ļ»æ34. Courageous Conversations about the 2024 Election with Isaac Wright and Dr. Carrie Cochran-McClain
Michelle Rathman: Hello, one and all, and welcome to the Rural Impact. I'm Michelle Rathman, and on behalf of everyone working on this podcast, I mean it sincerely. We thank you for spending some time with us and especially for your interest in conversations that help to connect the dots between policy and rural everything.
Okay, well, today marks Episode two in our series, Courageous Conversations, about the 2024 elections. And we recorded these conversations that you're about to hear at the end of the second week in July. And since that time, the ground under our political feet has certainly shifted now with, President Joe Biden announcing the end to his bid for a second term, and as of the date, I'm recording this, vice president, Kamala Harris, the presumptive nominee for the democratic ticket. But you know, here's the thing, because I'm sure things will change before you hear this as they always do. Regardless of whose names are on the ballot, whether it's for a federal election, state, even your local government, the policies put forth to the American people, including millions of rural voters, will ultimately determine the quality of rural lives.
And for those who live in rural, the impact is different than those who don't. But of course, we know that regardless of your zip code or the view outside your window right now be it a skyscraper, cornfield, mountainside, or a shopping mall, rural matters to all of us. As Senator Heidi Heitkamp reminded us on our last episode of this series. Everybody eats, and if you eat, you best be thinking about the impact that policies have on rural soil, if you will.
Okay, for this second episode in our series, I have the opportunity to talk with Mr. Isaac Wright. And Isaac is the co-founder of the Rural Voter Institute. And I won't go into detail because you're going to hear all about that in just a moment.
But the work that they're doing is incredibly insightful and it all was born out of what happened in, from the 2016 election. So that's all I'm going to say, but I want you to stay tuned for that conversation coming right up after this introduction. And in the second part of this episode, you're going to want to stay with us because I am joined by Carrie Cochran-McClain and Carrie is the chief policy officer at the National Rural Health Association.
And yes, the answer is yes, we are talking about health again, because we know this, whether or not you are a frequent user of health care, you will be at some point in your life. And I asked Carrie to start us off by sharing recent bipartisan legislative activity in support of rural health improvement, including access to care and among other things.
We talked about how the 2024 election may impact rural health policy moving forward, because if you really want to dig in to be a policy wonk, like we are to really think about the platform of each party and what they're sharing with us about their vision for the department of health and human services, for example.
So, all of that has implications to our lives, our collective lives. So, with that said, you know, I'm going to say it again. It's that time when I invite you to tune out the noise, get into your podcast conversation frame of mind and listen to my conversations with Isaac Wright and Carrie Cochran-McClain.
We are already here at the Rural Impact, so let's go!
Michelle Rathman: Hey, Isaac Wright, co-founder of the Rural Voter Institute. Welcome to The Rural Impact. I mean it when I say it, we're really glad that you're here because we have a lot of things to talk about today.
Isaac Wright: Well, it's great to be here. Thank you so much. I'm really glad to join you, Michelle.
Michelle Rathman: Thank you so much. Well, you know, when we're recording this, this right now, I let folks know, you mean we're not doing this in real, in real time, but this is the latter part of the mid part of June. And things are changing really, really fast by the day. And I really work to keep my myself focused on no doom scrolling or anything like that.
Just really focused on policy. So, I want our listeners who are not familiar with you to understand what the Rural Voter Institute is and what was the catalyst for forming the organization. I think your origin story is very interesting.
Isaac Wright: So, after the 2016 election, And I've been the Executive Director of a Hillary Super PAC in 2016, my business partner and I are members of a national progressive organization that asked us to do an autopsy for their national convention about what happened with rural voters. Cause if you think back to the 2016 election, that was the big topic about sort of the, what was an unexpected upset by a lot of political odds makers when Donald Trump won the white house.
Apparently with thousands of members nationwide we were the two token rural kids. One of us from South Dakota, one from the Northwest of Tennessee. And so, we went back and looked at the election results. And I mean, the autopsies that have been written, those numbers of rural voter turnout had been sliced and diced six ways to Sunday.
So, we wanted to be able to talk to people, not just about what happened, but about how we could do better. How do we communicate better with rural communities about the stakes in our elections? How do we do a better job of not just talking, but of listening? And so, we thought, well, between the two of us, we had at that time, about 40 years of experience in political campaigns, we'll just turn to the treasure trove of information on the democratic side about rural voter communication and all of the research and polling and focus groups that have been done over the years.
And we quickly learned that was a missing set of information. There was no data. It hadn't been kept in years. I think that was part of the problem. And so we turned to social science and we found works of social psychologists who specialized in rural community communication and psychology.
