Hospitals / Clinics Are Continuing To Close In Rural Areas

The following is from Axios.com: 

A string of recent rural health clinic closures is threatening to further reduce access to care in outlying areas as health systems brace for cuts in the in the Republican budget law and grapple with inflation and workforce issues.

The big picture: Rural health cutbacks already are a fact of life. But some of the latest closures are in anticipation of the nearly $1 trillion reduction in federal Medicaid spending that will in large part hit starting in 2027.

State of play: Three health clinics in rural Virginia will be consolidated and patient care moved to other facilities, Augusta Medical Group announced last week.

 

• The change is "part of Augusta Health's ongoing response to the One Big Beautiful Bill Actand the resulting realities for healthcare delivery," the provider said. 
• Curtis Medical Center in Nebraska, the first health provider to cite Medicaid changes as a reason for closing, will shut its doors on Sept. 30, per the Washington Post.
• At least three rural health centers in Maine have announced plans to close this month, Portland's WMTW reported.
• Mayo Clinic last week said it's closing six clinics in southern Minnesota, including in rural towns, and reducing services at a hospital in the area, although a spokesperson told Axios the transition isn't tied to the new law.

Zoom out: Nearly 200 rural hospitals have closed or ended inpatient services over the past two decades, far outpacing expansions or facility openings.

• Almost half of rural hospitals operated at a loss in 2023, according to the American Hospital Association. 
• "Rural hospital financing has not worked well for a long time," said Carrie Cochran-McClain, chief policy officer for the National Rural Health Association.

The tax and spending package Congress passed in July is widely expected to add to the financial difficulties in rural areas, where patients are often poorer and older and where there are fewer private coverage options. 

• Federal Medicaid spending in rural areas could decrease by $137 billion over the next decade, KFF estimates.
• The law established a $50 billion rural health transformation fund to be doled out to states over five years, in part to assuage Republican lawmakers' concerns about how Medicaid cuts would hit providers. 
• The size of the fund has been panned as inadequate. That, and ambiguity over how funds would be distributed, is raising concerns about whether funds will reach the hospitals that need it most.

Rural Support For Donald Trump Is Economic Suicide

 

During his campaign Donald Trump made many promises. He said he was going to bring prices down. He said he was going to brings jobs back to America. The voters in rural America believed him, and gave him their support.

Their support allowed him to score a very slim victory. About 62% of rural voters chose Trump. And they made up a significant 44% of his total vote. Without the support of rural voters, Trump would have been defeated.

But the policies that Trump have pursued since moving back into the White House are not helping those rural voters. In fact, they are making life much more difficult for them.

His tariffs Are increasing prices.

Inflation continues to rise in this country. And Trump is making sure they will continue to rise in the future. That's because he has placed tariffs on almost every country in the world. Every country is subject to a 10% tariff, and some have an even higher tariff. Since the U.S. imports much of what is on store shelves, this means prices for those goods will rise by at least 10% and more for some goods. This is bad news for those already struggling with inflation (which is everyone but the rich).

Farmers are going to be hurt.

The farming community had not fully recovered from the tariff mistakes of his first term - and now he has imposed much broader tariffs. One of the biggest market for U.S. farm products is China, but because Trump has put a 145% tariff on them China has retaliated by cutting off the buying of U.S. farm products. They have cancelled the orders they had, and they are increasing their buying from other countries (especially in South America). Trump has also cut almost all foreign aid by USAID. Much of that aid was food provided by American farmers. This double whammy by Trump could put many family farmers out of business.

The poor will suffer.

It is not known by many, but rural areas in this country have a lot of poverty. In fact, in many rural areas the percentage of poverty is higher than in urban areas. The rural poor will not only be hurt by rising inflation (much of it due to tariffs), but will see less help from the government as Trump and the GOP-controlled Congress cut government social programs. They are cutting these programs so they can give big tax breaks to the rich.

Healthcare is going to suffer.

Because of the significant poverty in rural areas, the number of people (especially children) on Medicaid is high. And Medicaid is high on the list of budget cuts. Both the Congress and Trump have proposed bills that could mean as much as $800 million in cuts to Medicaid. That would not just affect the poor and working classes. Many rural hospitals are barely hanging on, and they need the money Medicaid provides them. A serious cut to Medicaid will likely cause many rural hospitals to go out of business - forcing rural inhabitants to travel many miles to get to the nearest city hospital. That would make life harder for those in every economic bracket.

