Amid all the talk of Texas being a swing state because of its big city blue meccas, it’s easy, but perilous, to lose sight of the roughly 3 million people who live in rural areas.
For the past century, the state’s rural population has been dwindling, it’s young workers migrating to cities and suburbs because of a changing economy and an increasingly mechanized agriculture industry.
“We used to have an active union here and a union hall here, but we don’t have that anymore because we lost a huge number of manufacturing jobs,” Shirley Layton, a Lufkin resident with the Texas Democratic Party’s Non-Urban/Agricultural Caucus told the Signal. “With that, people really turned inward,” she said of her community.
Layton described a host of problems that plague rural Texans, such as lack of access to broadband or high-quality jobs. Above all, she said healthcare was the top issue for cities like Lufkin, a small town with a population of 35,000.
In 2015, a survey found that 185 Texas counties– representing more than 3 million people– had no psychiatrist. The survey also found that 158 Texas counties had no general surgeon and 147 counties had no obstetrician or gynecologist. “That is like saying Kansas doesn’t have a psychiatrist. That is like saying the state of Nebraska or Montana doesn’t have an obstetrician,” said one researcher at the time.
The lack of readily available physicians in rural Texas also corresponds with a rash of hospital closings. Since 1960, a total of 142 rural hospitals have closed down, with 26 shutting their doors since 2010, according to the latest count by the Texas Organization of Rural & Community Hospitals.
So far, the state’s GOP leaders have done little to alleviate these healthcare issues. Most notably, Gov. Greg Abbott’s decision to not expand Medicaid is likely a leading reason for Texas leading the nation in rural hospital closings. Studies have shown that states that chose to expand Medicaid under the Affordable Care Act had lower uninsured rates in rural areas and a substantially lower likelihood of hospital closures in rural markets.
As for President Trump, who overwhelmingly won most of Texas’ sparsely-populated counties with the exception of the Latino-majority counties in South Texas, most of his major promises to rural America– like revitalizing aging infrastructure or bringing back manufacturing jobs– have yet to materialize. Trump’s trade war with China has only made Texas farmers nervous and produced almost no results in returning outsourced jobs to the U.S. “On an actual personal level, there’s nothing,” Layton said of Trump’s promises to rural Texas. “They see percentages of employment, saying ‘we’ve got jobs’, but he hasn’t fulfilled any of those economic promises to East Texas.”