Tuesday, July 18, 2017

Rural healthcare in the news (Part II)

It's the day after Mitch McConnell pulled BCRA (the Budget Care Reconciliation Act) from consideration, a decision prompted by the announcement of Senators Mike Lee of Utah (R) and Jerry Moran  (R) of Kansas that they would not support the bill.  Some pundits have noted that both Lee and Moran were elected in 2016 with comfortable margins, suggesting that they are lending cover to other more vulnerable Republicans who would be more reluctant to stand up to McConnell and Trump.  Others have noted that Moran was rare among Republican Senators in that he held town hall meetings with constituents during the recent summer recess.  I have not, however, seen folks talk about the rurality or urbanicity of Utah and Kansas.  I suspect that most are like me in that they think of Utah and Kansas as largely rural states.  In fact, both are highly urbanized, especially Utah, which is the 8th most urbanized state in the nation, with 90.58% of the population living in "urban" places, as that term is defined by the U.S. Census Bureau (population clusters of 2,500 or more).  As for Kansas, 74.2% of the population live in urban areas.  (Compare these figures with Maine, which is the least urbanized state, with 38.7% of the population living in cities, and with Mississippi, where just under half of the state's population are urban; ditto Montana).  I wonder, nevertheless, if a certain rural ethos or understanding or concern still dominates (or at least survives, persists) in states like Kansas and Utah--if the urban residents of these states still know lots of rural folks and care about the likely closure of rural hospitals that would have been wrought by the BCRA.  Might this have influenced Moran and Lee and even their urban constituents?

While I was in the midst of drafting the paragraph above, I got the push notification from the New York Times that three Senators have already declared that they will vote against McConnell's Plan C:  Repeal Obamacare now, but make the repeal effective only two years from now, which would give the Senate time to develop a replacement.  Those three Senators are all from states popularly thought of as rural:  Alaska, Maine and West Virginia.  Here's an excerpt from the story:
Senators Susan Collins of Maine, Shelley Moore Capito of West Virginia and Lisa Murkowski of Alaska, all Republicans, immediately declared they could not vote to repeal the Affordable Care Act without a replacement — enough to doom the effort before it could get any momentum.
For the record, 66% of Alaskans live in urban areas, but just 48.72% of West Virginia residents do.  Maine is the state with the highest percentage of rural residents, at nearly 39%, as noted above.

Claire McCaskill (D-Missouri), Shelley Moore Capito (R-West Virginia), Heidi Heitkamp (D-North Dakoa), Martin Heinrich (D-New Mexico), Ron Wyden (D-Oregon), Jeff Merkley (D-Oregon) (see image below from July 16) and Michael Bennet (D-Colorado) are among those I've seen expressing concerns about rural folks and rural hospitals as the vote on the BCRA has loomed.

As the headline for this post suggests, it is Part II of a short series on the attention rural people and places--and especially rural hospitals--have been getting since the U.S. House passed the AHCA and the U.S. Senate responded with the BCRA.  Part I is here.   Another such story is focused more on the rural doctor shortage, which it notes has not been part of the health care reform discussion.   Like the stories featured in my prior posts, this one is also from NPR, this time out of Bisbee, Arizona, a remote community (population 5,575) that lies some 70 miles south of Tucson and just about five miles north of the Mexican border.  The headline is especially interesting to me because it invokes a theme we've seen a lot post election--the fact (or at least assertion) that rural American has been forgotten.  It is "Doctor Shortage in Rural Arizona Provokes Another Crisis in 'Forgotten America.'"  The story provides some data that isn't very surprising for those of us who study rural:  By 2020, rural areas could be short 45,000 doctors by 2020, and those are conservative estimates according to some trade groups.  More than 70 rural hospitals have closed since 2010.

