While much of the funding for rural hospitals comes through the federal government, state legislatures also play a key role in funding, supporting and safeguarding their rural hospitals. So, how do rural hospitals ensure their needs are prioritized in the state budget and through state law?
On today’s episode, hosts JJ and Rachel talk with Michigan State Rep. Andrew Fink about funding and representation for rural hospitals.
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Audio Engineering & Original Music by Kenji Ulmer
Transcript
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Rachel: We talk about health policy constantly on Rural Health Rising and how important it is for rural hospitals and health care providers to have a seat at the table.
JJ: That’s right, Rachel. There are many ways to have an impact on health policy, but for our listeners who really want to gain experience in policymaking at the federal level, we have a great opportunity to share.
Rachel: The Robert Wood Johnson Foundation Health Policy Fellows program seeks out midcareer professionals who are interested in federal health policy to learn how to improve the health of our nation and ensure everyone has a fair and just opportunity for health and wellbeing.
JJ: The program starts in September and runs for one year. Applications are open now and close on November 7, but you’ll need at least a few weeks to get your materials together, so don’t wait.
Rachel: If you’re interested in learning more or applying to this prestigious program, visit healthpolicyfellows.org. That’s healthpolicyfellows.org. While much of the funding for rural hospitals comes through the federal government, state legislatures also play a key role in funding, supporting, and safeguarding their rural hospitals. So how do rural hospitals ensure their needs are prioritized in the state budget and through state law?
JJ: With solid relationships, straightforward communication, and a clear understanding of their state legislature’s role.
Rachel: I’m Rachel lott.
JJ: And I’m JJ Hodshire.
Rachel: And this is Rural Health rising.
JJ: Welcome to episode 76 of Rural Health Rising. I’m JJ Hodshire, president and chief executive officer of Hillsdale Hospital.
Rachel: And I’m Rachel Lott, director of Marketing and Development.
JJ: So, Rachel, we’ve often talked about federal funding and federal regulations, and, my goodness, do we ever have a challenge with both?
Rachel: Yeah.
JJ: How many federal audits can a hospital undergo in a given year? We’ll just ask our skilled nursing facility and our hospital. But that’s not what you’re saying.
Rachel: Evidently there’s not a limit.
JJ: Absolutely.
JJ: We’ve learned that. But we’ve also seen that state legislatures play an incredible role in funding and sustaining rural hospitals. Even since the start of the pandemic, we’ve witnessed this as many federal dollars have been distributed and appropriated through the state of Michigan, and that’s been the pass through. So, they’ve had a very important role in the last year and a half.
Rachel: Yes, an increasingly important role. And we are talking to a return guest this week for not his second but third episode of Rural Health Rising, and I think you might be our third, our first person to be on for a third.
JJ: That’s incredible time.
Rachel: So eventually we’re going to have to do what do they do on SNL?
JJ: Do we give Timers club or whatever?
Andrew Fink: Yeah, he’ll be in the light sketch under Steve Martin.
JJ: John Belushi. You look more like him.
Andrew Fink: No, Martin was a host. Belushi was a cast member.
JJ: You know much more about us.
Rachel: I was going to say dan Ackroyd. He’s in that club, too.
JJ: Really?
Rachel: Five times? I think so.
Andrew Fink: Yeah. But he was also a cast member to start. Martin was never a cast member.
JJ: I think a little bit like Dana carving. You can do a little George Bush impression. Right.
Andrew Fink: Also, a Lutheran. Yeah.
JJ: There you go. So that’s good. I’m Baptist. All right. We did accomplish that, Rachel.
Rachel: JJ Loves the George W. Bush impression. I have a great picture of him doing that at least last week. I’ll show it to you. So, with that, now that we’ve kind of given it away, I guess, JJ. Would you like to officially introduce, for those who’ve not guest so far, who this is?
JJ: That’s right, Rachel. Our guest today is state Representative Andrew Fink, serving now it’s no longer district 58, right?
Andrew Fink: Well, I’m still serving my first term, so I do still serve district 58, but the new district, which I hope to serve beginning January 1, is the 35th district.
JJ: All right, very good. So 58th now, 35th in the future. And welcome back. It’s great to have you on the podcast.
Andrew Fink: Thanks. Great to be back.
Rachel: So, if none of that was confusing right? And that was that little noise, was representative knocking on wood?
JJ: I don’t know that you need to.
