDC study indicates that “the death rate gap between urban and rural America is getting wider.”  The rates of the five leading causes of death — heart disease, cancer, unintentional injuries, chronic respiratory disease, and stroke — are higher among rural Americans. Access is key to addressing these health care disparities.

4.) New payment models. Rural America has demonstrated the ability to provide quality care, and now is time to invest in new demonstration projects targeting rural populations. To create economic vitality in rural America – to make rural America work again –  the rural hospital closure crisis must end. Stopping Medicare cuts to rural hospitals, as in the Save Rural Hospital Act, will stabilize rural hospitals, stabilize rural communities and create a new model for rural hospitals.   

5.) Don’t forget the forgotten.  Rural America voted for Trump - Election exit polls indicate that rural America voted for Donald Trump 3 to 1. In many cases, this vote represented a loss of hope among a population which has long been overlooked and marginalized, the rural middle class, and rural low income.  A rural health focus demonstrates that this administration “gets it” and plans to take action on their behalf.  This includes empowering both the White House Rural Council and the Centers for Medicare and Medicaid Rural Council to identify burdensome regulations ensuring that rural America has a strong voice within the vast federal government.

So, the question is not whether the new Administration will launch a rural health initiative, but rather why would they choose not to engage? Rural America matters, and it’s time for all policy leaders to recognize the new reality.

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