I find the story heavy on nostalgia as a reason we should care about places like Bisbee.  Kirk Siegler of NPR quotes the town's mayor, David Smith, who says many Bisbee residents are uninsured or rely on Medicaid.  He also says it's hard to recruit doctors because of the lack of amenities:
Among other things, this summer, the public pool is finally reopening. 
Still, there is no movie theater. There is only one grocery store left in town and no soccer fields. Little things like these can be a deal-breaker when it comes to recruiting new doctors and other professionals.
Siegler notes that this rural physician shortage isn't "even part of the health care debate in Washington right now." Smith sees the shortage as "part of a broader story of rural neglect" commenting that "Rural America is forgotten America."  And that leads into the nostalgic bit, again quoting Smith:  
Copper from Bisbee, Ariz., is what helped win World War I.  And yet, when we are in need, we are forgotten because it's not convenient — and because it's not a whole bunch of people here that are voters.
The CEO of the 14-bed Copper Queen Community Hospital notes the negative feedback loop in communities like his who are looking for physicians--physicians don't want to come because the pay is low, but the pay isn't going to get better and the amenities are not going to increase unless the local economy rebounds.  That's unlikely to happen because it wasn't diversified to begin with, hence the hard hit when copper ceased to be mined.  It's also hard to revitalize the economy in such a remote place.  The principal economic driver now is tourism, but that is largely seasonal.  Siegler also touches on the role of caps on visas for foreign-trained doctors, a source of physicians that communities like Bisbee have relied on in the past.  For now, the hospital is relying increasingly on telemedicine, including through the Mayo Clinic's Phoenix outpost.

All of this reminds me of another truth in relation to rural health care--well, rural services generally:  consolidation seems to be the name of the game.  Here's a June story from the Washington Post about how Planned Parenthood is closing clinics as services are increasingly consolidated.  With the most recent round of closures, Wyoming joins North Dakota as the only two states without a Planned Parenthood clinic.  

It'll be interesting to see, in the coming weeks, whether the GOP tries once more to repeal the Affordable Care Act and, if they do, what role rural people and their health care will play in this important policy discussion and decision making.  

Friday, July 14, 2017

Location, location, location: rural law schools and their role in the rural lawyer shortage

Location, Location, Location - a familiar mantra to most of us. It refers to the idea that location is a very important determining factor in the success of a given project or initiative. In this post, I will explore the role that rural law schools play in addressing the rural lawyer shortage. I will admit that my analysis of this issue will be focused on the eastern United States and I apologize in advance to any readers who may feel that I am ignoring great initiatives in the West.

Rural law schools are a relatively rare thing and understandably so. Law schools want to be in locations where internships, externships, and clerkships are easily accessible. Students, after all, expect a return on their law school investment and think that attending a law school where there are plethora of job opportunities will give them the best opportunity to make this happen. Even law schools associated with rural colleges are often placed in urban areas. We see this is in North Carolina with Elon and Campbell Universities, whose law schools are located in Greensboro and Raleigh respectively. In fact, when Campbell University moved their law school from their campus in Buies Creek in Harnett County, NC to downtown Raleigh in 2007, the move was justified by school administrators as a move designed to give students greater access to judges and law firms. The board chairman even said that the "world is changing" and that the move to Raleigh was in the best interests of the school.

There is the understandable idea that we have too many law schools. Much like lawyers, law schools are increasingly concentrated in just a handful of urban centers. For example:

  • The City of New York and Long Island, NY have 10 ABA accredited law schools (11, if you count Pace just to the north in White Plains). There are only 4 (Syracuse, Buffalo, Albany, and Cornell) in the rest of the state and only Cornell is located in what may be considered a rural community (but even that is stretching the definition of rural). 
  • 7 out of the 9 law schools in Massachusetts are located in the Boston metropolitan area and only 1 out of the 9 is located west of I-495.  
  • In the rest of New England, only Vermont Law School in South Royalton would qualify as particularly rural.
  • North Carolina has 8 law schools, not a single one is located in a rural part of the state and all are clustered along the I-40 and I-85 corridor in Central North Carolina. 
  • Virginia also has 8 law schools, and two are located in rural communities, Washington and Lee in Lexington and Appalachian Law in Grundy. 
With only ~50% of law graduates getting long-term legal jobs, it may seem obvious that reducing the number of law schools would result in a favorable outcome. However, is it possible that law schools, like lawyers, are distributed in a manner that encourages economically inefficient clustering in urban centers?