Rachel: Knock on wood, but that’s what that was.
JJ: That’s right. He doesn’t need to knock on wood.
Rachel: So, to start, for those who maybe did not hear you on your first or second appearance of Rural Health Rising, or those who did and need a little reintroduction, why don’t you give us a quick brief introduction of your background and your work at the state House.
Andrew Fink: Yeah, well, I grew up in southeast Michigan, and Ypsilanti and I came out this direction to go to Hillsdale College when I was 18. After that, I worked for our congressman, Tim Walberg, on his first successful race, which I’m sure we’ve mentioned before is how JJ. And I got to know one another.
JJ: Yes, we did.
Andrew Fink: I went to law school at Michigan, and while I was there, I got married and we started a family, and I joined the Marine Corps. So, my first job after law school was back in Hillsdale at the college for a little while. Then I was on active duty in the Marines. When I got out, I came back to Michigan, was practicing law with my family, and I opened up my own kind of branch of our law firm here in Hillsdale about five years ago. And after three years of doing that, I decided to run for the State House. And so, I’m in my first term, but I’m coming towards the end of it. I serve on the health policy committee and a bunch of appropriation subcommittees, including health and human services, which is by far the largest portion of the state budget of any of the individual subcommittees. And my wife and I met at Hillsdale at the college, and we’ve got five kids and live a little outside of Hillsdale now, a little outside the city on a little bit of acreage and enjoy the lifestyle and the friends and the community that we have here.
JJ: In Hillsdale, we often ask an important question and we ask the why. Why do you do what you do? Why do you get up in the morning and do the things that you do? So, Andrew Finn, what is your why? What motivates you? What gets you up out of bed in the morning?
Andrew Fink: Yes. I’m sure that when I’ve answered this question for you before. I’ve mentioned just having the five children that I have and watching my friends who have kids that they’re trying to raise and thinking about what it means to kind of be stewards of our community and of our culture and our constitutional republic in order to sort of hand it over to the next generation better than we found it. Which. To be honest. Not all that many American generations have been able to pull off. With some important exceptions. The easier thing to do is to kind of let things sort of carry on. And when you don’t think you’re heading in the right direction, whether it’s fast or slow, eventually you’re going to need to make a course correction. And so that’s sort of what got me interested in getting into politics now, is sort of thinking that the overall direction of our politics has gotten to be stagnant in some ways and heading the wrong direction in some ways, especially economically, as well as the kind of social issues that tie our communities together. So that’s what got me going. And it’s when I am focused on those things, I think that I’m at my best as a legislator now.
JJ: Well, I want to commend you because it is a noble why. Obviously, you had a very successful law firm and could have stayed doing that, and that would have done very well for you and your family. But you chose a life of public service, and the example that you set for your children in this community is very remarkable. You’re not doing an ego if they know you. Everyone knows you’re not an ego guy. You’re here today in shorts and a T shirt, and that’s just who you are. You’re honorable, you’re out in the community. You mix it up well. No pretentious attitudes. And so, I want to commend you for really connecting in Hillsdale as you have. It’s different when we were students right at the college, and then you come off the Hill and then you face the realities of Hillsdale and the challenges. It’s nothing like the Hill and nothing against the Hill, but we were kind of segregated up there to a certain extent and isolated. And so, you’ve done very well since your days of loving Hillsdale and a Michigander at Acclimating to Hillsdale County, and I want to commend you for that. It’s tough sometimes, so it’s not easy coming in from the outside, but you’ve done it remarkably well.
Andrew Fink: Yeah, I think that’s a good point, that it’s not I mean, and I don’t think it’s probably unique to Hills that you hear about kind of town and gown relationships everywhere, but I’m blessed to be able to say, I think back on my time in college, and I attended church at St. Paul’s, where I go to church now. Dan Johnson, who’s the pastor, who is half a block from where we’re sitting right now, when I was sick, I went to the college health center. Well, who took care of me there? Dr. Kimball lives even closer.
JJ: That’s right down the road.
Andrew Fink: And these fixtures in our community that I got to know there. And I do think that being on the congressman’s campaign, he wasn’t the congressman at the time. That was his first successful campaign for Congress. But getting to know the Hodshire family, the Lininger family. Gary Lininger was the county treasurer back then. Ken Kurtz, who was one of my predecessors now, but was running a funeral home in town back then.