Older residents will suffer.

Trump has allowed Elon Musk and his DOGE team to do serious damage to the Social Security system. Offices have been closed and staff has been cut. This will make it much more difficult for retirees to get Social Security and/or make needed changes to their Social Security accounts. And if not rectified, could even interfere in payments in the future.

Rural voters put their faith in Donald Trump. But he has betrayed them. While increasing his own wealth, and that of his rich buddies, his policies will devastate the people in rural America.

Hospital Beds Are Decreasing - And Republicans Want To Make It Worse

 

Researchers have determined that the availability of hospital beds is decreasing. Between 2009 and 2019, the hospital occupancy rate was 63.9%. By 2024, the rate had risen to 75.3%. It is estimated that by 2035 the occupancy rate will reach 85%.

An 85% rate is deemed to be a shortage, because medical officials say at that rate "basic hospital operations can become dysfunctional and even unsafe".

The reason for the decrease is two-fold - an increase in the number of senior Americans (who require more hospital care than you're people) and hospitals that are closing their doors and going out of business.

This is especially true in rural areas, where many hospitals are having trouble meeting their expenses - and many are closing each year.

Sadly, the Republican in Congress are planning to make things worse - not better. How? By making a huge cut in Medicaid funding. In the bill under consideration, they want to cut Medicaid by more than $800 million. 

This would be devastating for many hospitals, especially in rural areas. These hospitals rely on Medicaid to provide the money they need to keep operating. Without the Medicaid money, they will have to close.

And it won't be just rural hospitals that will be hurt. The rural people will have to then travel to urban areas to get hospital treatment. That will decrease the number of hospital beds available in urban areas.

It is critical for everyone's medical care that hospitals everywhere remain open. That means it is critical to maintain Medicaid funding at the present level (or increase it).

NOTE - Republicans are now considering a continuing resolution to keep the government open. While that would avoid the draconian cuts to Medicaid they want, it would include smaller cuts to it. And it would just delay the larger cuts until September. That's not a solution.

House GOP Is Ready To Take Healthcare From The Poor To Give More To The Rich

 

We have been expecting it, but the House has now taken the first steps to an insane budget. They approved (on a party line vote) a proposal to give tax cuts to the rich - and they would partially pay for that by cutting hundreds of millions of dollars from Medicaid.

It just shows they are not listening to the people who elected them.

Poll after poll has shown that huge majorities of Americans (including a small majority of Republicans) don't think the rich need a tax cut. They actually think the rich are not taxed enough! But while the public won't like more tax cuts for the rich, it is the cuts to Medicaid that will cause the most blowback.

Republican officials (and too many in their base) seem to think that Medicaid only goes to nonwhites in the large cities - and since those cities tend to vote blue, they won't be hurt. But they are going to find out that is simply not true.

Medicaid is badly needed by ALL of the poor - including whites and those living in rural areas. And losing Medicaid would not only hurt the rural poor - it would hurt everyone living in rural areas. That's because rural hospitals need it to stay in business.

Many rural hospitals have closed, and many more are in danger of closing. They are barely covering their costs. Losing the money they get from Medicaid patients would push them over the line, and they would have to close. It would mean rural patients would have to go to the nearest city if they needed hospital care, and that could be hundreds of miles from some rural areas.

This wouldn't just hurt the rural poor. It would hurt everyone living in a rural area - even those with private insurance or plenty of resources. 

Rural voters voted for Republicans because they thought it would make their lives better. Congressional Republicans are now showing them they were wrong. Cutting Medicaid to give tax cuts to the rich is just putting a knife in the back of Rural people

Are Rural People More "Traditional" Than Urban People?

 

Rural voters tend to favor Republicans, while urban voters tend to favor Democrats. Some think this makes rural people more "traditional" than urban people. But the facts don't bear that out. Consider this article by Shelley Clark and Matthew M. Brooks in The Washington Post.

