March 18, 2017; New York Times
Miriam Jordan’s article “Rural Areas Brace for a Shortage of Doctors Due to Visa Policy” reviews an issue that is gaining some traction despite most of the public’s attention being focused on the “slim budget.” In the article, Jordan gives example after example of how rural health providers depend on foreign doctors to provide primary care to the people who turned out in droves to vote for Donald Trump.
While the Trump administration is fighting, in the courts of justice and public opinion, for its temporary travel ban affecting six countries, the slowdown in the rural doctor pipeline shows how even a small, relatively uncontroversial change can ripple throughout the country.
When President Trump revealed he found healthcare “unbelievably complex,” he probably never considered the interactive complexity of health and immigration.
Ms. Jordan’s article builds on efforts by Democratic senators Heidi Heitkamp (D-ND) and Amy Klobuchar (D-MN). In an earlier article, entitled “Heitkamp, Klobuchar say change in visa processing could hurt rural healthcare,” Sam Easter, a reporter for the Bemidji Pioneer, makes the connections between foreign-born physicians and access to healthcare in rural communities.
The coming pause on faster processing [of visas] has some worried. The senators’ concerns are centered on the “Conrad 30” program, named for former Sen. Kent Conrad of North Dakota. It allows for foreign doctors finishing their residency on a certain visa—30 in each state every year—to skip requirements that they leave the U.S. for two years afterward and instead help underserved populations.
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While this sounds like a bureaucratic glitch, the bigger question is whether medical professionals want to stay in the U.S. under a Trump administration.
NPQ’s Michael Wyland called the steady decline of rural hospitals as a “death by a thousand cuts,” but the impending synergy of immigration restrictions and Medicaid cuts could deliver a double whammy to rural healthcare providers. A Boston Globe story about the impact of the American Health Care Act outlines some potential impacts of healthcare reform that will actively undermine the social stability provided by safety net programs: “Of the 39 states that use the federal health insurance exchanges created by the health care law, the 10 states whose residents would lose the most under the Republican alternative all backed Trump in the general election.”
This may not just a rural issue. This past week, Children’s Hospital in Columbus, Ohio, closed a suburban facility because of a staff shortage. Earlier last week, Cleveland Clinic announced a closure of maternity services in an outlying facility. In that case, staff shortage was not explicitly cited as a reason for the move, but the plan seems to clearly reflect a consolidation of services into more metropolitan settings.
Is President Trump is willing to take this “hit” with his voters in order to curry favor with the Republican establishment? Columnist Matthew Yglesias says, “The whole situation is highly unusual—just like a lot of things are unusual about Trump’s political career. And it to an extent raises the question of whether Trump realizes how far the bill he’s backing diverges from what he said he would do.”
A slightly different analysis might be that President Trump’s supporters will discount a continuing attrition of local services if they are getting symbolic and stylistic reinforcement of a return to American greatness. This allegiance to nostalgia is the message of a Guardian story: “Nostalgia: the yearning that will continue to carry the Trump message forward.” Guardian reporter Chris Arnade reports on the persistence of belief in President Trump’s vision of American greatness. The support of the rural whites profiled in the story is rooted in the intangibles of self-respect, greatness, and a better future for their children.
If this is true, Democrats risk making the same mistake Hillary Clinton made in the 2016 general election: focusing on programs instead of vision. In fact, attacks on President Trump’s policies could backfire. Democratic West Virginia Senator Joe Manchin’s effort to pin Medicaid cuts to President Trump’s lapel by passing out the White House phone number at his town hall meetings could prompt the Trump believers to endure an unpleasant present for the promise of a brighter future. Paraphrasing the King James Bible just a little, “Without a progressive vision, the people will perish.”—Spencer Wells