JJ: Rick McCoy, pastor, all those guys.
Andrew Fink: So just all these people and getting the opportunity way back then when I still was a 20-year-old kid you were 20, man.
JJ: I was the old guy then.
Andrew Fink: Yeah. That sort of helped me fired by that. Help me fall in love with the community. Yeah, you’re right. The college is famous. People know about the college all over the place. They take the online classes, and they’ve gotten some of that college experience, the substance that you can dip into there. And that is all great, but living in the community is great, too. And college is a part of what makes the community great. But there’s a lot more to Hillsdale County now.
JJ: You met your wife there.
Andrew Fink: Yes.
JJ: Well, that’s like the most important thing.
Andrew Fink: Yeah, absolutely. That would have made it worth it. All by myself.
JJ: Yeah, I just wanted to throw that in there. So, I got some brownie points. And then children, they are acclimated to our community. They go to school here, involved in activities here. I know they’re involved in the church. So very good, well rounded. And I had the pleasure of seeing your dad again not too long ago. He attended a church service. Oh, yeah. Your dad is a good man as well. So, it’s great to have you, obviously, in our county representing us. I’m very proud of you and what you’ve done so far and look forward to what we have ahead of us. So, Rachel, I’m going to let you ask that first question.
Rachel: Yes. So, let’s start with a little bit of understanding for obviously, it’s different in every state, but here in Michigan, if we talk about funding, there are, I think, some other issues we’re going to go over today as well. But there’s some recent appropriations in Michigan that have impacted hospitals. So, let’s start a little bit with funding. What authority does the state legislature have when it comes to the state budget? And in what way is that able to be used to support rural hospitals in general?
Andrew Fink: Well, there’s a sense in which the legislature is the authority for the state budget. Spending has to be appropriated by the legislature. But there are other senses in which, especially in the area of health spending, that the legislature’s authority is limited by the fact that some of the money that we’re talking about spending are what are referred to as past $3, where the federal government’s appropriated dollars to the state for the purpose of funding basically Medicare, Medicaid reimbursements. And I guess Medicaid reimbursement has been the major feature there, and the state has some influence over how to kind of divide that money up. But generally, what that money is for is given to you by the federal government with varying kind of degrees of strictness and the boundaries. An example of where we have some influence anyway would be in the last couple of years, we’ve increased the reimbursement rates for home health nurses that come to your house. I don’t remember what the figures were, but say we took the reimbursement rate from 19 an hour to 22 an hour or something like that. Not a huge increase, but a meaningful one, especially at the scale that you’re talking about. And that was responsive, I think, to the overall nursing shortage that we have in Michigan, probably other places, but certainly in Michigan, that was a place where the source of the funding we’re talking about Medicaid reimbursements either way. So those are basically federal pass-through dollars that were influencing we had some discretion there. So that’s, I think, a good example of kind of in the normal course of business, making some adjustments to what the reimbursements are going to be for a given service. We have some influence there.
JJ: Representatives, let’s talk about the state’s role, specifically as it relates to rural hospitals, okay. And funding and or supporting those rural hospitals, which when we say supporting financially, that’s the most critical thing that the state can do. So, you’ve just passed two supplemental bills in the past six months, one in June and one a week ago. The June appropriations included a safety net, so to speak, for a couple of rural hospitals. And I’m not going to name them because I’m not here to target them, but it basically helps them keep their doors open and one through the end of the year and one a little more long term and obviously a lot of questions and a lot of surface during that period. How is that funding support decided on? In other words, are you getting lobbied as someone saying, hey, these folks, if they don’t have health care in those respective communities, hundreds of people are going to die? I’m not sure how that lobbying takes place, I guess. How does that fit into the state legislature’s role? Because then the question is all right. Are you in the healthcare business? What is it that you’re doing? Is it the free-market economy that should be regulating this? Could you give us a little glimpse into that? There’s been at least three that I know of, hospitals that secured funding.