The Trump administration recently issued new guidelines for the Transportation Department, surprisingly prioritizing spending and infrastructure for “communities with marriage and birth rates higher than the national average.” In other words, communities with large traditional families. We know what you’re probably thinking: That means rural and small-town America — presumably President Donald Trump’s core constituency — will disproportionately benefit from these funds.

But you could very well be wrong.

Many Americans still imagine rural communities as bastions of tradition, where marriage is widespread and families with lots of children abound. A quarter-century ago, these perceptions would have been largely correct. They no longer are.

Our research shows that over the past three decades, among women ages 15 to 44, marriage rates have fallen much faster for rural women and girls than for their urban counterparts. Between 1988 and 2018, the proportion of rural women who were married fell from 55 percent to 33 percent. Marriage among urban women also declined but to a lesser degree.

At the same time, cohabitation has risen more sharply and divorce has declined more slowly in rural America. By 2018, rural women were more likely than urban women to be in an unmarried, cohabiting partnership (19 percent vs. 14 percent). The proportion of women who have never married has also increased steadily for both rural and urban women. And although the proportion of urban women who have never married remains slightly higher, this is mainly because urban women marry at older ages.

Childbearing in the United States has fallen overall, but the “baby bust” has been larger among rural women. Although they still have slightly more children than urban women, a substantially higher share of rural children (54 percent) than urban children (45 percent) are born outside marriage. This is a significant change from years past. In 2002, the reverse was true. These rapid transformations in both marriage and nonmarital childbearing help explain why many rural residents and politicians are inclined to think the traditional family is under threat.

These changes in marriage and childbearing shape the family structures children are raised in, which has implications for their well-being. In a forthcoming study, we show that between 2005 and 2022, the proportion of rural children living with two married parents declined at more than twice the rate of urban children. White, Black and Hispanic children in rural areas were all affected by this decline, while at the same time the proportion of urban White children living with married parents remained stable, and the proportion of urban Black children living with married parents rose. There are now sizable rural-urban gaps in the percentage of White children living with married parents across all regions, ranging from 5.7 percentage points in the Midwest to 12.3 percentage points in the Northeast.

These findings suggest that using marriage and family size as the criteria for transportation funding is likely to disadvantage rural regions. There are more straightforward reasons, based on equity and common sense, to support rural transportation. Those who live in rural America have to travel greater distances to access necessities: school, health care, child care, work, even groceries. Effective infrastructure can reduce these costly geographic barriers.

Other policies could strengthen rural families themselves. Our study identifies two main reasons for lower rates of marriage and higher rates of childbearing outside marriage in rural areas: rural women’s lower educational levels (20.2 percent of rural women hold a bachelor’s degree vs. 33.2 percent of urban women) and lower rural household income (62.9 percent of rural vs. 50.5 percent of urban households earn less than $50,000). These results should not be surprising. It is well-established that there is a strong positive association between higher education and income and higher marriage rates and more children born within marriage.

Policies that expand access to higher education or create better-paying jobs, with family-friendly policies that include regular work schedules, parental leave and child care, would help alleviate the chronic strain rural families face. Rural communities and the scholars who study them have been clamoring for these types of programs and supports since at least the 1980s.

Moralistic prioritizing of traditional marriage over other types of families doesn’t produce sensible transportation policy. Nor does it generate effective rural development strategies. Instead of arbitrary decisions on infrastructure funding based on outdated stereotypes about small-town family life, we need policies based on sound social science data to support rural families’ real needs.

Note To Allred: Don't Neglect To Campaign In The Red Areas

The Harris/Walz campaign is doing something I like a lot. They are taking their campaign to the red areas of Georgia - and they plan to do the same thing in other states. That's smart. Even if they can't win those red areas, they can reduce Trump's margin in them (and that might allow them to win statewide).

I think Democrat Colin Allred should do the same thing in his race for the Senate in Texas.

Texas' largest 15 counties contain about 65% of the total votes in the state. And if the election was only in those 15 counties, Democrats would do very well. But Texas has 239 other counties, and most of them are bright red. While they only have about 35% of the vote, they normally give Republican a 30% to 40% vote margin. That huge margin gives the GOP the votes they need to overcome any deficit they might have in the large cities in the state - and it allows them to keep control of the state.

