As Congress starts planning its next coronavirus relief package, Sen. Amy Klobuchar (D-MN) has shared her new plan for rural America exclusively with Vox.

Though much of the national media focus so far has been on “hot spots” like New York City and New Jersey, coronavirus has already hit America’s rural communities. And if it hasn’t yet reached a given area, it likely will in the coming weeks and months. A recent New York Times analysis found that as of April 6, two-thirds of rural communities have confirmed at least one coronavirus case; the number of cases could continue to rise.

Covid-19 is colliding with a weak health care infrastructure in rural areas with older and lower-income patients who have seen their local hospitals close. With far fewer resources than cities or suburbs, the 60 million people who live in rural areas could be devastated by the coronavirus.

Rural communities are also being hit by the economic ripple effects of the virus’s spread. Some in rural areas have no access to high-speed broadband, which they could use to work remotely, file for unemployment, or get their kids logged on to virtual school. Farmers and ranchers fear the virus could wreak havoc on the food supply chain and their livelihoods. And people of color, including Native communities, are particularly at risk.

“We’re facing a national crisis — it affects every American, no matter where they live,” Klobuchar told Vox in a statement. “While COVID-19 may be slower to spread to some rural areas, its impact will likely be just as serious, as we’ve seen in places like Albany, Georgia, and Martin County, Minnesota.”

Klobuchar’s plan is expansive. It includes some proposals like small-business relief, which was in the CARES Act and is part of another small-business loan bill negotiation between Republicans and Democrats. Other pieces have already been introduced as stand-alone bills. But now that the first coronavirus wave seems to be leveling off, the Minnesota senator recognizes a second wave could hit rural America particularly hard and wants her plan included in coronavirus stimulus packages to come.

Some rural communities are ill-prepared for Covid-19

As the coronavirus hit large urban areas like New York City, Detroit, and New Orleans, rural communities didn’t see many cases at first.

The lack of dense population might make it seem like these communities don’t have as much risk. But no one’s risk is zero.

“If we believe that the way seasonal flu spreads through the country is likely similar to Covid-19, the rural eruptions tend to be later and briefer but more impactful than in big urban areas,” Roger Ray, a retired neurologist, physician executive, and physician consulting director with the Chartis Group, recently told writer Lois Parshley for Vox.

And when the coronavirus does hit, rural areas simply have fewer resources to deal with it. From 2005 to 2020, 170 rural hospitals around the country closed, leaving critical gaps in the rural health care infrastructure. Physician shortages have followed; a 2019 poll conducted by NPR, the Robert Wood Johnson Foundation, and the Harvard T.H. Chan School of Public Health found a quarter of people living in rural areas said they could not access needed health care — and many said it was because their health care facility was too far away.

Per Parshley:

More than half of counties in America have no hospital ICU beds, posing a particular risk for the more than 7 million people over the age of 60 living in those places, who are at higher risk of severe cases of Covid-19. In February, the Chartis Group released a study showing that more than 450 rural hospitals are vulnerable to closure. “If you’re vulnerable enough to risk losing the ability of making payroll, how valuable can you be to the community in crisis?” Ray asks.

Even if these rural areas may not face coronavirus rates like New York City did, the virus could exacerbate some devastating trends.

What’s in Klobuchar’s new plan

Klobuchar’s proposal is a wide-ranging, four-part plan that takes into account everything from support for rural hospital and medical professionals to relief for farmers, increased rural broadband, and support for local governments.

“We need to ensure that all communities across rural America are not left behind and have the resources they need to respond to this pandemic,” Klobuchar told Vox.

Here are the main points of her plan.

Bolstering rural health care

Protecting rural hospitals from closing: Well before the coronavirus hit, rural areas faced a dire trend of hospitals closing: 170 rural hospitals around the country have closed in the past 15 years, and coronavirus could worsen that trend now that many hospitals have had to cancel elective surgeries and other moneymaking procedures. Klobuchar wants to expand the $100 billion Public Health and Social Services Emergency Fund for these hospitals, as well as giving them lower interest rates and more time to repay under the Medicare Accelerated Payments Program.

Well before the coronavirus hit, rural areas faced a dire trend of hospitals closing: 170 rural hospitals around the country have closed in the past 15 years, and coronavirus could worsen that trend now that many hospitals have had to cancel elective surgeries and other moneymaking procedures. Klobuchar wants to expand the $100 billion Public Health and Social Services Emergency Fund for these hospitals, as well as giving them lower interest rates and more time to repay under the Medicare Accelerated Payments Program. Temporarily reopening closed rural hospitals: Klobuchar is asking the US Department of Health and Human Services (HHS) to explore ways to reopen recently closed hospitals to be overflow facilities for other hospitals dealing with an influx of coronavirus cases. Much like the Javits Center is serving as a temporary hospital in New York City, recently closed hospitals could be used if needed. Klobuchar is also asking for more assistance for rural health clinics, which are often the main source of health care in rural areas.

Klobuchar is asking the US Department of Health and Human Services (HHS) to explore ways to reopen recently closed hospitals to be overflow facilities for other hospitals dealing with an influx of coronavirus cases. Much like the Javits Center is serving as a temporary hospital in New York City, recently closed hospitals could be used if needed. Klobuchar is also asking for more assistance for rural health clinics, which are often the main source of health care in rural areas. Strengthen the rural health care workforce: Many rural areas have doctor shortages. Rural areas, on average, have about half as many physicians per capita as urban areas, forcing some people to travel hours to visit their doctor or wait longer to see a physician. Klobuchar wants HHS to give rural providers maximum flexibility to develop staffing plans in response to the coronavirus. For instance, where specialists in some hospitals have been asked to help with coronavirus care, it can be harder in rural areas because these specialists sometimes work at different hospitals, which requires shifting personnel across buildings. Klobuchar also proposes expanding student loan forgiveness for health care and long-term care workers in places with shortages.