We turned to sociological data and sort of approached it then from a social science standpoint of this is how science has measured there are different ways people communicate in rural parts of North America than in other parts of North America. And from that people started asking us to speak more.
And, and suddenly we said, you know, if we're going to do this, we should really do it. And somebody came to us with the funding that said, well, you know, you said the, the precipice of the organization was the missing data. So, if you want that data to be there, you know, you here's some resources and go fill in that gap.
And so we have five years of collective data, predominantly focused groups. Russell's polling we've done with Midwestern battleground state rule voters where we explore using those pillars of social science about how we do a better job of communicating. And that's not just how we communicate outbound, but it's how we listen as well.
Michelle Rathman: Yeah. You know, one of the reasons I was so, really wanting to have this conversation is because at the core of my, the fiber of myself communication, it, it's everything to me and as our listeners know, my other, part of my work is focused on rural health. And, you know, we have encountered some significant challenges when it comes to, I mean, we take a look at what happened with the pandemic and I wish I'd never had to revisit this subject again.
And, you know, the communication was just, it was really a major roadblock and helping to convey the importance of personal protection and so forth. But let's kind of talk about that rural voter gap data and the impact because obviously we can speculate to the cows come home, but that doesn't do us any good.
And so, talk to us a little bit about some of the data, some of the findings that I think our listeners might say, didn't know that. I mean, maybe some insight on, on the data that helps us be better informed about the decisions we make when we are thinking about the platforms that we should, you know, really focusing on the platforms and the policies and not just the identity and the assumptions that we're making.
Isaac Wright: Yeah. So, I mean, there was a study by Cornell very recently post 2016, I think it was in about 2020 that found an 18-percentage point gap with how rural and urban Southerners vote, right? Meaning there's a partisan gap with rural voters in the Southeast of 18 points and they regionalized it.
It was one of the only studies that's been done to look at what the gap is regionally and even you know, in the Northeast, right. It's small and it's still a 15-point gap in the Midwest. It's a 22-point gap in the Western region of the country. It's a 20-point gap. And again, this is a gap with rural voters simply by the letter, by the name.
This is the gap we see. And so, there's this, this huge sort of brand issue that, like you said, that enters into politics that before the person or their ideas come into, into play, the brand changes the dynamic dramatically with that gap.
And if we're going to move America forward, we have to worry less about political brands and more about what we're going to try to accomplish. And, you know, that's part of what we want to work on with the Rural Voter Institute as part of what we've worked in track with data is how to better sustain that kind of meaningful communication.
Michelle Rathman: And so, on that point, you have your 2024 blueprint we're halfway through the year 2024 blueprint for rural and small-town voter communication. Walk us through those details. I mean, it's great to say we need to communicate differently, but what does it actually look, sound, and feel like?
Isaac Wright: Right. Well, for one thing, we don't just show up every four years and ask for people's votes. That is. Yeah, that is not the way to do it. This has to be an ongoing conversation, right? Both listening and doing, putting things into practice. Yeah, I think there's been some really interesting studies that have come out of Maine, a couple out of the Midwest on I would call it longitudinal canvassing, but other people call it deep canvassing, right? This idea of having long term conversations between canvassers and voters where first they just listen to concerns before they try to have an outward conversation. But that's one of the things we have to be there, right?
We have to be present. And that's not just term in terms of infrastructure, i.e. government building projects like roads, water and electric, but that's also political presence, right? That's having a presence there to listen, to hear concerns, to address so that that becomes part of policy and platform.
And nothing is what we talk about, right? You know, obviously you and I share an interest in healthcare and what that means in rural communities, but too often we see people in politics who equate rural and agriculture as though they're somehow synonyms and interchangeable, right? I mean, Pewā€™s numbers show and they're shown for a long time, only about one in ten rural Americans work in the ag industry.
So, when a politician, when a candidate for office shows up in rural America in a small town, and they want to talk about their rural agenda, and it's all about ag policy, they're confirming perceptions by nine out of ten of the electorate there that they're out of touch. That rural issues, rural crisis, the, the, there is a rural crisis, right?
The rural crisis is being ignored. And we talk about that rural crisis, right? There was a, a study by the joint economic committee of the U. S. Senate a couple of years ago, that showed there is a wage gap that rural Americans are only making about 75 cents on the dollar compared to their metropolitan counterparts, right?
That's a crisis. We see a lack of economic opportunity that is costing real population changes in rural America. It's the only geographic segment of the country that is shrinking in population size, and it has created this sort of upside down population pyramid where we have younger people who are leaving rural America and moving to more metropolitan areas, whether it is for educational opportunity, economic opportunity, et cetera.