These red areas are mostly rural and they don't get a lot of visits (or attention) from politicians. Many just regard them as hopelessly owned by the Republican Party.

That's a mistake. There are a significant number of Democrats and Independents in those rural counties. While the Democrats can be counted on, the Independents should not be ignored. They could be courted to vote blue, but they need to be asked to do so - in person, not just in a TV ad. They need to be shown they are not discounted or forgotten. Right now, many of them stay home on Election Day because they don't believe anyone cares about them. That doesn't have to be!

Now you may be thinking that even if a Democrat campaigns in these areas they will still lose there. That may well be true. But a Democrat like Allred doesn't have to win in these areas. He just needs to cut into the GOP margin there - lowering it from 30% to 40% to about 15% to 20%. That might well be enough to stop the GOP from overcoming the Democratic advantage in urban areas - and give the Democrats a statewide win.

As someone who lived in a rural red county for many years, I believe the Democrats could help themselves there. But it can only be done by going there and asking for their votes. 

Raising the Democratic margin in blue areas must be combined with reducing the Republican majority in red areas if Democrats are to win a statewide race in Texas.

Walz Could Help Dems Reach Small Town Voters

The following post was written by Patrick Healy in The New York Times:

Republicans used to brag a lot about family values, but Donald Trump cooked that turkey when the G.O.P. traded moralizing for an immoral president.

In his wake, there hasn’t been much talk in national politics about ideals, principles and conscience — that is, until Wednesday night, when Tim Walz made an awfully persuasive case for Democrats as the party of old-fashioned, small-town and, yes, conservative values, stressing the theme of neighbors looking after neighbors and especially children as the measure of a country’s humanity.

“While other states were banning books from their schools, we were banning hunger in ours,” said Walz, the Democratic vice-presidential nominee, in one of several lines that drew effusive applause from the party’s convention hall in Chicago. 

“We respect our neighbors and the personal choices they make,” Walz said, invoking his support for abortion rights while also noting his respect for those who hold differing views. “And even if we wouldn’t make those same choices for ourselves, we’ve got a golden rule: Mind your own damn business.”

On one level, Walz delivered a classic running mate’s speech: He delved into his biography to introduce himself to the country (Nebraska-born, 24 in his high school class, close-knit community, then the National Guard and a career as a social studies teacher); his political beliefs (a center-left agenda focused on health care, education, gun control and a social safety net); and the case for the top of the ticket, Kamala Harris, and some shredding of Trump.

But Walz’s speech was really about something greater: a vision of a party and country that take pride in the military uniform, that show awareness for vulnerable families struggling with illness, poverty and debt, that prize the most essential workers (“never underestimate a public-school teacher” drew huge applause).

I’ve heard quite a few running mate speeches at conventions — John Edwards, Joe Biden, Sarah Palin, Mike Pence, Tim Kaine, Kamala Harris — but I’ve never heard one as values-driven and down-home as Walz’s. (Edwards’s was a little like this, but far more slick.)

Don’t get me wrong, it wasn’t all sugar and honey — he knocked Trump plenty, like saying “some folks just don’t understand what it takes to be a good neighbor.” Walz knows how to be an attack dog: Speaking of Project 2025, he drew on his football coaching days and said, “when someone takes the time to draw up a playbook, they’re going to use it.”

But the man has a way with a speech. “We’ll build a country where workers come first, health care and housing are human rights, and the government stays the hell out of your bedroom,” Walz said.

It was a peroration that would make any progressive proud, but it also felt grounded in core values — dignity, humanity, privacy — that a great many Americans of all parties care about.

Democrats Should Reach Out To Rural Voters

 

Rural Shift To GOP Is Based On Lies And Misconceptions

Many voters in Rural America think they are being short-changed and disrespected. Neither is true. Here is the truth from Paul Krugman in The New York Times: 

Rural resentment has become a central fact of American politics — in particular, a pillar of support for the rise of right-wing extremism. As the Republican Party has moved ever further into MAGAland, it has lost votes among educated suburban voters; but this has been offset by a drastic rightward shift in rural areas, which in some places has gone so far that the Democrats who remain face intimidation and are afraid to reveal their party affiliation.

