Rural health could be a powerful issue in the 2020 election

The views expressed by contributors are their own and not the view of The Hill

As former senators from rural states, we’ve seen firsthand the importance of providing affordable, quality care to those living in rural areas. The isolation that exists in some parts of South Dakota and Maine means residents have limited access to care.

Many patients must travel great distances to even reach a hospital. Yet more and more rural hospitals are closing around the country. In fact, 106 of them have shut down since 2010. It is staggering to think of these challenges when, compared to people living in urban and suburban areas, rural Americans are generally older and poorer, more uninsured or underinsured, and therefore less healthy.

Rural health is a bipartisan issue that greatly concerns all Americans. While it has never been a top tier issue on the campaign trail, we believe it could be a powerful topic in the 2020 election and demands attention by policymakers and candidates.

Our survey with the American Heart Association conducted by Morning Consult, shows that 92 percent of Democrats and 93 percent of Republicans consider access to rural health an important issue. Perhaps even more encouraging, three in five voters say they are more likely to endorse a candidate who makes access to rural health care a priority.

At a time when Democrats and Republicans agree on little, it is clear rural health transcends political parties. However, efforts by lawmakers to revive rural America have been largely unsuccessful in recent years. People living in remote areas continue to face greater disparities and barriers to high-quality health care than those in non-rural communities.

More than half of the rural voters polled say access to medical specialists, such as cardiologists, oncologists and gynecologists, is a problem in their local community, compared to 33 percent of non-rural voters, and more than one-quarter (27 percent) say it is difficult to access behavioral health professionals, compared to 16 percent of non-rural voters. Forty-seven percent of rural voters also agree access to quality health care is a challenge, compared to 34 percent of non-rural voters.

In addition to our national poll, we surveyed adults living in three rural states that will be important in the 2020 election: Iowa, North Carolina, and Texas. When it comes to accessing medical services or treatment, rural voters are more likely than urban and suburban voters to agree that appointment availability (56 vs. 50 percent) and the distance to receive care (50 vs. 37 percent) are obstacles.

Today, nearly 60 million Americans live in rural communities. Data from the Centers for Disease Control and Prevention show these residents have a greater risk of dying from heart disease, cancer, stroke, and chronic lower respiratory disease, and that should prompt candidates and policymakers alike, to take action.

Four policy options could help rural communities receive the quality care they deserve:

First, allow rural communities to adjust their health care services to better suit the needs of their local area. Critical Access Hospitals and other rural inpatient facilities need pathways to transform, in order to focus on emergency and outpatient services, and primary and prevention-focused care.

In Texas alone, 17 hospitals have closed in the past nine years. One in five Texas voters say it is difficult to access hospitals, urgent care facilities, primary care physicians, and medical specialists in their community.

Second, create new payment mechanisms for rural providers that account for low patient volumes, growing health care needs, and demographic trends in rural communities. Facilitate alternative payment and care delivery models that could help hospitals transition to value-based care.

Third, build and support a sustainable and diverse workforce. The patient-to-primary care physician ratio in urban areas is 53 physicians per 100,000 people, while rural areas have only 40 physicians for the same number of residents.  

Indeed, our survey shows that one in three rural adults in North Carolina — and 46 percent in Iowa — believe that access to medical specialists and quality health care are problems in their communities. New workforce models should be designed with universities and community health centers to expose providers to rural environments and telemedicine. Nurse practitioners, physician assistants, and pharmacists could also help fill vital primary care roles.

Fourth, expand telemedicine services to virtually connect patients with medical professionals. To be an effective tool, rural areas need adequate broadband and reimbursement for services.

Geography should never be an impediment to quality care. Tackling the barriers to delivering high-quality and efficient health care to rural America is long overdue. With the 2020 election campaign underway, candidates and policymakers have an opportunity to create a health care system that better serves all Americans.

Tom Daschle is a former Senate majority leader from South Dakota and a co-founder of the Bipartisan Policy Center.  Olympia Snowe is a former Senator from Maine and a BPC board member and senior fellow. They co-chair BPC’s Rural Health Task Force.