And then we have an older generation with no new workers to replace them in the workforce in terms of small business creation, small business incubation, it's creating sort of a brain drain. And also, as you have aging folks, we have less people there to help care for them, whether that's in a nursing home or assisted living facility, or it's just an adult child who goes by to check on their elderly parent every day or every week. And so, we see this, this crisis in rural America.
And there is a real frustration by the voters we've talked to over the last five years, that it's being ignored by the larger political dialogue and narrative.
Michelle Rathman: You know, and that's interesting because it picked that up, you know, we, we know that there's gaps and at the same time, there's always going to be someone who's going to be there to fill it. And I want to bring this up because we know that it can be very difficult to understand the root causes to these disparities.
They're complex. They've been happening over years so much related to policy and yet mainstream media and I am a convert. I mean, I used to work in the media industry, in another life and cable news. They are there to fill those gaps and they're, you know, when we see the fact, Isaac, that we see so many local newspapers that have gone by the wayside, you know, radio, traditional radio, and we are a part of a conversation where we talked about that a little bit, they are highly influential in shaping opinions and perceptions as a social media.
And so void facts and concrete information, we've got a lot of misinformation out there. So can you talk to us a little bit about how mainstream media and cable news, I mean, it may seem like an obvious question, but how much influence are these sources having on shaping opinions and perceptions when rural voters are trying to connect the dots between why the disparities and where the origins of those disparities come from.
Isaac Wright: The death of so many rural local newspapers weekly newspapers across the country, has really, really hurt our national dialogue in the, in the region. Ability to have an informed electorate.
You know, we actually did a study earlier this year about the unique role that rural and small-town radio plays and you know, terrestrial radio faces a lot of threats as the media landscape changes, right. And I'm sure this comes as no shock, but studies have shown folks in more metropolitan areas, urban, suburban areas are much more inclined and likely to be listening to podcasts.
Whereas rural and small town, Americans are much more likely to be listening to terrestrial radio. And so, whether it is the changing media landscape, whether it is buyouts by large national conglomerates in the radio industry, that threat to local small town and rural radio is another big threat we have to worry about.
And we did a lot of perceptions about local media in our study and found that rural and small-town radio plays a really unique role in the community because it is sort of a real timekeeper of events and culture and community. Right. A reminder, there's a local school board meeting going on tonight.
If you want to attend what's happening at the local park this weekend that you can take your kids to, and it plays an outsized sense of community role in the media landscape. And I think that's really something that we, we take for granted and we have to do a better job of trying to support and affirm local radio and rural and small-town communities.
Michelle Rathman: Yeah. Because that was media engines aren't slowing down. I mean, they're revving up and misinformation is like a business growth strategy for them. I wrote that yesterday. So now let's real quickly talk about the barriers that rural voters are facing with accessing details about policy over those politics.
Because today as we're recording it, As I understand it, there's, you know, some things going on that really disturb me, such as, you know, blaming the entire opioid crisis on a particular political party when in fact, I mean, these are deep, deep seated, the issues behind it, if only it were that easy. It's not that, it's not that simple.
And so, what are those barriers, you know, lacking that local source of trusted information for what's happening in your own region, but how can we kind of remove the barriers of accessing information that directly puts information in real voters hands about actual hardcore policy issues that are impacting their daily lives.
Isaac Wright: Right. I, I remember clear as a bell during the COVID pandemic, we did we were doing an online focus group and one person said, you know, they didn't know that there was a pandemic and that they didn't know that there were lockdowns and that businesses were temporarily closing their doors to the public until they showed up at Walmart and found it closed and they didn't know why, and they had to go look it up.
Yeah. And that is the danger of low information electoral politics. But that's not really unique to rural America. Right now that the dynamics of it may be different, right? Because we're seeing the hardships that so many local media entities, whether it's terrestrial radio or newspapers are facing in rural America.
But that's a problem across the electorate as the disinformation campaigns grow larger and larger. Hard news is getting replaced in a lot of the dialogue by, TikTok and Facebook and Instagram reels, right? And people have greater choice of where they're going to consume information. And the danger with that is we don't always know where that information is coming from and if it's coming with good intent or ill intent.
And so, I think that's something that we have to look at while there may be different dynamics that are unique to rural America, that is a problem across the board that we have to work on in rural America. I actually think some of the things that we can point to that would be quick steps in the right direction are even clear, right?
Which is supporting local journalism again.
Michelle Rathman: Yes.
Isaac Wright: Seeing, you know, local newspapers, both with a print weekly edition and an online presence that can be shared on social media. So, maybe your reel your sharing on Facebook didn't originate on TikToK with, you know, somebody working in the Kremlin at 2 a. m. U S time. But maybe it originated with a local journalist right down the street on main street at the paper. And so, supporting those things, whether it's the terrestrial radio newsroom, whether it's the print newsroom, that's one of the first big steps we could take in rural America.