Lawyering - an urban profession

Data from the Occupational Employment Statistics within the Bureau of Labor Statistics bears out the idea that lawyers are disproportionately urban and that rural areas are facing a dramatic shortage. As mentioned in an earlier post, only one non-metropolitan area has a location quotient of >1.0, Southwestern Montana. In fact, looking at the maps embedded in the link I just provided, you can pinpoint metropolitan areas by looking for the darkly shaded regions on the location quotient map. Even in historically predominantly rural states like West Virginia, lawyers tend to congregate in urban centers like Charleston, which has a concentration of lawyers that is almost twice the national average.

What about rural students? Wouldn't they be good candidates for rural practice?

The best analysis of this that I have seen came from this piece, co-authored by our own Lisa Pruitt, that examined Arkansas and students at the University of Arkansas. I do not want to duplicate their work but I do want to mention one takeaway, there are relatively few students from rural communities attending law school.

The University of Nebraska is attending to address this and recently announced the creation of the Rural Law Opportunities Program, which will give high school graduates from rural Nebraska scholarships to attend one of three state universities and provided they meet certain criteria, admission into the University of Nebraska School of Law. As their website notes, 11 out of Nebraska's 93 counties have no lawyers at all. This is one approach to addressing this shortage.

Rural students are underrepresented in higher education more broadly. According to the New York Times, only 29 percent of rural 18-24 year olds are enrolled in higher education, a figure which pales in comparison to 47 percent of their urban and suburban peers. Further, undergraduate institutions are only now starting to actively recruit rural students. Even if law schools try to recruit rural students, absent a pipeline program like what the University of Nebraska has pioneered, they are going to find the pool a bit shallower than they may want.

The role of the rural law school

There is perhaps no more better exposure to an issue than being immersed in it. A student, attending a law school in an urban center, can go through their entire law school career without being exposed to any rural issues and never be provided with a reason to consider practicing there.

A student attending a law school in a rural community, such as South Royalton, Vermont or Grundy, Virginia, has the opportunity to be immersed in the local environment and have contact with local attorneys, local courts, and the problems of rural people. Rural schools can facilitate this exposure by offering legal clinics, as Vermont Law School does. Prolonged first hand exposure is perhaps the best way to help someone decide whether or not they want to practice in a given area.

The onus is on the rural law school however to make sure that these opportunities are available. It is possible to attend school in a rural community and learn little about rural practice, especially if a person leaves to extern in a larger city during the summer. The law school existing in a rural space is not enough, it has to try to integrate the students into their surroundings and it has to create partnerships with local attorneys and government agencies to make this possible.

Even if a person decides not to stay in a rural area after attending law school however, being in the area and working with the local legal system will make them more aware of the issue and the fact that the shortage needs to be addressed. Many of my friends, including those who attended law school, are unaware that there is even a shortage. Many of them, believing the news reports about the lawyer surplus, assume that the market is universally oversaturated with lawyers. Someone with first hand experience learning the law and working in a rural community would be able to see this for themselves and it would increase awareness of this issue. The hope is that these people will advocate for policies, such as increasing legal aid funding, that will lead to an increase in the supply of lawyers in a rural community.

I will admit a limitation to this idea. In my own research of the quantitative data behind the rural lawyer shortage, I have not seen any correlation between non-metropolitan areas where law schools are located and an increase in local lawyers but I concede that getting access to county level data may help me understand this better. Right now, my answer to this is inconclusive.

Would more rural law schools be a net positive?

There is little empirical data that could definitely answer this question. We certainly do not need more law schools more generally. However, relocation of some law schools out of urban centers and into rural communities could have favorable outcomes. For example, if Campbell University were to move back to Buies Creek, North Carolina, it may increase the number of people interested in working in rural North Carolina and alleviate the glut of law schools in the Research Triangle area. On a bigger stage, if a law school in Boston or New York were to move to a surrounding rural community, it would lessen the amount of law schools in these cities and also be a benefit to the rural communities that they would relocate to. It would also provide people interested in rural practice with a place to study and work and a place for people who may never have considered rural practice to live and learn.

