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Pete Buttigieg

Growing up in the middle of the country, I’ve seen up close that America is only as healthy as rural America. Rural communities help sustain our country and propel our economy. Yet rural Americans are getting sicker and dying younger than people living in cities.

In 1982, the year I was born, Americans in rural communities could expect to live as long as Americans who lived in cities. Since then, too many rural areas have become economically marginalized and politically neglected. Today, the gap between urban and rural life expectancy is wider than in at least half a century. This reality is especially harrowing in states like Iowa, where one in every three people lives in a rural community.

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 firsthand the effects of this neglect. That’s why I’m putting forward a plan specifically to invest in overlooked communities.

It is time to break with the politics of the past and usher in a new era for rural America. We need to lift rural communities up as places of opportunity, both for this generation and future ones. That work begins by deploying investment and innovation to secure the health of all rural residents, whether that’s a veteran struggling with mental health challenges or a Native woman giving birth.

First, we’ll expand telehealth. The future of health care in rural America is one in which a doctor can remotely monitor her patient’s heart rate from home, and a teenager struggling with depression can meet virtually with a therapist. I’ll also support rural Americans by doubling funding for the Federal Communications Commission’s Rural Health Care Program.

Second, we must ensure that every rural resident has access to affordable health insurance. Rural Americans face greater risk of being uninsured — especially in states that have refused to expand Medicaid — than urban Americans. And rural Iowans pay almost $1,000 more a year on average for marketplace coverage than someone in Des Moines or Cedar Rapids. As president, I’ll implement “Medicare For All Who Want It” so everyone has access to an affordable Medicare-type plan, and make insurance cheaper for working-class Americans by increasing federal subsidies on the healthcare exchanges.

Third, we must increase the number of rural health providers. Rural hospitals are closing, depriving communities of critical health services and good jobs. Of Iowa’s 99 counties, half have a shortage of primary care doctors. I will act to reverse this trend. We will train homegrown doctors and nurses, and we will attract healthcare workers from elsewhere by expanding public service loan forgiveness, doubling the waiver program that encourages foreign doctors to work in underserved areas, and increasing Medicare and Medicaid reimbursement rates.

Fourth, we’ll increase access to prevention and treatment for mental illness and addiction. Today, you are 45% more likely to die by suicide in a rural town than in a city. In Iowa, deaths due to heroin and fentanyl are rising. That’s why I’ll 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.

Fifth, when barely half of Iowa counties have maternity units, we must make it easier for women to access critical services before, during, and after pregnancy. We’ll tackle this crisis by expanding Medicaid coverage for women up to a year post-delivery, keeping obstetric units open by increasing payments to maternal care providers, and training more nurses to provide basic maternal care services.

Finally, we’ll meaningfully reduce health inequities for the one in five rural residents who face worse health outcomes as people of color. As president, I will launch a National Health Equity Strategy to help communities improve equity, wellness and community health.

In 2019, where you live should not determine how healthy you are or how long you live. Let’s empower rural America to lead the way.

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Pete Buttigieg is the mayor of South Bend, Indiana, and a Democrat running for president.

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