Michelle Rathman: Um, And, to our listeners, I'll just tell you, we'll do our best to put some resources on our website. I mean, I take a look at organizations like the League of Women Voters, for example. I mean, these are institutions that are, you know, their entire purpose is just to really focus on policy and, and help people with information that informs policy versus incites, you know, there's a difference between having insight and inciting and anger and whatnot.
Michelle Rathman: So, let me kind of shift gears with the time that we have left. You know, we know that the, the Rural Voter Institute, you guys are doing great work over there with respect to increasing and understanding and communication in the rural.
But let's talk a little bit about anything that you can tell us with respect to the roadblocks that rural voters might be facing just to cast their ballot. You know, we, we end this show a lot by just reminding people to check their voter registration. And that is my advice, no matter which way you lean.
What are some of those barriers that you foresee for the 2024 election, given that we've got you know, a lot of controversy brewing.
Isaac Wright: Right, polling places, right? How many polling places are there? How far apart are they? How far are they from the voter? What are the early vote laws in your state? Can you cast an absentee ballot? You know, I, I think there's at least one state in the country that still is purging voter rolls if you miss two consecutive elections without notification.
Those are super scary things. And we need to make sure every vote is counted and that it's accurate. You know, the, the 2020 election despite a lot of misinformation out there from those with ulterior motives was very well done, was well executed, was accurate. We want to make sure that is continued even as there are assaults on our democracy and our system of government.
And so that's going to be critical.
Michelle Rathman: Absolutely. All right. So, what advice do you have for our listeners when, you know, people want to veer off in another direction? How do we keep people in our conversations? Cause these are things, you know, it's easy to say, I don't want to talk about politics then say, how about we talk about policy in my perfect world?
How do we keep the conversations focused on policy in a tsunami of politic and identity politic conversations.
Isaac Wright: So that's where we really have to really be intentional, and we can't just silo the two things. If we want to have a serious substantive policy discussion, we also have to acknowledge that you know, study after study showing voters think in a motive fashion. And so, we have to be able to talk in a narrative form.
It's not simply about, you know, this tax plan works because if you look at the spreadsheet. All the numbers work out. They all add up on the bottom line. It's talking in moral language about why this is the right thing to do. Why that those who have earned the most and made the most from our system should be those who are giving back in order to lift other people up so that they have equal opportunities and that it is morally wrong that the frontline workers, nurses who face down a pandemic or emergencies, the people who stock our shelves at the grocery, and the people who bring the very food we eat to the grocery store so that we can buy it, are paying more of their income in taxes than a Silicon Valley billionaire.
That's not right. And that's wrong. And we have to be able to talk in that kind of moral language about our policy. And recognize that rather than siloing it off as separate, you know, purely a policy discussion about spreadsheets that the numbers work.
Unfortunately, the curse of being right is that you think if you explain it over and over enough times, logically, everybody will disagree. But unfortunately, we know from sociology and psychology, that's not how we as human beings consume and relate to information, right? It's through narrative form.
And so, we need to understand, right? Like what is the consequence? What is the right or wrong thing to do in that situation? And why can we trust one candidate or another candidate to do that thing when we turn our backs and they go off to do their day job leading the community or the state of the country?
Michelle Rathman: that's, that is really insightful, Isaac. And before I let you go, I mean, I think it's important, you know, we know that there's a, there is 2024 is ever than 2020, but the end of the day, we know that at the top of, every voter, not just rural voter, but because we look at the rural impact of all of this, some of the top issues on rural voters minds.
And so if you could just kind of, and we know, you know, I can say for sure, I know healthcare is one of the things on rural voters minds, and we're going to talk about that in a moment, but what are some of the other things that rural voters are looking at? The issue, the real issues for rural voters and not those, the things that the, the mass media would, would have you believe.
Isaac Wright: The number one issue we've seen come up, I would say consecutively for the last three, two and a half years, at least of our studies has been economic anxiety. Right. A concern about, can I earn enough to live the kind of life that I want? I want and provide the kind of life I want for my children in the next generation.
Can I save enough for a retirement that is you know, sort of the American promise of if you work hard and you play by the rules all your life, that your golden years will have dignity. And so, I would say that is, has been a consistent top issue. Immigration has popped up recently. You know, but, but I would say overwhelmingly the consistent issue has been for two and a half years, economic anxiety and concern.
And so, you know, President Biden has done some great things for the American economy, even as he talks about that. I think it's critical that he acknowledge that there are those who have, are not feeling as much of that goodness or opportunity because of inflation and rising prices. And, you know, I think that's why the President just this week announced plans to create caps on corporate housing, increasing rent by more than 5%.