But is this shift permanent? Can anything be done to assuage rural rage?

The answer will depend on two things: whether it’s possible to improve rural lives and restore rural communities, and whether the voters in these communities will give politicians credit for any improvements that do take place.

This week my colleague Thomas B. Edsall surveyed research on the rural Republican shift. I was struck by his summary of work by Katherine J. Cramer, who attributes rural resentment to perceptions that rural areas are ignored by policymakers, don’t get their fair share of resources and are disrespected by “city folks.”

As it happens, all three perceptions are largely wrong. I’m sure that my saying this will generate a tidal wave of hate mail, and lecturing rural Americans about policy reality isn’t going to move their votes. Nonetheless, it’s important to get our facts straight.

The truth is that ever since the New Deal rural America has received special treatment from policymakers. It’s not just farm subsidies, which ballooned under Donald Trump to the point where they accounted for around 40 percent of total farm income. Rural America also benefits from special programs that support housing, utilities and business in general.

In terms of resources, major federal programs disproportionately benefit rural areas, in part because such areas have a disproportionate number of seniors receiving Social Security and Medicare. But even means-tested programs — programs that Republicans often disparage as “welfare” — tilt rural. Notably, at this point rural Americans are more likely than urban Americans to be on Medicaid and receive food stamps.

And because rural America is poorer than urban America, it pays much less per person in federal taxes, so in practice major metropolitan areas hugely subsidize the countryside. These subsidies don’t just support incomes, they support economies: Government and the so-called health care and social assistance sector each employ more people in rural America than agriculture, and what do you think pays for those jobs?

What about rural perceptions of being disrespected? Well, many people have negative views about people with different lifestyles; that’s human nature. There is, however, an unwritten rule in American politics that it’s OK for politicians to seek rural votes by insulting big cities and their residents, but it would be unforgivable for urban politicians to return the favor. “I have to go to New York City soon,” tweeted J.D. Vance during his senatorial campaign. “I have heard it’s disgusting and violent there.” Can you imagine, say, Chuck Schumer saying something similar about rural Ohio, even as a joke?

So the ostensible justifications for rural resentment don’t withstand scrutiny — but that doesn’t mean things are fine. A changing economy has increasingly favored metropolitan areas with large college-educated work forces over small towns. The rural working-age population has been declining, leaving seniors behind. Rural men in their prime working years are much more likely than their metropolitan counterparts to not be working. Rural woes are real.

Ironically, however, the policy agenda of the party most rural voters support would make things even worse, slashing the safety-net programs these voters depend on. And Democrats shouldn’t be afraid to point this out.

But can they also have a positive agenda for rural renewal? As The Washington Post’s Greg Sargent recently pointed out, the infrastructure spending bills enacted under President Biden, while primarily intended to address climate change, will also create large numbers of blue-collar jobs in rural areas and small cities. They are, in practice, a form of the “place-based industrial policy” some economists have urged to fight America’s growing geographic disparities.

Will they work? The economic forces that have been hollowing out rural America are deep and not easily countered. But it’s certainly worth trying.

But even if these policies improve rural fortunes, will Democrats get any credit? It’s easy to be cynical. Sarah Huckabee Sanders, the new governor of Arkansas, has pledged to get the “bureaucratic tyrants” of Washington “out of your wallets”; in 2019 the federal government spent almost twice as much in Arkansas as it collected in taxes, de facto providing the average Arkansas resident with $5,500 in aid. So even if Democratic policies greatly improve rural lives, will rural voters notice?

Still, anything that helps reverse rural America’s decline would be a good thing in itself. And maybe, just maybe, reducing the heartland’s economic desperation will also help reverse its political radicalization.

GOP Votes Against Benefits Helping Rural Voters The Most

Democrats have passed some of the things that help rural voters -- things like Social Security, Medicare,  Medicaid, and the minimum wage. But those rural voters remain the group that's the most consistent voters for the Republican Party.

Now there is a new benefit that helps families -- the Child Tax Credit (CTC). Republicans voted against this new credit, claiming it was mostly a giveaway to urban dwellers.  But that is not true. As the chart shows, as a share of regional GNP, the CTC actually benefits rural voters more than urban voters. And the same is true when you consider the benefit per capita.

