85% of the House Democrats who voted against the party's health reform plan came from Congressional districts more rural than the nation as a whole.
Congressional legislation to reshape the U.S. health insurance system, H.R. 3962, passed by a tiny five-vote margin late Saturday night, as 39 Democrats – most of them representing rural districts — broke with the president and opposed the sweeping bill.
Voting overwhelmingly along party lines, the House passed the Affordable Health Care for America Act 220-215. Of the 39 Democrats who voted against the bill, 33 represent districts with higher-than-average rural populations. See the chart below for the full list of the Democrats who voted No and the rural make-up of their districts. (Congressional districts’ rurality is based on 2000 Census figures and calculations by the USDA found here).
Nationwide, 21% of Americans live in rural communities.
Six nay votes came from Democrats in the 20 most rural districts in the nation: Lincoln Davis (TN-4), Collin Peterson (MN-7), Rick Boucher (VA-9), Dan Boren (OK-2), Travis Childers (MS-1), and Ike Skelton (MO-4).
“I am concerned about the impact the legislation could have on rural hospitals and doctors,” wrote Skelton in a statement defending his opposing vote. Rep. Ben Chandler (KY-6) and Rick Boucher of southwest Virginia had both been early Obama supporters, but both voted against the health reform bill citing its potential to further weaken ailing rural hospitals.
“Most of our hospitals are operated on a nonprofit basis for the benefit of the community,” Boucher wrote. “While most of their receipts are from Medicare and Medicaid payments, they lose money on each Medicare or Medicaid patient they treat. These programs reimburse hospitals at rates below the actual cost of providing patient care.”
Funding for H.R. 3962 would come in part from reductions in some Medicare reimbursements.
A late amendment to the bill disqualifying payments for abortions from the federal health insurance plan was co-authored by Rep. Bart Stupak, a pro-life Democrat from rural Michigan; this measure appeared to have won crucial supporters at the 11th hour, among them Rep. Joseph Cao of New Orleans, the lone Republican who voted for the bill.
President Obama and House Speaker Nancy Pelosi had been toiling for months to build a majority for their health care reform plan. Among its far-reaching features are a public option for health insurance, provision of health insurance to some 36 million Americans who now lack coverage, and regulations that ban insurance companies from denying coverage for people with pre-existing illnesses. The cost of the proposed reform, estimated by the Congressional Budget Office at $1 trillion over the next 10 years, is to be borne by high earning taxpayers and through reductions in some Medicare costs.USA Today wrote that “vulnerable Democratic freshmen” in Congress were under special pressure to oppose the bill; many represented districts that had gone for John McCain in 2008. Rural freshman Democrats who opposed the bill were Parker Griffith and Bobby Bright of Alabama, Walt Minnick of Idaho, Travis Childers of Mississippi, and Frank Kratovil, representing Maryland’s eastern shore. The Baltimore Sun called Kratovil, “one the most vulnerable House members in the country in next year’s election.” According to USA Today, he “was the congressman hung in effigy during the height of the August town hall meeting uproar.”
Several urban “freshman” Democrats turned against the party’s health care bill, also. Michael McMahon, representing Staten Island, New York, voted no, despite a Friday night phone call from the president.
Staten Island Live reported, “A source close to McMahon claimed voters on both sides of the bridge are ‘overwhelmingly opposed’ to the bill — and have let McMahon know it. At a raucous public forum McMahon hosted here last month, dozens of agitated Islanders decried the bill as a form of socialism. Reaction in Brooklyn has been slightly less vitriolic, but nearly just as opposed.” E-mails, phone calls and letters to McMahon’s congressional offices were said to “have been running 60-40 against the bill.”
Rep. Suzanne Kosmas (FL-24), a freshman Democrat from greater Daytona Beach — a district that went for McCain last year — also voted no.
As Obama worked to seize on his party’s majority in Congress for the legislation that may well define his presidency, not all defectors were rural conservatives. Rep. Dennis Kucinich of Cleveland also voted against the bill for failing to implement a federal single-payer system.
Kucinich called the House health bill “a bailout under a blue cross.”