Why Rural Health Must Matter

This is a guest post from Michelle Rathman, President & CEO of Impact! Communications, Inc. This was submitted in response to our request for responses the newly proposed budget.


I have worked in the healthcare sector for the past 21 years, first in public health, and now in rural for over 15 years.  As I travel from state to state, town to town, small hospital to small hospital, I shake hands and have conversations with dedicated, talented, and selfless men and women working tirelessly to support the health and wellbeing of their communities while also under tremendous pressure to do more with far less.

Each place I go, I eat at local restaurants, shop at local grocery stores, and every chance I get, walk along main streets to observe and look into the faces of people who are relying on their hospital to ‘always’ be there for them.  I spend a lot of time in hospital and clinic waiting rooms with the intention if gaining insight that will help hospital teams to improve patient engagement and experiences. I always leave with much more insight than anticipated.

That rural healthcare is, for lack of a more suitable description, under attack, makes absolutely no logical sense. Not in my mind anyhow.  I recognize there is a lot of unmet needs and compelling demands facing our country.  I also believe it's critical to understand that over 60 million people living in 60% of our nation’s most at-risk counties will face unimaginable circumstances if the AHCA or the 2018 Fiscal Budget, (oddly titled, “A New Foundation for American Greatness,”) passes in their current forms.

I’ve been thinking.  If every congressional and senate leader would spend a day in a rural hospital observing and listening (not defending or campaigning), I wonder if they would gain a better understanding as to why it is so essential to protect rural health and strengthen the safety net. While they receive letters from constituents or stand in front of emotionally-charged town halls, and even though we have a bevy of passionate and smart rural health advocates and stakeholders knocking on their Capitol Hill doors, nothing, not any other thing, compares to being there – present with the people affected by these life-altering decisions.

Representatives who come from rural have an understanding of the stakes, better than their non-rural counterparts it seems. The invitation today is for those who don’t know rural, even if they think they do, to spend time in someone else’s hometown.  We must do all we can to open their minds and hearts to learn firsthand what it’s like to have one option for care and wake each morning with the prospect of the only healthcare resource closing. To make matters worse, live day to day with mounting anxiety over losing insurance because there is no company willing to provide coverage in the region, or becomes completely unaffordable.

I don’t live in the rural communities I visit, (although it feels like I do because I’m on the road roughly 26-30 weeks each year) so why do I care so much?  I care because it is the right and responsible thing to do. Whether you live in rural, it is very likely you know someone who has or does. Maybe it’s a grandparent, a cousin, a guy you used to work with, or a classmate from college. 

The issues facing rural communities, including limited access  to jobs, housing, food, education, and healthcare are not just ‘rural’ problems. These are concerns that distress our country as a whole. I am of the same belief when urban centers face these issues; that is, rural folks should care about them too.  It is never okay for any group of people to be without life's necessities.  When rural communities lose their hospitals, they lose health care, and that means emergency rooms, doctors, nurses, diagnostic services, physical therapy, in other words, the works. The rate at which rural hospitals are closing, and projected to close if we keep this up, is alarming. I don't believe it's up to only those in the rural sector to fix it alone - they can't.

Consider that when a rural hospital closes, the health care needs of the community do not vanish, they just disperse. If you live in an area where a hospital 35, 50, 100 miles of you has closed, you're feeling it; you may not even know it. Rural hospital closures cause lives to be lost, displaced and changed forever.  Communities slowly (or quickly) become unrecognizable.

Rural hospitals are up against the clock, and just because you may not see a farm from your front door, it’s essential to understand that there is simply not going to be enough health care to go around for all of us. It's unfair and unreasonable that others, by way of their geography, have no health care and while others get theirs. All are deserving of quality, safe healthcare.  Now, more than ever, we need healthcare resources and leaders to focus greater efforts on health education that leads to improved population health. Instead, they are jumping through hoops of fire.  Shaming people for their medical predicament and punishing them for having a preexisting condition is not the way to greatness.  Doctors and health providers need to be compensated fairly and adequately for their amazing work, for treating chronic illnesses, saving lives, caring for sick kids and elderly patients. We must keep protections in place that support medical education and reward those willing and wanting to serve the healthcare needs of rural populations, not put up more roadblocks. Rural hospitals should not be set up to fail while the larger systems with more affluent communities and covered lives thrive. The passing of the President's proposed budget, along with health care legislation sitting before the Senate, does all this,and sadly, more. 

There is no perfect answer or one solution of course.  Certainly, we can do much better than this.  We must.

Working with The National Organization of State Offices of Rural Health in their efforts to bring greater awareness to National Rural Health Day, November 16,2017, I have developed #PoweofRural.  The goal for this #PoweofRural movement is to bring together industry and non-industry stakeholders to innovate, collaborate, education and communicate to benefit rural lives and those who dedicate their life’s work to improving rural health. 

Buckets of Opportunity

The Rural Assembly's coordinator Whitney Kimball Coe was published in New America this week in the piece "Buckets of Opportunity in Rural America."

In the article, Coe talked about the recent Big Ideas Forum and the current plight of rural America.

