Most of the 34 Democrats who voted against Barack Obama's massive health care bill represent decidedly rural districts.
The 34 Congressional Democrats who broke with party leadership and voted against President Obama’s massive health care reform bill represent, on average, far more rural constituencies than do Democrats who supported the legislation.
The rural population of the Democratic no-voters’ districts was nearly 39%; Congressional Democrats who supported the health care bill represented constituencies only 14% rural. All Republicans in Congress opposed the health care bill, which passed 219-212 on Sunday. (Figures on the urban/rural makeup of Congressional districts come from the U.S. Census.)
Among those Democrats voting against the Patient Protection and Affordable Care Act (H.R.3590) were Reps. Lincoln Davis (TN-4), Rick Boucher (VA-9), Collin Peterson (MN-7) and Dan Boren (OK-9). Their four Congressional districts are among the top ten most-rural in the nation.
A primary feature of the health care bill is provision of health coverage to some 31 million currently uninsured Americans. The Committee on Energy and Commerce provided information on how the bill would affect each Congressional district. It showed rates of uninsured citizens varying significantly from place to place.
Democrat Bobby Bright, who voted against the bill, represents Alabama’s rural 2nd Congressional District, where, according to the committee, 60% of all residents “receive health care coverage from an employer or through policies purchased on the individual market.” Democratic Rep. Dan Boren also opposed the health care bill, though in his rural district (Oklahoma’s 2nd) only 43% of the population now has health coverage. Boren wrote that he opposed the bill “emphatically.”
“There are cuts to vital services for seniors on Medicare. Second, it raises taxes on individuals and families, and third it imposes job killing mandates on small businesses. How could anyone think that these are the right steps during a time of record unemployment and recession?” he wrote. Making no mention of the many Oklahomans without health care coverage, Boren said that he had voted in accordance with constituents’ “unwavering” requests: “The desire for me to oppose this health care proposal has been very clear,” Boren announced.
This map of the vote on H.R. 3590 shows regional disparities among the most rural members of Congress. Support for Obama’s health care bill was strong among rural Democrats in the Northeast and West. Rural Democratic opposition was concentrated in a stretch of the mid-South, from Boren’s district in eastern Oklahoma, through Arkansas and most of Tennessee, into Rep. Rick Boucher’s district of southwest Virginia.
Minnesota’s rural Democratic representatives split on the bill. Collin Peterson, from the western region, opposed it, but James Oberstar of northern Minnesota, voted in favor.
Oberstar stressed that the legislation, “not only expands health insurance coverage in rural America, but it also promotes the training and placement of health care professionals in rural areas.” He also emphasized that the new law would address “the longstanding geographic disparity in Medicare reimbursement,” that has tended to penalize hospitals and doctors in rural areas. “Northland health care providers have been greatly disadvantaged by unfair Medicare reimbursement,” wrote Oberstar; “this legislation closes that gap and moves us inexorably toward payment parity with the rest of the country.”
The legislation mandates paying a 10 percent Medicare bonus to primary care doctors and general surgeons practicing in underserved areas.
The Duluth Star Tribune reported that calls to Oberstar’s office had been mixed “with the Iron Range and Duluth favoring reform and the majority of people in the southern and western portions of (the) district against it. After the vote, however, Oberstar said calls and e-mails have been more than 3-1 in support of his ‘yes’ vote.”
Representing the most rural Democratic district in the country, Michael Michaud (ME-2) also supported the health care bill. Bob Carlson, director of Penobscot Community Health Care in Bangor, Maine, praised the legislation for providing some $11 billion to increase the number of health centers nationwide from 1300 to 7500. “For the rural areas this can mean huge benefits,” Carlson said, “to be able to move into those areas that are medically underserved.”
Bart Stupak, representing Michigan’s Upper Peninsula — the 5th most rural district in the U.S. — was a key negotiator in the work preceding Sunday’s vote. Stupak and several other Democrats had declared they would oppose any bill that permitted federal funding of abortion on demand. The Senate health care bill, which the House took up Sunday, did permit government-funded abortions.
In the end, however, Stupak, as well as Rep. Nick Rahall of rural West Virginia, another outspoken pro-lifer, did vote in favor of H.R. 3590. In a statement after Sunday’s vote, Stupak announced that he and others had gained assurance that President Obama would invoke the Hyde Amendment by executive order, reaffirming that no federal monies would pay for health plans that cover abortion.
Rep. Rahall justified his vote in favor of the health care reform bill to angry constituents: “There is a time when you have to look in your conscience at what you feel is best for the people you represent, for the children, for the uninsured. This was probably in the end, as I decided over the weekend, the most pro-life vote I have made in my 34 years in the Congress.”
Here are the 34 Congressional Democrats who voted against the Patient Protection and Affordable Care Act (H. R. 3590) and the percent of rural population in each of their districts. The average rural population across all U.S. Congressional districts is 21%.