Many rural areas have doctor shortages. Rural areas, on average, have about half as many physicians per capita as urban areas, forcing some people to travel hours to visit their doctor or wait longer to see a physician. Klobuchar wants HHS to give rural providers maximum flexibility to develop staffing plans in response to the coronavirus. For instance, where specialists in some hospitals have been asked to help with coronavirus care, it can be harder in rural areas because these specialists sometimes work at different hospitals, which requires shifting personnel across buildings. Klobuchar also proposes expanding student loan forgiveness for health care and long-term care workers in places with shortages. Deliver medical supplies and testing: Regardless of whether they are rural or urban, many hospitals and medical facilities are struggling to get adequate medical supplies and coronavirus tests. But with increased competition for what is available, rural providers have less money to compete. Klobuchar is asking their needs be considered when equipment and tests are allocated.

Addressing coronavirus’s impact on agriculture

Getting financial relief to farmers: Klobuchar is a senior member of the Senate Agriculture Committee and has been hearing from farmers that prices they’re getting for their commodities are starting to fall drastically. She’s proposing getting farmers credit and addressing these low commodity prices by expanding the safety net for farmers.

Klobuchar is a senior member of the Senate Agriculture Committee and has been hearing from farmers that prices they’re getting for their commodities are starting to fall drastically. She’s proposing getting farmers credit and addressing these low commodity prices by expanding the safety net for farmers. Protecting farm workers and food processors: Coronavirus outbreaks at large farms and food processing plants aren’t just worrisome for public health; they could also wreak havoc on the food supply chain. Already, one of the nation’s largest pork processing plants in Sioux Falls, South Dakota, shut down after a coronavirus outbreak among employees. Klobuchar (like other Democrats in the House and Senate) is calling for increased Occupational Safety and Health Administration regulations that protect workers on the job for food processing and farm workers, as well as training for these workers in multiple languages, as many are immigrants.

Coronavirus outbreaks at large farms and food processing plants aren’t just worrisome for public health; they could also wreak havoc on the food supply chain. Already, one of the nation’s largest pork processing plants in Sioux Falls, South Dakota, shut down after a coronavirus outbreak among employees. Klobuchar (like other Democrats in the House and Senate) is calling for increased Occupational Safety and Health Administration regulations that protect workers on the job for food processing and farm workers, as well as training for these workers in multiple languages, as many are immigrants. Keeping the food supply chain running: Klobuchar is proposing a number of other measures like exempting commercial truck drivers from state travel restrictions and providing emergency funding for the nation’s ports.

Klobuchar is proposing a number of other measures like exempting commercial truck drivers from state travel restrictions and providing emergency funding for the nation’s ports. Increasing SNAP and other food security programs: Klobuchar is echoing a demand from Democratic leaders in the House and Senate — increased funding for food security programs like SNAP and increased benefits for teenage family members to make sure low-income families and children have enough food.

Support for small businesses

Increased funding for small-business loans: A small-business loan fund that was set up by the CARES Act is already running out of money and is the subject of congressional negotiations between Republicans and Democrats. Klobuchar is arguing that businesses need increased access to loans and grants but also is calling for increased technical assistance for rural small businesses.

A small-business loan fund that was set up by the CARES Act is already running out of money and is the subject of congressional negotiations between Republicans and Democrats. Klobuchar is arguing that businesses need increased access to loans and grants but also is calling for increased technical assistance for rural small businesses. Expanded access to child care: There’s already limited access to child care in rural areas, and the recent closure of schools in many states has exacerbated the problem. Klobuchar is calling for increased funding for the Child Care and Development Block Grant and increasing subsidies to encourage more rural child care centers to open and have money to operate during coronavirus.

Rural broadband and more funds for state and local programs

Rural broadband: One issue Democrats have long wanted to address as part of a larger infrastructure package is the lack of high-speed broadband internet in many rural areas. Klobuchar argues that’s especially important now, as families must shelter in place and do work and school from home. It’s also essential for unemployed workers trying to apply for benefits from home. It could take months to develop an infrastructure program, so Klobuchar proposes additional funding to the E-Rate program to provide wifi hotspots to students who don’t have broadband at home.

One issue Democrats have long wanted to address as part of a larger infrastructure package is the lack of high-speed broadband internet in many rural areas. Klobuchar argues that’s especially important now, as families must shelter in place and do work and school from home. It’s also essential for unemployed workers trying to apply for benefits from home. It could take months to develop an infrastructure program, so Klobuchar proposes additional funding to the E-Rate program to provide wifi hotspots to students who don’t have broadband at home. Affordable housing: Klobuchar is pushing for enforcement of a temporary eviction moratorium on properties with federally backed mortgages and calling for increased emergency rental assistance for those in rural areas.

Klobuchar is pushing for enforcement of a temporary eviction moratorium on properties with federally backed mortgages and calling for increased emergency rental assistance for those in rural areas. Supporting the US Postal Service: As the Postal Service suffers from a drop in people sending and receiving mail, Klobuchar and other senators and members of Congress are calling for increased federal support to keep it going as an essential public service.

As the coronavirus spreads to rural areas, Congress will likely have to extend more assistance to those areas. As a senator, former presidential candidate, and potential vice presidential contender, Klobuchar may be in a good position to make the case for helping Americans who live there.

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