In an op-ed in The Hill, former senators Tom Daschle of South Dakota and Olympia Snowe of Maine made the case that limited access to healthcare in rural states will be a significant issue for voters in the 2020 elections.1

Survey on Rural Healthcare Identifies Shortcomings and Challenges

The senators pointed to a Morning Consult poll of nearly 2000 registered voters. The survey found that2:

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  • More than 9 in 10 Republican (93%) and Democratic (92%) voters believe access to healthcare in rural communities is important.
  • Three in 5 voters would be more likely to vote for a candidate who prioritizes healthcare in rural America.
  • More rural voters (54%) than non-rural voters (33%) say access to medical specialists is a problem in their local community.
  • Rural voters find it more difficult than non-rural voters to access behavioral health professionals (27% vs 16%, respectively).
  • Availability of appointments and distance to receive care are greater barriers for rural voters than urban and suburban voters (56% vs 50% and 50% vs 37%, respectively).
  • Nearly half (47%) of rural voters agree that quality healthcare is a challenge in their community compared with approximately one-third (34%) of non-rural voters.

Nurse Practitioners: The Answer to the Healthcare Provider Shortages?

In a response op-ed in The Hill, Sophia L. Thomas, DNP, FNP, PNP, FAANP, president of the American Association of Nurse Practitioners (AANP), argued that NPs are the solution to the healthcare shortage in rural America.3

Thomas stated that, although 80 million Americans lack access to adequate primary care and the primary care workforce is shrinking, there is good news: more than 270,000 NPs are licensed in the United States. She described NPs as an “under-utilized asset in the struggle to strengthen and expand primary care access.”

“NPs are qualified to assess patients, order and interpret diagnostic tests, develop treatment plans, and prescribe medications in all 50 states,” she wrote. “More than three-quarters of NPs are trained in primary care focus areas including family care, adult and geriatric care, women’s health, and pediatrics.”

The NP primary care workforce is expanding, with 26,000 new NPs completing academic programs in 2017-2018. According to one projection, the number of NPs in the workforce should increase by 6.8% annually through 2030.4

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Calls to Action

Thomas calls on state and federal officials to remove barriers to care. She advocates for3:

  • Granting every state full practice authority (FPA). Currently, less than half of US states authorize FPA for NPs. “States with FPA have healthier residents and consistently rank higher on state health report cards.”
  • Streamlining care. “States should take steps to streamline care delivery by allowing NPs to sign the forms for the care they deliver instead of being forced to get redundant third-party signatures.”
  • Congress passing the Home Health Care Planning Improvement Act. By doing so, NPs would be able to provide necessary at-home care for Medicare patients.

“NPs are uniquely qualified to provide high-quality, comprehensive, and cost-effective primary healthcare to all patients,” Thomas concluded. “It’s time that policymakers at both the federal and state level take the steps needed to ensure that all Americans, regardless of where they live, have access to the primary care they deserve.”3


  1. Daschle T, Snowe O. Rural health could be a powerful issue in the 2020 election. The Hill. June 12, 2019. Accessed July 29, 2019.
  2. New poll shows rural health may be powerful issue in 2020 election [press release]. Washington, DC; American Heart Association; June 12, 2019.
  3. Thomas SL. Nurse practitioners are the solution to health care provider shortages. The Hill. July 16, 2019. Accessed July 29, 2019.
  4. Buerhaus P. Nurse practitioners: a solution to America’s primary care crisis. American Enterprise Institute. September, 2018. Accessed July 29, 2019.