There is little question however that the current distribution of law schools is overwhelmingly urban and that prospective lawyers are gaining little exposure to rural practice and rural problems. We also know that rural students are not attending law school (or college for that matter) at a comparable rate to their urban and suburban peers. These factors limit the ability to train and recruit people to work in rural communities.

Monday, July 10, 2017

Quantifying the rural lawyer shortage

Hi everyone, this is my first post in a while so I thought I would break the silence by providing a sneak peak into a project that I have been working on and am incredibly excited about.

I have spent the past couple of months working on a project for my MPA program where I have used Department of Labor data to analyze the quantitative aspects of the rural lawyer shortage.

What is clear from the data is that the lawyer shortage is widespread and only one rural area exceeds the national average in employment (as measured by examining the location quotient), Southwest Montana. My research has so far only focused on the Carolinas and Virginia and has found that the lawyer shortage is unique in its ubiquity. Another profession of similar prestige and educational requirements (and student loan debt), family and general practitioners do not experience the same levels of rural shortages that lawyers do. This is particularly troubling but not terribly surprising, given that there are already programs that actively encourage doctors to move to rural areas. There is also no correlation between the number of general medical practitioners and lawyers in a given rural community, thus possibly questioning the idea that lawyers may gravitate to areas where there are similarly situated professionals.

I encourage readers to look at the embedded links for themselves. It is difficult to argue with objective data, especially when we have a similarly situated profession as a comparison point.

I will be talking more about this in the future but just wanted to provide a quick sneak peak.

Friday, July 7, 2017

BCRA has rural hospitals, rural health in the headlines (Part I)

The now-months long effort to repeal and replace Obamacare (aka the Affordable Care Act) has brought rural people, their health and the hospitals who serve them onto politicians lips and into national headlines in recent weeks.  I've seen a number of U.S. Senators--mostly Democratic, but  also Susan Collins, Republican of Maine--mention their rural constituents as a reason they are opposed to the Senate version of Obamacare's repeal, the so called Better Care Reconciliation Act (BCRA).  Indeed, on June 27, Collins posted three consecutive Tweets (emphasis added), two of which used the word "rural":
○ “I want to work w/my GOP & Dem colleagues to fix the flaws in ACA. CBO analysis show Senate bill won’t do it. I will vote no on mtp.” 1/3 
○ “CBO says 22 million people lose insurance; Medicaid cuts hurt most vulnerable Americans; access to healthcare in rural areas threatened.”2/3 
Senate bill doesn’t fix ACA problems for rural Maine. Our hospitals are already struggling. 1 in 5 Mainers are on Medicaid.”
In this post, I want to highlight a few recent mentions of rural health care in the national media, starting with this piece on NPR on June 22:
Since 2010, at least 79 rural hospitals have closed across the country, and nearly 700 more are at risk of closing. These hospitals serve a largely older, poorer and sicker population than most hospitals, making them particularly vulnerable to changes made to Medicaid funding. 
"A lot of hospitals like [ours] could get hurt," says Kerry Noble, CEO of Pemiscot Memorial Health Systems, which runs the public hospital in Pemiscot County, one of the poorest in Missouri.

The GOP's American Health Care Act would cut Medicaid — the public insurance program for many low-income families, children and elderly Americans, as well as people with disabilities — by as much as $834 billion. The Congressional Budget Office has said that would result in 23 million more people being uninsured in the next 10 years. Even more could lose coverage under the budget proposed by President Trump, which suggests an additional $610 billion in cuts to the program.
That is a problem for small rural hospitals like Pemiscot Memorial, which depend on Medicaid. The hospital serves an agricultural county that ranks worst in Missouri for most health indicators, including premature deaths, quality of life and even adult smoking rates. Closing the county's hospital could make those much worse.
And a rural hospital closure goes beyond people losing health care. Jobs, property values and even schools can suffer. Pemiscot County already has the state's highest unemployment rate. Losing the hospital would mean losing the county's largest employer.
And on top of all that, annual payroll is about $20 million for the hospital as employer.

