MICHAEL E. SHEPHERD 

Over the last four decades, the health of rural Americans has been in free fall. Just as opioid and gun deaths have ripped apart rural communities, hospitals have closed at alarming rates, leaving millions desperately far from care. At the same time, voters in struggling rural communities have increasingly come to vote for the Republican Party.

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In Rural Pain, Republican Gain, I demonstrate that these two trends are closely connected. At both the federal and state levels, the Republican Party has increasingly enacted policies that worsen rural health. Rural voters are not indifferent to this development (quite the contrary), but they mis-assign blame to the Democratic Party, which has “ownership” of health as an issue area. Republican politicians reap rewards even from their own destructive policies by appealing to the

shared grievances of rural people.

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Drawing on wide-ranging data, including in-depth studies of the opioid epidemic, hospital closures, and COVID-19, I quantify the harm of Republican policymaking and its disproportionate effect on rural communities, and expand our understanding of  growing Republican support among less-healthy and lower-income rural white Americans.