The Republicans are also very likely to vote against extending the CTC (even though it helps their voters the most). Will rural voters wake up and realize that voting for Republicans is actually voting against their own interests?

It Ain't Just The Cities Anymore - COVID-19 Goes Rural

 

From DailyYonder.com:

Covid-19 spread in rural America at a record-breaking pace again last week, adding 160 counties to the red-zone list and bringing the total number of rural Americans who have tested positive for the coronavirus to more than 1 million.

Nearly 70% of the nation’s 1,976 rural (nonmetropolitan) counties are now in the red zone, a term used by the White House Coronavirus Task Force to designate localities where the spread of the virus is out of control. Red-zone counties have a rate of at least 100 new infections per 100,000 in population.

Those Believing Rural Areas Are Not In Danger Are Wrong

The governors of several mainly rural states have refused to issue stay-at-home orders and closed non-essential businesses. Donald Trump has said that several states may be ready to reopen for business even before his ridiculous May 1st date. And some right-wing websites and groups say the nation should reopen in many places.

The idea behind that is that rural settings in many states, because the virus has been slow in coming there, will not experience the pain that other areas have had to endure. That they are somehow immune to the Coronavirus epidemic in this country. That is shortsighted and wrong! And it could cause rural communities, many of which already have inadequate hospital facilities, to become sitting ducks for the virus.

The following is part of an article by Megan McArdle in The Washington Post about the danger the virus poses to rural America.


There is something to the rural exceptionalism story, some reason to believe that covid-19 might spread more slowly in rural areas than it does in dense cities. People who live in large, well-ventilated homes with more than one room per person, shop in airy grocery stores with mile-wide lanes, and drive to work in a private vehicle rather than crowding onto public transit with hundreds of strangers might well have fewer opportunities for exposure than your typical New Yorker does.

That said, a slow-motion disaster is still a disaster. And human beings are geniuses at inventing false reasons to feel secure.

At every stage of this pandemic, people have come up with dozens of plausible reasons that the areas overwhelmed by covid-19 were different from their own, happily still secure neighborhoods: more air pollution or smokers, more mass transit or elevators, more cheek-kissing or multi-generational homes. Then as the virus moved on, they came up with reasons that that new place, too, was full of people who are Not Like Us.

Some of those reasons were no doubt true. They just weren’t true enough. It turns out that as long as you have human lungs, the virus likes your flavor just fine, no matter where you live. And unless we take strenuous measures to stop it, eventually the virus will spread to where you live and do its best to kill you.

While rural areas may not have a mass transit system for the virus to move through, they have plenty of churches, high school football games and Rotary pancake breakfasts. As we have already seen, without lockdowns, those can do the job just fine. South Dakota, Nebraska and Arkansas, three states that had looked relatively immune, are all now dealing with serious outbreaks.

In fact, rural areas have some distinct disadvantages compared with big cities. In the large cities where covid-19 first took hold, it took the handful of initial cases months to double and redouble until the sheer number of infections started to overwhelm hospitals. But in a county of 20,000, a disease that is doubling every three to five days would take less than two months to infect 100 percent of the population. By the time doctors even recognized that the disease had arrived in the area, it might well already be too late to stop the disaster.

Those areas don’t have so many of the professional jobs that allow people to work from home, so once the disease does get going, it will be very hard to stamp out. . . .

The hospital systems in rural areas have nothing like the capacity they would need to cope with that sort of outbreak on a wider scale. More than half of all counties in the United States have no intensive care beds. Yet the citizens of those counties tend to be older and sicker than people in urban areas, meaning that if they contract covid-19, they are more likely to need intensive care.

So one can tell a very different story about the nationwide lockdowns, almost the opposite of the one in which less dense areas are being forced to #canceleverything in order to protect New York. In that story, New York’s experience is protecting them by serving as an early warning while they still have time to avoid that city’s fate — or possibly an even worse one — by shutting down now, and then building up the test-trace-quarantine infrastructure that can keep their region covid-free even when restrictions are lifted.