You know, he's taking steps to address that and he has to acknowledge while he talks about the positives record, also acknowledge that there are people who have been, still been left behind by the economy and how he is currently working to address that.
Michelle Rathman: Yeah, well, and I would also encourage and maybe Isaac, you'll agree with me that, every election matters. Local elections matter. If your rural community is suffering from housing shortages or disparities, you know, grocery store deserts or school issues or what have you, those are things that are really have they're rooted locally.
And so, I just encourage our listeners to, you know, we're in our own community, we're looking at an abysmal turnout. And you know, when you only have like a quarter of your rural county voting for local elections, it's pretty hard to point the finger elsewhere when we're not doing a good job at home.
Oh my gosh, Isaac, you are welcome back. I mean, we'll, we'll have to have this conversation on the other side when we're beyond it, but again, we're really grateful that you're very, very busy. We're grateful that you spent some time with us. It's been great to have you here.
Isaac Wright: This was a lot of fun. Thank you so much. I look forward to doing it again.
Michelle Rathman: It's my pleasure. Okay, for the rest of you, do not go anywhere because when we come back, we are going to continue this Rural Impact Conversation because I am joined by Carrie Cochran-McClain, and she is the Chief Policy Officer at the National Rural Health Association. And you guessed it, we are talking about rural health policy in the implications of the 2024 election.
So stay with us. We'll be right back.
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Michelle Rathman: We are back, and we just heard from Isaac Wright, and Isaac, of course, as you heard, is the co-founder of the Rural Voter Institute, and we know that during the 2023 election cycle, although it was very different than the magnitude of the 2024 election, but we do know that healthcare was then and is certainly now on the minds of rural voters.
I want to tell you that in a piece that I read back in 2023, I looked it up in the Daily Yonder. You also know one of my favorite publications written by Liz Carey, a quote from Michael Shepard and Michael is the assistant professor in the Department of Government and the Health and Society Program at the University of Texas in Austin.
And this is what he had to say about the matter. And this is a direct quote from that piece. "Rural voters care a lot about healthcare and they talk about it quite often." And he went on to say, "I think accessibility has increasingly come to reach parity with costs over time. 10 or 15 years ago, the conversation would have entirely been about costs. Accessibility is much more of an issue now in rural areas."
And it is because of that reason and so many others that I did the phone a friend and we reached out to my next guest and that is Carrie Cochran-McClain and Carrie is an invaluable resource to me and others as the Chief Policy Officer at the National Rural Health Association.
Carrie, always fantastic to see you and so appreciative for your time. I know you are one very busy person.
Carrie Cochran-McClain: Oh, thanks, Michelle. It's wonderful to be here. Thank you for having me.
Michelle Rathman: It is my pleasure because, you know, in the framework, of what we're talking about. I mean, obviously we know, I know this and I want to share with our listeners. We've had Alan Morgan, your president, and then Brock Slabach as well. The National Rural Health Association is not a political organization, rather it is a national nonprofit membership.
And what you all do is bring together thousands of members across the U. S., many rural hospital leaders, rural health, anyone who's really a rural health stakeholder, and you provide leadership on rural health issues through advocacy, communications, education, and research. And with that, I happen to know your work and the work of your staff is laser focused on advocating for policies that address rural health care disparities.
And that all that that entails, including access. So knowing this, Carrie, that rural population represents, I don't know, the numbers keep fluctuating, 60, 65 million people living in America's rural places. Let's get a little granular here. And I think maybe connect some dots between rural health policy and these issues that are on rural votersā€™ minds.
So, what do you say? Let's have a go at it.
Carrie Cochran-McClain: Sounds great. Looking forward to it.
Michelle Rathman: Okay. So there have been, I think it can be really easy if you're following any kind of social media, it can be so easy to go shoop, right over our heads because there really actually has been some significant at the time that we're recording this in the middle latter part of the middle of July, a lot of, wins for rural health policy.
And that includes, I think I, the numbers like 400 million or plus that's, you know, been provided through the Federal Office of Rural Health Policy. Talk to our listeners about the kind of investments that are being made and it could feel so distant, but how are these investments actually touching rural lives and rural communities in real health situations?
Carrie Cochran-McClain: Yeah. So we have fortunately been able to really lift the rural health conversation at the national level. And, and you're right, Michelle, it does feel sometimes like there is this disconnect between what people are living day to day and the struggles that they're facing and getting access to care. And then what we're doing here in Washington.
