As a Democratic candidate for Congress in rural Pennsylvania, I watched the recent presidential debate between Kamala Harris and Donald Trump with deep interest and concern.
In 2020, Pennsylvania garnered more attention from presidential campaigns than any other state, and that focus has only intensified in 2024. The Commonwealth leads the nation in campaign visits, advertisements, fieldwork, and spending. Yet, during last week’s debate in Philadelphia, my state was discussed only in the context of its fracking industry.
This narrow focus on fracking has long dominated presidential campaigns in Pennsylvania. Campaign consultants seem to think Pennsylvanians care only about natural gas, but that’s far from reality. After spending over a year talking to voters across rural Pennsylvania, I’ve been asked about fracking exactly once—during a Chamber of Commerce meeting.
The issue that comes up far more often is the closure of rural hospitals. The district I seek to represent is one of the most rural in the nation. Despite being home to just 5 percent of Pennsylvanians, it has suffered 12 percent of the state’s hospital closures over the past two decades.
The impact on my community has been devastating. When a hospital in Elk County closed earlier this year, thousands of people were left without access to maternity care. Currently, rural Pennsylvania has five times fewer OB-GYN doctors per birth than urban areas. A decade ago, that ratio was closer to two-to-one.
To make matters worse, two critical federal programs—the Medicare Dependent Hospital Subsidy and the Low-Volume Hospital Adjustment—are set to expire at the end of this year. Without congressional action, three Medicare-dependent hospitals in my district will lose vital funding. Senator Bob Casey’s (D-Pa.) Rural Hospital Support Act aims to make these programs permanent, but no vote is expected before the election.
Hospital mergers are also threatening access to health care in rural communities. Private equity firms have closed hospitals across the state while transferring resources to more affluent urban areas. Although state lawmakers from both parties are working together to curb this trend, Washington has remained silent.
Rural health care in Pennsylvania and across the country is on the brink of collapse. Yet neither Kamala Harris nor Donald Trump have addressed this crisis or offered solutions to fix it.
Both campaigns know that every vote matters in Pennsylvania.
Vice President Harris visited Johnstown, Pennsylvania, a rural town of 18,000, on Friday, less than two weeks after former president Trump held a rally there. Yet her anti-Trump speech hardly referenced the Commonwealth nor the problems our people and communities face.
As the Democratic standard-bearer in rural central Pennsylvania, I have a humble piece of advice for my party’s nominee in future visits: talk less about Trump and fracking and more about hospitals and health care.
Democrats can’t afford to ignore the electoral realities at play. In 2020, President Joe Biden nearly matched former president Barack Obama’s results in Philadelphia and Pittsburgh but trailed him by double digits in rural counties. If that trend continues on November 5, there won’t be enough votes in the state’s biggest cities to make up the margins in its most rural areas.
This election will be won by the candidate who addresses the real issues facing rural Pennsylvania. Right now, that issue is health care—not fracking.
Zach Womer is the Democratic nominee for Congress in Pennsylvania’s 15th District.
The views expressed in this article are the writer’s own.
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