That provides some helpful background from a persistent poverty county in the Ozarks, where the need for healthcare for the poor is especially acute, not least because so many are so poor and in need of government assistance--for healthcare and otherwise.  The story, reported by Bram Stable-Smith, also covers the Missouri decision NOT to expand Medicaid, which was on offer as a bargain to states under the Affordable Care Act.

Since this story out of Missouri several weeks ago, the situation with the BCRA has gotten more acute in the sense that we now know what is in the BCRA.  The other two stories I'm featuring here are also by NPR and were published on July 1 and July 5, the first out of Hugo, Colorado (population 730), and the second out of Modoc County, California (population 9,686).  Both of these stories illustrate well the critical role that rural hospitals and healthcare facilities play in rural communities.

From the NPR story reported by John Daley out of Hugo, home to a regional hospital that lies between Denver and the Kansas state line, comes this quote:
From the outside, Lincoln Community Hospital looks more like a small 1960s-era apartment building. But it has all the essential high-tech health care equipment: modern imaging machines, tele-medicine links — even an AirLife helicopter. Rachel Smith, the assistant director of nursing, says the thing that really sets the hospital apart is the quality of its care. 
"It's definitely not treat 'em and street 'em," Smith says. "It's definitely somebody you're going to see — maybe even later that day, later that week."
From the NPR story out of Modoc County:
Modoc County, in the northeast corner of California, is roughly the size of Connecticut. It's so sparsely populated that the entire county has just one stoplight. The nearest Walmart is more than an hour's drive, across the Oregon border. Same with hospitals that deliver babies.
Greta Elliott runs a tiny health clinic in Canby, on the edge of the national forest. "Rural" doesn't begin to describe the area, she says. This is "the frontier."
"There are more cows in Modoc than there are people," Elliott says. 
There's a frontier mentality, too. People take care of each other, and they take care of themselves.
April Dembosky of NPR goes on to report that Ms. Elliott has herself chosen not purchase health insurance, thus reflecting the frontier mentality.  But the "frontier" reference is not just cultural.  It's a term used to designate the least populous MSSAs (Medical Service Study Area) in and by the State of California, which also uses "rural" and "urban" designations, though not in a way synonymous with the U.S. Census Bureau definitions.

Dembosky then explains the regional politics of far northern California (discussed in this recent post) and explains how the region's reliance on California's expansion of the ACA/Obamacare--called Covered California in the Golden State--has made strange political bedfellows.  She quotes Dean Germano, CEO of  Shasta Community Health Center.
The data shows it's the rural communities that have greatly benefited from the Medicaid expansion. That's the irony.  These are places that voted much more heavily for Donald Trump.
In fact, 70% of the voters in Modoc and neighboring Lassen County voted for Trump in 2016, and 64% of voters in neighboring Shasta County (home of the regional population center, Redding) voted for him.
But now a coalition of clinics from across the northeast corner of the state is lobbying local officials to take an unpopular position in this conservative land: defend the Affordable Care Act. 
And the right-leaning Shasta County Board of Supervisors took them up on it.
Germano commented on that decision:  
We thought "Whoa! That is really bold." I was surprised.
Though the Shasta County Board of Supervisors has lobbied their U.S. Congressman, Doug LaMalfa, to vote against the AHCA--the house version of Obamacare's repeal--LaMalfa has supported the repeal, defying at least this faction of his constituents.  

I'll return soon with another post on the issue of rural health care and the attention it's drawing from the national media and politicians.  

Thursday, July 6, 2017

NYTimes piece on rural, far northern California struck a nerve among liberal elites

Let me begin this post by acknowledging that I am a member of a group I often reference, frequently pejoratively:  "liberal elite."  This is different, mind you, from being a liberal elitist.  But I am in the privileged position of being an academic, and I am liberal/progressive...so I must own up to being a liberal elite. I am also a coastal elite by virtue of the fact I've lived in California for the past 18 years, doing the job that conferred "elite"-ness on me.  But I found myself really annoyed at another group of liberal elites yesterday when, following the New York Times story I blogged about here, some of the ones on Twitter started bashing the great grey lady (the New York Times, that is) for running that story!  Joy Reid of AM Joy (an MSNBC weekend program) let loose with this Twitter storm, partly captured in these images, but then transcribed below because the screen shots can be difficult to read.

