The Issue

For decades, rural communities have borne the brunt of an underfunded and corporatized healthcare system. Worse, healthcare has become highly politicized, and rural communities are often used as pawns or testing grounds in political battles that are no longer between differing ideas but between science and fiction. 

Rural regions have high rates of uninsured people and some of the worst health outcomes in the US, yet many policymakers representing these areas fought against passage of the Affordable Care Act, which has benefited millions of their hardworking constituents, and have refused the expansion of Medicaid in their states, which would cover hundreds of thousands more. Drug companies targeted rural communities with opioids they knew were highly addictive, leading to hundreds of thousands of deaths across the country. As healthcare costs have risen and providers have consolidated, rural hospitals and clinics have closed, leaving large swaths of the country without basic care. Reproductive healthcare has been under attack for decades, making women’s healthcare in particular hard to access in many states. With the Dobbs v. Jackson Women’s Health decision outlawing the right to abortion, doctors in many states cannot provide basic standards of pregnancy care. Most of the states where abortion is now illegal have large rural areas, putting the health and lives of rural women and pregnant people even more at risk. Finally, extremist legislators across the country have passed or are considering serious attacks on the health of transgender children and on the ability of their parents to provide them with medically-recommended care. Targeting trans people as a fear-mongering tactic to build extremist support was first tested in rural communities, and again, rural trans people and families will be disproportionately impacted by these harmful laws.

Framing: security, privacy, community care

As progressive policymakers, we must champion the health and well-being of all Americans and fight intrusive, anti-science policies that target rural families and so many other hardworking people across the nation. Given how politicized healthcare has become, connecting across values can be especially powerful. The values of security, privacy, and community care resonate in this area because these values are deeply held among working people, regardless of where they live or what they look like. 

With the support of policy priorities that address healthcare for all like those below, local communities will have what they need to solve local problems. Opposition continues to talk at families, we are forging a new path to ensure legislators are speaking with families. By using effective communication strategies, we can neutralize inflammatory language, unite our coalitions, and pass the policies we all need.


Effective communication requires not only facts but leveraging the values people share to resonate across race, class, age, gender, and place. The best messages follow the VPSA model: Values, Problem, Solution, Action. First, we unite along shared values to introduce the issue, then demonstrate the collectively-held problem, name the solution to the problem, and finally, when appropriate, leave with a call to action joining you to solve the problem. This formula keeps our messages concise while disarming opponents who seek to divide us. To get you started, here are three rural values that are particularly relevant for communicating with rural constituents about providing healthcare for all:


  • Framing: Too many rural Americans are anxious about what will happen to them and their families if a medical emergency should arise. Medical debt is one of the leading causes of bankruptcy in the US, and for many hardworking rural people, one illness or accident could send them into extreme poverty. Reliable and affordable healthcare gives families peace of mind and security.
  • Example Statement: (Value) In rural America, we all want to live in communities that are safe and healthy for our families. (Problem) But so many rural hospitals have closed that it has become a challenge for rural families to get reliable healthcare. In the case of an emergency, that can be dangerous. (Solution) Our bill invests in recruiting providers and reopening healthcare facilities in rural communities across the state, to provide families with the security of medical care close to home. (Action) I’m calling on my colleagues to vote for the Rural Healthcare Promise.
  • Example Talking Points:
    • Extending coverage for telehealth can ensure that working families in small towns and rural communities can access the care they need when they need it.
    • If we want our small towns and rural communities to be safe and healthy places to start a family, we must ensure that all people can access the full range of reproductive health care services.


  • Framing: Rural people value privacy and their right to make their own decisions, in consultation with family and trusted professionals. New laws restricting abortion, reproductive health care, and care for transgender people essentially bring the government into the examination room, where it does not belong. What should be private decisions based on individual circumstances are instead determined by legislators rather than medical doctors. 
  • Example Statement: (Value) I grew up in a small town, raised by hardworking parents in a community where we respected our neighbors and didn’t stick our noses in other peoples’ business–especially when it came to healthcare decisions.(Problem) But now government is sticking its nose in everyone’s business, making what should be private family decisions into public matters and barring access to basic healthcare. (Solution) Healthcare decisions of all kinds must be private, between patient and doctor. (Action) That’s why we are taking a stand to protect women’s privacy to choose what reproductive decisions are best for them and their families.
  • Example Talking Points:
    • Healthcare decisions are private and need to be made between patient and doctor, not by the government.


  • Framing: Community care is a key part of the rural way of life – rural families look out for each other. Trusted local doctors are part of that equation. Reliable medical coverage ensures working people in rural communities can get back to doing what they do best: caring for their families and neighbors.
  • Example Statement: (Value) In rural America, we look out for each other and make sure our neighbors have what they need to thrive. (Problem) But the consolidation and closure of many healthcare facilities has left many rural families without the basic healthcare they need. (Solution) It’s time for our state to support the health of our hardworking rural families. (Action) That’s why my colleagues and I are advancing a public health insurance option that is available to all those who need it.
  • Example Talking Points:
    • Rural women need to be able to access a wide range of reproductive health services in their community and from doctors they know and trust.
    • Everyone deserves to have access to the medications they need to live healthy lives. Our State Drug Review board will protect people from price-gouging by pharmaceutical companies.

In practice: Media getting it right

News | How the pandemic killed a record number of rural hospitals, 2021

    • The article leads with the impact the hospital closure had on the rural community, honoring the rural working families who kept the hospital running for decades. This centers the issue on working people rather than on insurance coverage, data, etc. Working people are more relatable to rural communities than systems, policies and statistics.
    • The article weaves together the general socioeconomic makeup of rural communities, environmental impacts, and biological factors that underline the importance of investment in rural medical systems. It doesn’t blame rural people for their problems but instead shows that access to adequate healthcare prevents negative health outcomes.
    • Many rural people are worried about whether or not they will have access to healthcare as they age. It is wise to acknowledge their fears and the realities of our precarious healthcare system.

News | Rural hospital closings cause mortality rates to rise, study finds, 2019

    • This article connects politically progressive healthcare measures like Medicaid expansion to better health outcomes for rural patients. This points to the value of political engagement, to not just improve outcomes for oneself but for the whole state.
    • In showing how political will can drastically improve quality of life for all rural families, the article paints a picture of how rural patients fare better in some states than others. This has great potential to unify rural families across geography for healthcare for all.
    • Connect hospital closures and to the real-life impacts on rural families. Lead with the shared values and describe how solutions to these problems are also connected to those same shared values.

Article | ‘It Sucks That I Have to Be Scared’ – Conversations with Rural LGBTQ Young People, 2023

    • Uses personal experience not as anecdote, but as fact. Lived experiences are often used to confirm or demonstrate statistics or other research data, but for minority populations, the research itself is frequently insufficient. For rural LGBTQ+ people, for example, research does not wholly capture their experiences, and so their stories must stand in as fact.
    • Cited research draws from credible sources with authentic relationships in the LGBTQ+ community. These sources provide a deeper understanding of their subjects and more nuanced insights that are often missing from research sources not embedded in the communities they survey.
    • When possible, always lead with values. It would be powerful to draw analysis of the shared experiences of the people interviewed to then highlight their shared values. In contrast, these could act as the values rural communities would be confronted with to overcome bias, and embrace a culture of inclusivity for all rural residents.


To learn more and explore policy examples, visit our resources on health care access and LGBTQ+ protections.

If you have questions or feedback about these communications guides, please be in touch with the SiX Agriculture and Food Systems Team. We love to hear from you!

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