But for this story to have its happy ending, they’ll have to abandon that other narrative and face the unpleasant reality that New Yorkers have belatedly acknowledged: No person or place is really that different from you, and no law of nature will keep this virus in far-off places, killing people you’ve never met.

Trump Must Win In The Suburbs To Be Re-Elected

These charts reflect the results of NBC News / Wall Street Journal Polls done in January, February, March, May, June, and July of this year. The margin of error for the polls is about 3.5 points.

The top chart shows Trump support in urban areas, and the second chart shows his support in rural areas. It's pretty obvious that Trump will lose big in the urban areas (about 27% of population) and win big in the rural areas (about 21% of population).

That makes the suburban vote very important. The suburbs have about 52% of the U.S. population, and in 2018 they comprised 51% of the votes cast (and the suburban vote is what gave Democrats their win in House elections). Trump must carry the suburbs by a fairly comfortable margin to offset the urban vote (which is larger than the rural vote).

Can he do that? Right now it's not looking real good for Trump. He is actually down about 3 points in the suburbs (47% to 50%). He needs to do at least 7 or 8 points better than that in the suburbs, or he will lose.

Trump's Policies Hurt His Most Reliable Voters (Rural Voters)

These charts reflect the results of a recent Politico / Morning Consult Poll -- done on April 28th and 29th of a national sample of 1,995 registered voters, with a margin of error of 2 points.

It shows that rural voters are the most reliable supporters that Donald Trump has. By a 12 point margin, they approve of the job Trump is doing. Suburban voters disapprove by a 15 point margin, and urban voters disapprove by a 35 point margin.

The same is true when those voters are asked if they would vote to re-elect Trump. Rural voters would reelect Trump by a 7 point margin. Suburban voters would vote against him by 20 point margin, and urban voters would vote against him by a 39 point margin.

One would think that Trump would go out of his way to take care of those rural voters. But just the opposite is true. His policies have hurt rural people worse than either suburban or urban people.

Here is some of how Nobel Prize economist Paul Krugman puts it in The New York Times:

Rural America is a key part of Donald Trump’s base. In fact, rural areas are the only parts of the country in which Trump has a net positive approval rating. But they’re also the biggest losers under his policies.

What, after all, is Trumpism? In 2016 Trump pretended to be a different kind of Republican, but in practice almost all of his economic agenda has been G.O.P. standard: big tax cuts for corporations and the rich while hacking away at the social safety net. The one big break from orthodoxy has been his protectionism, his eagerness to start trade wars.

And all of these policies disproportionately hurt farm country.

The Trump tax cut largely passes farmers by, because they aren’t corporations and few of them are rich. One of the studies by Agriculture Department economists that raised Trumpian ire showed that to the extent that farmers saw tax reductions, most of the benefits went to the richest 10 percent, while poor farmers actually saw a slight tax increase.

At the same time, the assault on the safety net is especially harmful to rural America, which relies heavily on safety-net programs. Of the 100 counties with the highest percentage of their population receiving food stamps, 85 are rural, and most of the rest are in small metropolitan areas. The expansion of Medicaid under the Affordable Care Act, which Trump keeps trying to kill, had its biggest positive impact on rural areas.

And these programs are crucial to rural Americans even if they don’t personally receive government aid. Safety-net programs bring purchasing power, which helps create rural jobs. Medicaid is also a key factor keeping rural hospitals alive; without it, access to health care would be severely curtailed for rural Americans in general.

What about protectionism? The U.S. farm sector is hugely dependent on access to world markets, much more so than the economy as a whole. American soybean growers export half of what they produce; wheat farmers export 46 percent of their crop. China, in particular, has become a key market for U.S. farm products. That’s why Trump’s recent rage-tweeting over trade, which raised the prospect of an expanded trade war, sent grain markets to a 42-year low.

It’s important to realize, by the way, that the threat to farmers isn’t just about possible foreign retaliation to Trump’s tariffs. One fundamental principle in international economics is that in the long run, taxes on imports end up being taxes on exports as well, usually because they lead to a higher dollar. If the world descends into trade war, U.S. imports and exports will both shrink — and farmers, among our most important exporters, will be the biggest losers. . . .

Trump’s biggest supporters are his biggest victims.