Last month, Missourians approved a constitutional amendment to expand their Medicaid program and extend government-sponsored health-care coverage to more than 230,000 people. Progressives rightly celebrated the win, but the results also confirmed a dismaying divide: the vast majority of rural Missourians opposed the amendment. It lost by an average of two-to-one in rural counties—only slightly outperforming Democratic Sen. Claire McCaskill’s margins in her losing bid for reelection in 2018. Overall, the amendment carried only eight of the state’s 114 counties.
It was not that rural Missourians uniformly voted against the measure. More than 200,000 of them favored it, and their votes helped lift the amendment to victory. But it was striking that such large majorities in rural counties opposed expanding Medicaid, despite the fact that those counties have the highest rates of uninsured workers.
Pundits certainly noticed the lopsided nature of the Missouri vote. Discussing the matter on the podcast Pod Save America, former Obama speechwriter Jon Favreau didn’t seem especially concerned by the lack of support for Medicaid expansion in poorer, rural parts of the state. He optimistically noted that the amendment made up for this by overperforming with middle- and upper-income voters in urban and suburban areas.
Favreau’s co-host Dan Pfeiffer disagreed. He lamented “a steady erosion” of rural support for the Democratic Party and progressive causes since the Obama era. According to recent Pew Research Center analysis, rural voters were nearly as likely to identify as Democrats as Republicans from 1994 all the way through 2008, when Obama captured 45 percent of the rural vote nationally. In the years that followed, however, rural support for Democrats declined dramatically and the GOP gained a twenty-point advantage with these voters.
This trend should worry progressives. Addressing some of our nation’s most pressing economic issues—such as corporate consolidation of agriculture and unequal access to broadband—will require the active participation of the rural communities most affected by them. But there’s also the troubling fact that gerrymandered districts give rural voters disproportionate power in shaping the House of Representatives. The Senate, which awards two seats to each state regardless of population, gives outsized power to rural voters as well.
Even if measures such as Medicaid expansion in Missouri can narrowly win on the strength of the urban and suburban vote, the long-term viability of any progressive economic agenda will require stronger rural support. But this is a daunting challenge, especially considering the ever-widening political chasm between urban and rural voters. What will it take to revive economic populism in rural America?