And I've been really, happy and proud to say that the last several months, six months in D. C., we really have seen some traction in terms of getting those needs and concerns heard and, and it's wonky inside D. C. baseball, but some of the key committees here in Washington, the Senate Finance Committee had a hearing on rural health care, and had experts from across the country, come and talk about, from their perspective, what are the things that Congress, the Senate needs to do to change the House Ways and Means Committee. Which is a big committee on the House side that works on really hospital and Medicare, Medicaid related payment, had a markup of a number of bills that would change a whole array of issues related to telehealth and hospitals and other things in rural communities.
So, we've seen some really good movement in this space, but it's, it's always it feels too slow. Right? And so what we want to make sure happens is that we're continuing as we're making this progress that we're continuing to invest in critical programs like those that we see in our Federal Office of Rural Health Policy and the programs that you're mentioning that are so important to getting, dollars, not only through reimbursement through Medicare and Medicaid, but through grant programs and to state level entities that can then do direct support, a direct collaboration with rural health care providers in our communities.
The good news, more good news on that front is that as we've worked through the budget for fiscal year 25, which starts just around the corner, October 1st, actually of 2024. That budget, overall, is looking real dire across the board for health care. The labor HHS portfolio is taking cuts across the board, pretty significant cuts.
But, as we've seen the House do their initial work in the Appropriations Committee, we've seen some really good boosts and actually increases for rural health. So, that, to me, it shows that Congress is hearing about the struggles that we're seeing in rural areas. And really connecting the dots between not only the importance of making sure that we can access health in our areas or access healthcare in our rural areas, but the importance that health plays in making sure that we've got healthy rural communities.
Michelle Rathman: You, you make so many questions come to mind because I do think about the, the reality of rurality, if you will, in terms of, you know, just again, kind of that access issue. And we think about the fact that, yeah, I mean, you guys in the work that we do, that I've been privy and privileged to, to witness that you do, it's, it's all about getting, yeah. You know, support from all sides and I really personally, I hate that health care has become such a political, you know, lightning rod because it's unfortunate. It doesn't it doesn't help the work that we're doing and certainly we know that there is a great deal of influence around things like access to OB care.
I mean, you would be hard pressed to not understand, you know, that rural communities have been facing the dire situation of dwindling OB services, primary care services, you know, mental health and behavioral health have, have long since been a challenge. So, let's talk a little bit about some of the policy work that is connected to addressing these disparities because, you know, when there's a certain position, that should be one way, the money isn't going to be allocated for resources. And somewhere something's got to give, you know, if you remember that movie, something has got to give.
So, let's talk about some of the policy advocacy work that the organization is doing around those things. OB deserts, primary care deserts. What are some of the things that are, are we need to be understanding and have on our radar screen to when we are trying to ask intelligent questions and advocate for things that really have some, you know, teeth on them, put some teeth on that.
Carrie Cochran-McClain: Right. Yeah. Great question. So let me preface it by saying as an organization, you, I think started our conversation here. We are a nonprofit. We are a membership organization. I very much I'm not going to say always, but I'm going to say 99 percent of the time, the legislation that we work on at NRHA is bipartisan.
So, if we are going to work on a bill, we do everything we can to get both a Republican and a Democrat introducing and co-sponsoring that legislation for us. Because we recognize that to get anything done, we've got to have everyone at the table. And we are lucky in the sense that most parts of, especially in the Senate, but most parts of the country have some type of rural.
Now, we can get in all sorts of debates and you know this about how rural places are, but rural is relevant to many, many of our congressional members, which is a good thing. And cuts across both Republican and Democratic parties. So, we try to then bring it home to members of Congress and really understand what's going on in their district and what resonates with them.
So, when you're you're, you mentioned obstetric care, which is an issue that is near and dear to my heart. We actually have been working really closely in the Senate. With Senator Wyden, Senator Hassan, Senator Collins, there's a number of folks both on legislation that, well there's a bill that we worked on getting introduced that would help our, rural hospitals that have lost their OB units make sure that they can maintain access to the equipment and the training that's needed for obstetric related emergencies.
It doesn't have to just be precipitous birth, right? When someone's coming in and in the middle of labor. It can be the prenatal and the postpartum emergencies as well, because we know that's where a lot of our maternal morbidities and mortalities are happening in our rural community. So, trying to make sure we've got some legislation introduced that's trying to make sure that hospitals have the funding and resources for training and equipment in those spaces, regardless of whether they have an obstetric unit or not.
We also have been working with the Senate Finance Committee. This is right now a partisan, just the Dems have introduced it, but we're hoping to make it bipartisan, a piece of legislation that's pretty groundbreaking that would actually reimburse at higher rates in Medicaid for rural births.
Michelle Rathman: That's, that's a long time coming.
Carrie Cochran-McClain: Right. And when you talk to our rural hospitals, there's so much that needs to be done. Obviously, workforce is a huge issue, but getting paid more, especially when your, when your births are 80, 90 percent Medicaid, you just need to get paid more or paid differently to make the bottom line meet.