Joy Reid: So let me get this straight: they got the president they wanted and receive the bulk of federal/state aid but they feel disempowered?

NYT Politics: Conservative voters in the northernmost reaches of California feel alienated by the state’s liberal urban majority nyti.ms/2siVgbJ

Joy Reid: And now they would very much like to secede from “liberal cosmopolitan elite” California but they’re broke so they wouldn’t survive alone?

Joy Reid: So in sum, they want their dole, they want all the guns they can stockpile, AND they want to run California and dominate their benefactors?

Joy Reid: Otherwise they’ll feel sad and disrespected and the @NYTimes will write doleful odes to their misery so the rest of us will pity them?

Joy Reid: People please. Your ethos is now running the United States. We are run by your rural, right wing Christian “values” and Ted Nugentian ethos.

Joy Reid: The vulgar, erratic, embarrassing president you wanted plods through the White House daily.

Joy Reid: Despite getting millions less votes, your congress IS expanding water and air pollution and gun proliferation and legislating women’s bodies

Joy Reid: just as you want. Sure, you may loss your Medicaid, but THAT’S WHAT YOU VOTED FOR: to “repeal Obamacare!” and free you from liberal tyranny!

Joy Reid: You hate clean air and water rules? Meet Secretary Zinke! I’m sure he’ll be turning over federal lands to your billionaire friends soon

Joy Reid: and I’m SO CONFIDENT they will trickle down the benefits to you (though I would advise against holding your breath w/o healthcare.)

Joy Reid: You are getting everything you wanted PLUS blue states/cities money to pay your dole. What is it you want now? Hugs? A parade?

Joy Reid: Hollywood to make movies about you so you feel important? @robreiner could you please get on that right away???

Joy Reid: These durges are getting old. These demands that we pity the poor victors who have achieved rural domination of urban America.

Joy Reid: You know who I feel sorry for? Urban America, whose values are denied while our hearts bleed to GIVE red states our money…

Joy Reid: Urban communities who have now been told their country will no longer fight climate change, and will let polluters run free to poison them.

Joy Reid: Immigrants who now live in fear of federal raids, Muslim students afraid to go home for holiday breaks or to wear their hijabs outside…

Joy Reid: Black motorists terrified of MAGA-amped police and children taunted with “Trump” as they are bullied for being brown or girls or LGBT.

Joy Reid: Let’s have some durges about how they feel. I’m weary of these demands that we cradle the people who clairm they “took their country back.”

Joy Reid: You go the White House and congress. You don’t need a cuddle. And we in the majority have bigger fish to fry than your hurt feelings.
* * *

In a similar vein, Anita Creamer, formerly of the Sacramento Bee, Tweeted:
Anita Creamer: THIS. What next, NYT? Want to interview the 5 sad Trump voters in Hawaii who are scared and lonely and need a hug? Enough.
Various folks chimed in to cheer Reid on, with one calling her Tweet storm "poetry." 

I guess the best way to sum up my response to Reid (and the many others who chimed in by re-Tweeting her or by writing their own similar Tweets) is to publish my own Tweet storm response here, in full:  

Lisa Pruitt: I find the tone of this #thread disdainful & #unproductive. Would we coastal #elites have spoken this way to #rural #white folks be #Trump?

Lisa Pruitt: No, before #Election2016, we were largely ignoring them, forgetting them, letting them know they & #food they produce don’t matter #rural

Lisa Pruitt: Here is my analysis of #rural bashing by #media #MSM during #Election2008. Papers.ssrn.com/sol3/papers.cf… Must we #liberalelites be so contemptuous

Lisa Pruitt: Oh & where’s evidence that folks in #rural northern #California are on the dole? Not saying it doesn’t exist, but let’s map data, show it.

Lisa Pruitt: #federal & #California funding streams not same: cannot tax #publiclands; #spatialinequality #unevendevelopment problems to be reckoned with

Lisa Pruitt: If we want to tell these folks to “move to town” & be #urban, then let’s be straight & say it. But many are suffering economically as is.

