When it comes to health care, we live in a divided nation. Decades of disinvestment have left rural areas with significantly less access to critical care. The painful result: if you live in a rural area, you are more likely to get sicker and die younger than those living in cities.

As the mayor of a diverse city in the industrial Midwest, situated among the rural counties of Northern Indiana and Southern Michigan, I’ve seen the tragic impacts of this neglect firsthand. That’s why last week, I released a comprehensive plan to bring investment and innovation to overlooked communities and ensure rural Americans have the health care they deserve. 

Few understand the urgent need for action like pregnant mothers in rural New Hampshire. Since 2000, nine N.H. hospitals have closed their maternity wards — two in the past year alone — forcing some women to drive an hour or more to give birth. This greatly increases the chance of complications and puts the lives of mothers and babies at risk. Sadly, New Hampshire is not alone. More than half of all rural counties nationwide lack a hospital with obstetric services.

And it’s not just expectant mothers that are affected — rural hospitals are closing at an alarming rate. In New Hampshire, five of the state’s 17 rural hospitals are at risk of closure. With more than a third of New Hampshire residents — and 44 percent of veterans — living in rural areas, thousands could be left without easy access to critical health services. Meanwhile, amid a mental health crisis, only 45 percent of the state’s need for mental health professionals is being met.

It’s time to set rural New Hampshire and rural America on a new path where everyone — from newborns to seniors — has the care they need to lead healthy lives. 

To ensure that every rural resident has access to affordable insurance, we’ll implement “Medicare For All Who Want It” and make insurance cheaper for working-class Americans by increasing federal subsidies on health-care exchanges. And we’ll make it so that people in rural areas can actually see their doctors by expanding telehealth, so a physician can remotely monitor her patient’s heart rate from home or a teenager struggling with depression can meet virtually with a therapist.

To end the rural maternal health-care crisis, my administration will make it easier for women to access critical services before, during and after pregnancy. We’ll help keep obstetric units open by increasing payments to maternal care providers, funding innovative models of care like pre-maternity homes for women nearing term, and expanding Medicaid coverage for women up to a year after giving birth.

To support rural veterans, we will strengthen collaboration between VA hospital providers and other providers in the community. Increasing provider options is critical as New Hampshire is the only state in the continental United States that lacks a full-service VA hospital, forcing veterans to travel hours for care. 

To confront the mental health crisis and the opioid epidemic that have plagued the Granite State, we will prioritize universal access to effective treatment and enforce mental health parity. We’ll also train communities to provide localized support and address stigma through my national service plan’s Community Health Corps.

Finally, to end the shortage of rural primary care doctors and prevent the further closure of rural hospitals, my administration will recruit health-care workers by expanding public service loan forgiveness programs, doubling the waiver program that encourages foreign doctors to work in underserved areas, and increasing rural providers’ Medicare reimbursement rates so it is more sustainable to treat patients.

We are in a make or break moment — and with the second-oldest population in the country, the challenges facing New Hampshire will only grow more complicated. After decades of Washington, D.C., politicians letting these problems fester, it’s time for real solutions that will enhance people’s everyday lives.

It’s not too late to build a future where everyone can lead a healthy life regardless of where they live — but only if we have the courage to break from the past and meet this moment with the urgency it requires.

To learn more about my plan to improve rural health, go to peteforamerica.com/rural-health.


Pete Buttigieg is the mayor of South Bend, Ind., and a Democratic candidate for president of the United States.

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