And so that's another proposal that we're really excited about and hope to see. And hopeful that we can get kind of somewhere in, in the middle and make some movement. So that's one space, but we're working kind of across the board, knowing that rural America it's, it's all aspects of healthcare.
And we know that issues around hospital financing, workforce, telehealth. All of those things are critical to folks who are living in our rural communities. And we're trying to move the needle where we can in each of those areas.
Michelle Rathman: Yeah. You know, I actually myself participated in a, in a conversation on an NPR station yesterday and, and the question that was asked to me was, you know, do policies always hurt or do they help? And I said, listen, it's a mixed bag. Right. I mean, like, let's talk for a moment about, I mean, you just talked about reimbursement for physicians and we know this has been ongoing, for as long as I can remember .You know, folks, many folks just don't even recognize that that is a policy issue. That is a matter of policy. And in rural, in particular, you know, there is a direct line. You don't have to go very far to make a direct connection, but it also speaks a lot to, you know, our hospital closures and what we're seeing right now with the rural emergency hospitals.
And but to your point, I mean, just being able to recruit providers into a rural community, knowing, I mean, no, one's doing this because they want to volunteer. I mean, they have to be reimbursed.
Carrie Cochran-McClain: You gotta make ends meet. No, no, what is the great thing? No, no margin, no mission, right?
Michelle Rathman: You know, no mission, no, no marginal mission.
Carrie Cochran-McClain: margin, whatever the order is, you need both, right? You need both.
Michelle Rathman: Where do you think, let me ask you this, because, you know, I know that, and folks who listen to this podcast, they know that I am all about, you know, reinforcing the fact that all roads to quality of life are paved by policy.
And I think one of the things that's been interesting to me, exciting, and still, I think. kind of moving a little bit slow is that those who work in the rural health space are now really expanding. They understand it, but they're expanding their understanding and their reach when it comes to addressing those social drivers of health that we talk about.
And I know that your organization is also doing the same. So, when we talk about policy as it relates to things like nutrition assistance, housing and so forth. Carrie, you must be hearing from your rural health constituents, boards, CEOs and things and physicians about, we need policies that help us do better what we're doing because we, we know that we're caring for the older and the sicker and the generally poorer, but there are conditions that are driving that.
Can you talk a little bit about any work that the NRHA is doing to kind of reach beyond the traditional avenues of, of going into just those health-related things and more into the things that I just talked about, transportation, housing, food assistance.
Carrie Cochran-McClain: yeah. Oh, so much, Michelle, and it's funny because I oh gosh, I could spend the whole time talking about this question.
So,
Michelle Rathman: Weā€™ll have to have you back.
Carrie Cochran-McClain: um, I know. I would love that. So, you know, it's when we, you know, this is being part of our Rural Health Policy Congress, which helps drive kind of the direction that we take our work at the association.
I really, one of our requirements is we're talking about issues is it has to have a connection back to rural health care. It has to talk about health.
Michelle Rathman: Mm hmm.
Carrie Cochran-McClain: But so much of where we've started to take our work has been outside of that traditional lane of health. And I have so many examples for you, but I think a couple of just off the top of my head, one the farm bill, which is up for reauthorization right now, typically it's
Michelle Rathman: uh, any day now. Mm hmm.
Carrie Cochran-McClain: Well, typically it's up every, you know, five years. So it was up in 2023. Now it's 2024. It doesn't look like we're going to get quite to it. So maybe 2025. In addition to kind of the traditional things that have been in the farm bill lots of important programs in the, in the rural development umbrella, including loan and grant programs for capital telehealth.
We've got some behavioral health things for farm and ag populations, but we also have seen a significant interest this year in including childcare and child care entities as a potential recipient of a lot of these kinds of programs, because we hear from our members that if you want to bring in a workforce, you've got to have some place for their kids to go.
So we're seeing a growth and interest definitely in inclusion of child care facilities as a resource to then be investing in so that we can bring our programs. workforce in. We also at NRHA in the last year or so in partnership with the Johnny Hartford Foundation have started a rural aging in place initiative which obviously talks a lot about health, but so much of what we're talking about are those determinants of living healthy in rural communities and housing is a huge part of that and making sure that you've got affordable housing, you've got safe housing.
That you've got housing that is accessible and right kind of accessible for the populations in your communities. Clearly a tie back to rural there.
Michelle Rathman: Yeah. And Carrie, and I'll just stop you there. Especially,
Carrie Cochran-McClain: I can keep going.
