As the coronavirus pandemic wreaks havoc on America, Congress has passed three bills to help the country weather the slowdown in economic activity due to necessary stay-at-home orders. But while these packages included help for individuals, small businesses and state and local governments, the provisions for rural America are sorely lacking.
Reports on struggles to stop the spread of this virus have centered on the tri-state New York area, as well as major cities like Detroit and New Orleans. However, COVID-19 knows no boundaries, and its spread throughout rural America is gaining speed. Given the Trump administration's late start in fighting the virus, infection and death rates will continue to rise and no areas will be spared.
This is already the reality for many rural communities.
We saw a precipitous increase in coronavirus cases in rural America just in the last week of March. Between March 23 and April 1, the number of cases reported nearly tripled in nonmetropolitan counties. A major concern is that rural communities will be particularly disadvantaged by the pandemic because of what makes rural America unique.
Rural areas are vulnerable
Rural communities have disproportionate shares of residents who are older, disabled and have chronic health conditions. These areas also have fewer financial resources and a struggling health care infrastructure.
Kaiser Health News produced a sobering map showing that the vast majority of rural counties across states like South Dakota and Georgia have either hospitals with no intensive care units or no hospitals at all. Meanwhile, our farmers in these areas are facing severe financial hardships because of trade wars, market inequities and workforce losses.
The fact that rural America is not monolithic is important to understanding the potential impact of COVID-19 on these communities.
For example, several rural communities in the West are tourist destinations and, as a result, were among the first rural communities to experience the outbreak. These communities also tend to have a large number of retirees, making the health consequences worrisome.
In rural areas in the South, a large portion of the population is African American — including Albany, Georgia, which per capita has the fourth highest rate of COVID-19 cases in the United States. Data shows that African Americans are particularly susceptible to severe complications from the virus due to long standing structural inequities.
This is especially troubling because of the number of hospital closures in this region and because half of the 14 states that have yet to expand Medicaid are in the Southeast.
Rural parts of the Midwest are also starting to see increases in their reported cases, though much of this is driven by the major metropolitan areas. However, as of April 6, seven states did not have stay-at-home orders — including Iowa, Nebraska, North Dakota and South Dakota in the Midwest, as well as Arkansas, Utah and Wyoming.
Meanwhile, California and Washington states have shown that stringent stay-at-home orders can flatten the curve. The longer the remaining states wait, the more the virus will continue to spread across rural communities.
While the situation is dire, federal and state governments have a chance to act quickly to help rural America:
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►We can remove barriers for immigrant medical professionals to practice in this country. Immigrant health care providers have been vital for rural communities before this crisis and will be essential in successfully combating the epidemic.
►We need to have transparency in the allocation of medical supplies and resources from the federal government to states. Right now, states are competing with each other for necessary medical equipment, and that's slowing the process of treatment for already infected individuals. Time is of the essence, and the process to access needed equipment needs to be fast and efficient.
Expanding Medicaid is crucial
►We need to make sure our most vulnerable populations are able to get COVID-related care by providing free testing and low- or no-cost treatment for conditions related to COVID-19. Rather than scaling down testing, an aggressive expansion of testing in rural communities is imperative.
►We need to find ways to make community health centers and rural hospitals more economically viable in the long run. Medicaid is one crucial tool for achieving this outcome. For states that have not expanded Medicaid, they must expand it now. While we must ensure federal emergency and long-term funding for our community health centers for their long-term stability, almost half of health center patients are Medicaid beneficiaries. Expanding Medicaid can also help struggling rural hospitals become financially sustainable. These expansions, along with removing state barriers to Medicaid enrollment, would offer greater access to coverage to those who need it most.
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►Finally, for those who are not eligible for Medicaid, the federal government should expand access to comprehensive health care coverage by establishing a one-time special enrollment period for the individual insurance marketplace. This too would enable more Americans to access coverage during this extraordinary time.
We are facing many competing challenges in the face of the COVID-19 crisis. But we urge Congress and state governments to act now to meet the unique and urgent needs of the rural communities that are awaiting their response.
Democrat Tom Daschle of South Dakota is a former U.S. Senate majority leader and founder and CEO of The Daschle Group. Stacey Abrams, a former Democratic leader of the Georgia House of Representatives, was the first African American woman nominee of a major party for governor and is the founder of Fair Fight and the Southern Economic Advancement Project. Follow them on Twitter: @TomDaschle and @staceyabrams