Rural people are aware of the health care crisis affecting their communities. Hospital closures are concentrated in the south, but even here in Michigan the issues of health care access, cost, and quality are the top concern of rural residents. I know because I went out and talked to them.
Rural America is facing a health care crisis. Hospitals serving rural communities have been closing at alarming rates over the last decade, and hundreds more are at risk for closure in the next few years. The rate of these closures accelerated with the implementation of the Affordable Care Act, resulting in the average distance between a rural American and a health provider increasing rapidly. Those farther from healthcare providers are less likely to visit a doctor, even when covered by government provided insurance, especially those with conditions requiring a specialist. Individuals who live far from providers are often simply unable to access care. This problem is compounded by the demographics of rural areas, which are poorer, older, sicker, and more likely to be injured than their urban and suburban counterparts.
I grew up in a town of 300 in rural Northern Michigan and experienced the complicated politics first hand. My home county was among many in our state that went for Obama twice and then Trump. To better understand the politics of these places and their people, I spent several weekends over the fall and early winter meeting with groups in some of these counties. Modeling the work of Kathy Cramer in her book “The Politics of Resentment” (2016), I invited myself into “klatches” of friends who met regularly to discuss politics and culture. The groups were diverse in age, ranging from twenty somethings through those well into retirement, and in politics, with a close to even split between self-identified Republicans and Democrats (although some of the Democrats voted for Trump).
Health care was, almost universally, the top concern of these klatches. Younger people were most concerned about affordability, while older folks were more concerned about quality of care. Everyone was concerned about access, and the distance necessary to travel for quality care and specialists. Don, a retired Republican in Northwest Michigan, discussed his concerns over access: “If you need some kind of special treatment…. forget it. You’ve got to drive a couple hours down to Grand Rapids probably, and that’s if you can get an appointment.” Frank, a small tradesman also in Northwest Michigan, like many respondents had negative experiences with providers near his hometown. These experiences led him to distrust the quality of care available to him and his loved ones. “I tell you what, I think they give us all the shitty doctors up here,” he said. “We have to go up to Traverse [an hour-and-a-half drive] or down to Grand Rapids to get someone that’ll actually help.”
Very often, these concerns took surprising forms given the respondents professed partisanship. Over and over, self-identified Trump voters and Republicans expressed a desire for the government to step in and fix health care, even if it meant significant investment. To them it wasn’t as much about higher or lower taxes as it was of seeing (or not seeing) the benefits of the taxes they paid. Gary, a self-professed Trump voter in Northern Michigan captured a common sentiment: “Look man, I hate paying taxes, because I don’t trust the government to do anything right. But these hospitals, they’re run by private companies, and they’re not getting it right either. They don’t care about you; they just want to take your money. I wouldn’t even mind [paying higher taxes] so much, if it meant I could go to a good doctor when I need it. Right now, first of all, there’s not many good doctors around here.” Linda, a stay-at-home mom, and Republican put it more succinctly. “I was against ObamaCare, but I don’t think taking away people’s insurance is right either. I just don’t want to be paying for somebody else’s when I don’t see [any benefit]. If they’re taking money out of my paycheck on it, it should be less expensive for me...and everybody that needs it.”
Many went farther, expressing intrigue with ideas like Medicare for All. This seems less surprising when put into context with totality of the conversations I had. Most people I spoke too were much more open to the idea of universal programs than means-tested programs — provided the taxes they paid benefited them and their loved ones. Many complained about money going “downstate” to the state Capitol and never coming back. Others complained about supporting neighbors they perceived as dependent on benefits. Shawn, a Trump voter in his late twenties approved of universal health care proposals he had heard about: “I hate [to see] my taxes going up, but if they’re going to [anyway], it should be for something that’s for everyone.”
Support for progressive policy options in rural areas shouldn't come as a surprise. These voters are not ideologues for the most part. I spoke to many who voted for Obama once or twice before voting for Trump. We also know that rural voters identify as conservative largely for cultural as opposed to economic reasons, making them open to other traditionally left policy proposals. Democrats would be wise to take heed of this. Their path to a majority, at any level, will necessarily cut through many rural districts. If they want to win back those voters, many of whom they only recently lost, they should run on health care, and issue that is felt broadly and deeply. If they doubt the efficacy of this strategy they should do what I did, go out and listen to rural people, in diners and gas stations and garages. They might be pleasantly surprised at what they hear.
 All names have been changed to preserve anonymity.