Michelle Rathman: Oh yeah. Especially because when we're talking about it, I mean, I, I personally know of so many rural hospitals that at one point were also the, the nursing home long-term care, and we see. You know, the bookends childcare deserts and long-term care deserts.
And so healthy aging in place, all of these things. I mean, to me, it just feels like, man, we are smart enough to do this. We can make this happen. And so, before we close out, this is so important to me because it's one thing for you and I, and those of us that we do this work. As a part of our profession, but at the end of the day, for our listeners who might be in a different industry, any listener, we're so grateful that you're here and the reason why we are doing the second part of this episode focused on health care is because we know that's something that everybody needs and whether or not you think you need it now, you will at some point in your life.
And when you're living in rural, we shouldn't be sitting here saying, you know, maybe someday we'll be through the rural hospital, closing, crisis. I mean, I hope that you and I live to see that day. So, with that said, one of the things that I love about kind of the logo or slogan that you guys use is your voice louder.
And that really encompasses all of us. But that can't just be people who work at a hospital. Okay, so in your mind, for any listener who will use health care at some point in time in their life or if they have a parent or family members who live in rural, what is your recommendation for how to advocate because these things happen at the state level
Carrie Cochran-McClain: yeah,
Michelle Rathman: when we take a look at states that have not expanded Medicaid. So you've got to be an advocate for that.
And then at the federal level, what can the average person do? And there's everyone else here is special. So no one's average, but what can the rest of us out here do to make sure that those who are vying for our votes. The seekers and the holders, what do we need to be conveying to them to, to let them know that not just in abstract terms that health care is important to them, but what are some things that you can say that will hit closer to home and get to the heart, their hearts to make them advocate for policy for us and, and finance, and the investments that need to be made.
Carrie Cochran-McClain: yeah Michelle, I'm just gonna, you know, this is gonna sound really basic, but I would encourage everyone listening to just get engaged. You know, it's, it's so easy in today's climate to get frustrated and to throw our hands up for all sorts of reasons of about what we're hearing at the federal level, depending where you live, maybe at your state level.
And what I would ask you to do is to stay in the dialogue. Reach out to your policymaker, make one action to connect with your state, local, federal policymaker. It could be your mayor, it could be your state representative, it could be your member of Congress. And let them hear from you about what your concerns are.
I think the most important thing as I do my job, if I go to a member of Congress and ask them to support something that NRHA is trying to change or further, they need to have already heard and know that it is an issue of importance to their constituents. So you doing the education and letting them know that this is important to you because your grandmother couldn't get access to care or couldn't get into the long-term care or the nursing home in your facility, in your area, or your EMS service closed or, you know, whatever the issue is in your community, make sure that they know that and hold them accountable.
Their job is to represent you. You elect them to those positions. So don't be intimidated. And it doesn't have to be confrontational. It's a dialogue. It's a conversation. It's an education. So, it doesn't have to be fancy. It's nothing that you have to memorize. It's really tell your story and let them know what your experience is.
And then if you want to go to the next level, our website ruralhealth.us has all the information that you need in terms of helping to think about those specific policies. To move forward to help with rural hospital sustainability or workforce recruitment or retention, those kind of issues that we're working on at the association.
Michelle Rathman: That's great advice. And I'm glad that you mentioned telling stories because I know talking with policymakers myself, they want to hear your stories. And you know, I just think about, I read something today the Nebraska Rural Health Association, Nebraska Hospital Association. I mean, they're doing a great job advocating and they're, what they're done, they're doing is they're telling the story about how many hours staff members are spending at the hospital trying to help people get prior authorizations.
You know, and so that is something that your elected officials can do something about. You know, it's not something your doctor's office can do something about, but we need policies just for that. My gosh, you're right. We could have this conversation forever. I, I, to my fellow policy, healthcare policy wonk, I can't do the.
It's been wonderful to have you here, Carrie.
Carrie Cochran-McClain: I canā€™t believe the time has flown by like that. We could keep going forever.
Michelle Rathman: It's so great to have you share your insights. And what is certainly not a light subject. We know that, but we do hope as we say that we've enlightened our listeners. And again, Carrie, thank you so much.
And before we go, I just want to remind everyone that we'll put links on our website so that you know how to find the a great advocacy material that is, you know, designed for, for the everyday person who can use that to help advocate for health policy that is beneficial to your rural community. And you could do that also by just heading over to theruralimpact.com. Make sure you subscribe to get on our email list, to receive our blogs and other news about the show and see where we're going to be on the road next.
And again, you know, until we're together, remember that every road to quality of life, as I said, is paved by a policy. I want to thank Brea Corsaro and Sarah Staub for all their great work. And until next time on a new episode of The Rural Impact, take good care of yourself and everyone else around you.
If that's the least you can do, do that. We'll see you soon.