"It’s more critical than ever to keep rural places in the nation’s consciousness, not because of the rural vote in the 2016 election, but because the futures of the city and the countryside are intertwined. Rural health and prosperity is essential for all of us," she says.

Read the full piece here.

Invest in People in Place

This guest post is the Rural Voices for Conservation Coalition’s contribution to the Rural Assembly’s call for Big Ideas.


We have to do better.

“The employment rate in rural areas was 2.9 percent lower in mid-2016 than it was in early 2007, just before the Great Recession started. In contrast, the employment rate in metropolitan areas is 4.8 percent higher than its 2007 level, and businesses are adding jobs twice as fast in urban areas as they are in rural ones. The recovery from the Great Recession is dramatically different than recovery from past recessions - there has been no jobs recovery in most of rural America. . .

  Image credit: Ashley Rood

Image credit: Ashley Rood

Rural vitality is critical to American progress, prosperity, and political stability. Our nation cannot achieve its economic or social ideals if the cultivation of opportunity is concentrated in urban areas. Rural America is both the home and the steward of abundant natural resources on which the American economy depends, and through which the American spirit is nourished.”
These ideas set the stage well. They are familiar, yet impactful, words from Nils Christoffersen, a leader within the Rural Voices for Conservation Coalition (RVCC).

RVCC’s vision is simple: healthy landscapes and vibrant rural communities throughout the American West. We have to do better to get us there. We need some Big Ideas. We need to invest in people in place.

To find these Big Ideas it’s important to remember, there is no one ideology that represents rural America. There isn’t a one-size fits all policy. There isn’t one big fix. Small, dispersed solutions can make a big impact. We need to not only scale up, but to find ways to scale out.

How do we catalyze the kind of rural communities we need? Invest in local jobs and training for community-based organizations. Community-based organizations play essential roles in designing solutions that cannot be filled by government agencies and businesses on their own. These organizations serve as the nodes of innovation, the liaison between decision-makers, and the heartbeat of the communities they represent. Without these groups and this core capacity, the rural places they serve will slowly fade away. The philanthropic community needs to invest in these community-based organizations. They in turn, must advocate for a clear platform of priorities that articulates a case for positive reinvestment in rural America.

Investing in local jobs and training for community based organizations is at the core of what RVCC promotes because we believe that community, economic and environmental health go hand in hand. Investment in the stewardship of our forests, watersheds and rangelands creates local jobs, while providing clean water and clean air for the Nation. We believe our places, our people, and our work matters.

As we pursue this big idea and others—we need to be prepared to spend some money and make some noise. We’ve got a short window where a lot of people are paying attention who normally wouldn't be.

We will do better.

To learn more about RVCC, and our strategy for rural community prosperity in the West, check out our most current transition memo for the new administration.

What if We Kept One Old "Big Idea" – Or What If We Dumped It?

This is a guest post from Joe Belden, a writer and consultant based in Washington, DC.


The Housing Act of 1949 created the USDA rural housing programs.  They may have been a medium-sized idea at the time but grew rapidly in the 1960s and 70s into a big idea – a major resource that has allowed over 2.6 million low-income rural families to become homeowners or live in decent and affordable rental units.  These programs have undergone major budget cuts in recent years but are worthy of rejuvenation and restoration.  Conservatives may like that most of the federal billions invested in these programs over the years are loans and get repaid to the federal government with interest.  

Today these programs are at a crossroads.  They have been cut very substantially since the early 1980s, and there is some interest in turning the programs into block grants or in moving them to HUD.  Instead what if we not only kept these efforts but rejuvenated them to robust funding levels?      

The biggest USDA housing effort is the Sec. 502 home mortgage loan program.  Since 1950 it has provided over $71.5 billion – all loans – to allow rural families to build or buy 2,152,757 modest homes.  All the borrowers are low-income and most of them would never have become homeowners without the Sec. 502 loans.  (A subset of this program is a self-help, sweat equity effort in which families receive a  Sec. 502 mortgage but also cooperatively build their own homes in a group effort, contributing 65% of the labor needed.  Conservatives should love this one.)  USDA itself is the bank here, making and servicing the loans (a really big idea that have may have less attraction to conservatives).  Sometimes called “a hand up, not a handout,” the program has allowed families to build equity, and it does not make predatory loans to unprepared borrowers.  Today about 7,000 new homes are being supported a year, but in the late 1970s this figure was over 100,000 homes a year. 

On the rental side, since 1963 the USDA Sec. 515 multifamily program has provided $15.8 billion in loans to sponsors who have built 533,473 low-income apartments in every state.  Today many of these units are in danger of being lost from the affordable housing stock.  In many rural places these small projects are some of the only rental housing in the community.  Today no new units are being built, but in the late 1970s over 30,000 apartments a year were financed.  

These are resources worth saving – and worth funding at more robust levels.   Another what if (one that is my speculation):  What if you cut back by 90 to 100% programs that improve the lives of low- and moderate-income rural people?  Their opportunities for homeownership or a decent, affordable apartment become much less.  Do many of those people turn sour and vote for a demagogue promising salvation?