Lisa Pruitt: I understand how easy it is to be angry at #Trump voters; I’m furious at them, nearly unconsolable. But his thread is contemptuous of #rural

Lisa Pruitt: The #thread & its tone are so #destructive. Garnering #Twitter followers, yes, but not showing empathy or building bridges to others…

Lisa Pruitt: As for pollution, #rural areas bear brunt accdg to many analyses. Environmental injustice not only #urban phenomenon #environmentaljustice.

Lisa Pruitt: We #liberalelites #coastal #elites need to keep our eye on the prize: removing #Trump from office & then #coalition building to bring #USA back.

Lisa Pruitt: or is our plan to extract proverbial “pound of flesh” #poundofflesh from #swingvotoers #Trump voters if we get out of this mess alive?

Lisa Pruitt: Remember marital advice: do U want to be right or do U want to be happy? Do #liberalelites want to be right or build coalitions for future?

Lisa Pruitt: And why bash @nytimes for running this story on #rural northern #California? a polestar of #media integrity that we should support #MSM.

Lisa Pruitt: On @nytimes bashing, did U notice story ran on page 9? do we want further polarization where #NYTimes doesn’t cover #rural America at all?

All of this reminds me of something someone asked several months ago following a talk I gave about some of my work on rural white poverty. Essentially, he asked me why he should care, and he later circled back to explain his hostility:
some of these people were quite powerful in some domains, even exercising electoral power over California (and me) in the last election.
Frank Rich in a March 2017 article in New Yorker Magazine expressed similar anger at Trump voters.  He argued that Democrats should not "waste time and energy chasing unreachable voters in the base of Trump’s electorate." Rich calls it 
a fool’s errand for Democrats to fudge or abandon their own values to cater to the white-identity politics of the hard-core, often self-sabotaging Trump voters who helped drive the country into a ditch on Election Day. They will stick with him even though the numbers say that they will take a bigger financial hit than Clinton voters under the Republican health-care plan. As Trump himself has said, in a rare instance of accuracy, they won’t waver even if he stands in the middle of Fifth Avenue and shoots somebody. While you can’t blame our new president for loving “the poorly educated” who gave him that blank check, the rest of us are entitled to abstain. If we are free to loathe Trump, we are free to loathe his most loyal voters, who have put the rest of us at risk.
I'm reminded of a discouraging story from a few months ago that suggested that Democrats will cease to vie for seats with populations that are low-education, rural, and lacking in diversity.

Meanwhile, one commentator on Rich's article challenges the proposition that the media are looking to appease Trump voters, writing:
There is nothing but open contempt for Trump voters on every channel, in every magazine. Misplaced contempt perhaps (people didn't vote FOR Trump, they voted AGAINST coastal social justice pandering and identity politics). Out side of Fox Farce, who have you ever seen publish or speak kindly about Trump voters? 
Sadly, the commenter is describing the world in which I'm living, one with surplus disdain for low-income, low-education whites, rural or not, who are all presumed to have voted for Trump and therefore to be racists and sexists beyond redemption. But I won't go there right now, for that's too big a topic for this little blog post; indeed, it would be better suited for a book...

Monday, July 3, 2017

Little acknowledged in the nation or even the state, far northern California gets a day in the NYT spotlight

Near Plymouth, California, Amador County, July, 2017
(c) Lisa R. Pruitt 2017
Thomas Fuller reports in today's New York Times about disgruntlement among folks in far northern California--and we're not talking the Bay Area here, folks--where a majority are white, conservative, and voted for Trump (see post about California's rural vote in the 2016 presidential election here).  The headline is "California's Far North Deplores the 'Tyranny' of the Urban Majority." Fuller doesn't lead with the State of Jefferson movement/phenomenon, but he ultimately gets there because secession is one possible "solution" to what ails many in this far flung region of the Golden State.  Read more State of Jefferson coverage here, here, here, here and here.

