Rural Hospitals and COVID-19

Anyone who knows my background would know that I’ve spent most of my life living in a big city. So, you might be asking why I’d take an interest in rural hospitals during COVID-19, and why others should take an interest in this topic as well. There are really three answers to that “why” question:

(1) many rural hospitals were in danger before the pandemic,

(2) many rural hospitals may be in even more danger of closing as a result of the pandemic, and (3) such closures would reduce access to care for many during this pandemic.

Even before COVID-19, many rural hospitals had been closing at an alarming rate. The problem has been particularly bad in poor rural areas here in the United States. The reason for this is often attributed, at least in part, to the fact that some states have decided not to opt for Medicaid expansion, a move that affects the finances of hospitals severely.[1]

With COVID-19, this situation is expected to get even worse, unfortunately, especially in the states that have not expanded Medicaid. That’s not to say that the pandemic isn’t taking a toll on other places, but that toll is expected to be particularly bad in places that have not seen this expansion.[2]

What this will mean is potentially more rural hospital closures, especially in poor rural areas.

It means that many in these places who need urgent care for anything, whether it be for COVID-19 or something else, will need to wait longer to get urgent care that they need, ranging from heart attacks to severe strokes. Furthermore, it will mean that people in the areas affected by these closures will need to travel further to get the care they need, in the process putting more of a burden on the hospitals that do survive (both hospitals that exist in rural areas and ones that do not exist in rural areas).

All of this, in turn, would affect places’ abilities to adequately address COVID-19. I am presenting a rather doomsday scenario because it does sound like a doomsday situation, unless rural hospitals get the help they need.

There are two ways forward from this crisis, as far as I can tell. First, states that have resisted Medicaid expansion should end that resistance immediately. Second, federal assistance to rural hospitals, which from what I have read has been inadequate, should be much more substantial.[3] This is not to say that the situation will be universally great even with these measures because the entire American healthcare system is feeling the strain from COVID-19. However, the measures I suggest above would hopefully slow down some of the financial bleeding many rural hospitals are experiencing.

For any of my readers who live in rural parts of the United States and may be affected by the closures of rural hospitals, you may want to do the following:

  1. See if your state has implemented Medicaid expansion. If not, put pressure on your state officials to expand Medicaid in their states.
  2. Contact your members of Congress (particularly if your member covers some rural areas) to ask them to make sure that rural hospitals are adequately addressing any future COVID-19 relief or stimulus plan.

Yes, I may be a city kid in many ways, but I also know that we need urban, suburban, and rural hospitals alike to be in adequate shape financially as they confront this pandemic. Anything less than that is irresponsible and may result in unnecessarily losses of life.


[1] This Forbes article explains how a lack of Medicaid expansion causes significant financial harm to many rural hospitals: https://www.forbes.com/sites/claryestes/2020/02/24/1-4-rural-hospitals-are-at-risk-of-closure-and-the-problem-is-getting-worse/

[2] https://www.npr.org/2020/04/09/829753752/small-town-hospitals-are-closing-just-as-coronavirus-arrives-in-rural-america

[3] https://www.thegazette.com/subject/news/health/iowa-rural-critical-access-hospitals-money-problems-coronavirus-relief-20201019. This source, which is the paper of record for much of Eastern Iowa, has been consistently covering the issue of federal assistance to rural hospitals.

The Classism of the Trump Administration’s New Guidelines on Legal Immigrants

Last week, it was announced that the Trump administration would have a new regulation, called a “public charge rule,” where (from my understanding) someone applying for admission to the United States or someone who is looking for a change in residency status could be denied their request if they are deemed as likely to be a “public charge” in the future.[1] In other words, if the applicant is deemed to be likely to need some public benefit in the future, such as food stamps, then their application would be denied under the new guidelines.

Critics of the law have deemed this law anti-legal immigration, and those critics are right. Some critics have also deemed that this is anti-poor people, and they are right. However, there is one big word that must be used to describe this rule, a word I don’t seem to hear at all.

That word is classist. Yep, this policy is classist, and blatantly so.

Classism is “prejudice and discrimination based on class,”[2] according to the Merriam-Webster Dictionary. Class is “a group sharing the same economic or social status.”[3] Therefore, a set of guidelines that punishes people for being poor is classist. A rule that keeps people from obtaining green cards or U.S. citizenship because they are deemed as poor enough that they are likely to need Medicaid in the future, which is what these guidelines do, is classist. A rule is classist when it is defended by a Trump administration official by saying, “Give me your tired and your poor who can stand on their own two feet and who will not become a public charge.”[4] The rule is classist, and the defense of the rule is also classist.

And yet, it seems like few people, Republicans, Democrats, or people outside the political system, have actually gone as far as to say that it is classist or even mention the word classism. As I’m writing this, I did a Google Search for “classism Trump administration” within the last 24 hours (I wrote this about 24 hours after the rule was announced) and only found five pages of search results. It’s as if classism itself is not really on the radars of that many people.

Given the fact that the Trump administration’s recent action, it’s time to put classism on the radar, learn about it, and call it out for what it is. Republican and Democratic leaders may be hesitant to call out classism, let alone call it out for what it is, but that should not keep us from being frank about classism and classist policies.


[1] You can find the original source of the rule here: https://s3.amazonaws.com/public-inspection.federalregister.gov/2019-17142.pdf. Alternatively, if you just want to read a summary of the rule, you can read the BBC’s summary here: https://www.bbc.com/news/world-us-canada-49323610

[2] https://www.merriam-webster.com/dictionary/classism

[3] https://www.merriam-webster.com/dictionary/class

[4] https://www.npr.org/2019/08/13/750726795/immigration-chief-give-me-your-tired-your-poor-who-can-stand-on-their-own-2-feet