This key excerpt from Fuller's story provides critical background, especially for non-Californians who think that the greater "Bay Area" is "northern California" (Hint: It's actually central California):
California’s Great Red North is the opposite [of common images/stereotypes of the state], a vast, rural, mountainous tract of pine forests with a political ethos that bears more resemblance to Texas than to Los Angeles. Two-thirds of the north is white, the population is shrinking and the region struggles economically, with median household incomes at $45,000, less than half that of San Francisco.
Fuller acknowledges the "red' and partly rural Central Valley region, too, and then continues with his tale of this little known area:
But perhaps nowhere else in California is the alienation felt more keenly than in the far north, an arresting panorama of fields filled with wildflowers and depopulated one-street towns that have never recovered from the gold rush.
The story features some now-familiar (familiar post-election, that is) information about how rural folks don't feel seen, heard and appreciated.  Many are farmers, and many have been economically displaced by the decline of the timber industry, a phenomenon partly driven by environmentalist concerns.  Fuller quotes James Gallagher, the 3d District Assemblyman:
People up here for a very long time have felt a sense that we don’t matter.  We run this state like it’s one size fits all. You can’t do that.
* * *
In the rural parts of the state we drive more miles, we drive older cars, our economy is an agriculture- and resource-based economy that relies on tractors and trucks.  You can’t move an 80,000-pound load in an electric truck.
Accordingly, a recent rise in the state's gasoline tax will disproportionately hurt rural voters.  

Many point out that if these rural California counties seceded--along with counterparts in Oregon--to form the State of Jefferson, they would only be worse off, however. 
Because incomes are significantly lower than the state average and the region is so thinly populated, tax revenue from the far north is a fraction of what urban areas contribute. In 2014, the 13 northern counties had a combined state income tax assessment of $1 billion, compared with $4 billion from San Francisco County.
Spatial inequality as a function of uneven development is something I've written about here and here.   

Fuller also provides some really useful information I've not seen from another journalist:  he compares the number of folks represented by each Senator and Assemblyperson in the California legislature with the number represented by legislators in other states.  In California, each State Senator represents a million residents, while each North Dakota state senator represents just 16,105, each Wyoming State Senator represents just under 20,000.  Each California Assembly member represents nearly half a million residents, whereas in Vermont it's just 4,174, in New Hampshire, just 3,327.

One of the problems, at least from the perspective of agitators in northern California, is that the number of California legislators has been capped at 120 since 1862.  The legislature has not been able to grow as the state's population has boomed, which has led to a lawsuit by what Fuller calls a "loose coalition of northern activists and residents, including an Indian tribe and the small northern city of Fort Jones," which is asserting a constitutional claim.

A second possible solution is to amend California’s Constitution to change the way state Senate district are drawn.  Rather than base the Senate districts on population, as the current scheme does, "Senate seats would be tied to regions, giving a larger voice to rural areas in the same way the federal Senate does."

I am not very optimistic about the likelihood that either proposal will be adopted, either due to successful lawsuit or constitutional amendment.    

The story closes with some colorful quotes from U.S. Congressman Doug LaMalfa who represents California's 1st District.  LaMalfa is a "farmer/businessman" who lives in Richvale, in Butte County.  LaMalfa decries urban denizens' treatment of rural California as their "park," as well as their desire to save trophy "species."  
You have idealists from the cities who say, ‘Wouldn’t it be great to reintroduce wolves to rural California?’
He counters with a tongue in cheek proposal:
Let’s introduce some wolves into Golden Gate Park and the Santa Monica Pier.
As it happens, I passed the sign in the photo above as I drove through Amador County's wine country yesterday.  That's just about an hour southwest of Sacramento.  State of Jefferson flags and signs are not uncommon in Amador and neighboring El Dorado Counties--though these places are in central California, not the typical State of Jefferson territory.  Yet the State of Jefferson ethos is alive and well here, even amidst pockets of rural gentrification like the Shenandoah Valley wine loop.  Someone put a lot of work into this sign, so I stopped for a photo.  Especially glad now that I did because it's a terrific illustration of just the phenomenon that is the focus of Fuller's story:  the numbers game in relation to how Californians are represented in the state legislature.