Andrew Fink: Yes. In the cases that you’re talking about, from this past year, I was not involved in the conversations to allocate those dollars, but they made their way into the budget. I would presume through conversations with the chair of the DHHS Approach Committee, chair Whiteford, chair of the Approach Committee at the time, Chair Albert Or. It just happened on the Senate side and wound up in the bill through those negotiations. But that’s generally the process, is that they’re going to come to the chairs of those budgets and make their pitch there. But it’s not an ideal. So, I mean, what your question is, is that a free market response? Well, no, but the healthcare economy overall is probably the most regulated. It’s comparable at least to banks and investment institutions, and that is very closely watched. And a reason for that is, among other things, people think of it as obviously extremely important. Mortgage companies are also heavily regulated. Stuff that we sort of think is really fundamental to a person’s life is often among the most regulated. And you also have the problem in healthcare of consumers never being able to really even out the information disadvantage that they have with providers. If you want to question what your doctor is telling you, you usually do it by going to another doctor, right? Most people don’t trust their own ability to school up, you know, very quickly on a medical question. So even if they think they disagree with the doctor, they usually do it by asking other experts in the field. And so, you have this problem of patients thinking that this is very important, government thinking that it’s very important, but the patient’s not being in, seldom having the most information about the situation, which is different from somebody providing a service that you’re more or less capable of. You buying milk at the store if it’s sour. It’s not the same way with healthcare decisions. And of course, the body is trickier than a jug of milk, so nobody really knows as much about it as you do other things. But I do think that’s part of why it’s such a regulated industry. But the granting of dollars directly to a hospital to keep it open, it should be obvious to us, I think, that that’s not a long-term solution. Essentially, if you’re going to do that, the state should just own the hospital, which there is such a thing as government hospitals. But if that’s not your plan, then that’s probably not what you want to do long term, right? So, as I think you know, we’ve introduced legislation. I introduced a bill to allow Michigan hospitals to become rural emergency hospitals, which is a new federal designation, and this is part of the regulatory system that we’re in. But essentially the rural emergency hospital, the function there is that the hospital would cease being a long-term inpatient kind of facility. They’ve got to keep their average census under 24 hours, and if they do that, then their reimbursement rates can go up by 5%, and they’re essentially allowed to decertify their hospital beds. As you know, the state kind of keeps track, and the federal government cares how many beds are available. I’m saying we had to I introduced the legislation. It’s not that she passed, but we have to make those designations available if the emergency services are going to remain available in those areas. I think most people would say, I’d like to live within, say, 30 minutes of a full-service hospital, even a small one, a rural one, sure. But if that’s not possible, certainly you’d prefer to have the emergency services available to you relatively close by.
Rachel: Right.
Andrew Fink: With the knowledge that one of these hospitals does have a relationship with a higher-level trauma center to get people to if it exceeds their capabilities. That’s already an issue, obviously, if you’re a smaller hospital. So that’s a way in which we can kind of be responsive to the needs of rural areas. Make sure that the folks that live near one of those hospitals that just doesn’t have a path to profitability as a full-service hospital maintains a presence in the area. Allowing their citizens to feel that if there is an emergency around them. They’ll be able to be taken care of.
JJ: Yeah, and it’s not for everybody, obviously. It’s not going to be for Hillsdale because we’re a full-service hospital doing very well. But the option for some of these hospitals, and we think there may be a few in the state that would actually transfer over to this, I think is remarkable. It sustains that hospital in that community. We say time is tissue. The patient can quickly get to the hospital for that. Emergent care can be seen by a trauma surgeon, whatever it is. But your leadership is much appreciated by hospitals in Michigan as well as the Michigan Hospital Association. They’re very complimentary of your introduction of this. And so, on behalf of them, as a board member, I wish to express our gratitude for the work that you’ve done and champion this because it’s important. And to have rural health care in those local communities that you serve, I think is critical. Now, I guess the good news is that none of the appropriations have benefited our hospitals in your respective communities, and this rural hospital designation probably won’t. So, the goal is you’re doing it truly from a perspective of caring about the rural community, and I want to applaud you for that, because it’s not just about, well, I can get some votes out of this. It’s not at all what you’ve done because it really doesn’t apply to us. And so, thank you and congratulations on the work that you’ve done with that.
Rachel: Well, I was going to ask what brought this to your attention? I mean, because this isn’t your district. Well, I guess the hospitals in your district would not be affected by this. There’s probably only what we think, maybe two hospitals in Michigan that would transition to this designation. The primary one we know of is not in your district. So, what made you want to bring this particular bill forward? What got you interested in that?
Andrew Fink: Well, that’s a good point. I mean, I do hope that in my district, the full-service hospitals we have don’t look at this as a direction that they want to go, because I don’t want that to happen. I want our hospitals to be limited to 24 hours of care for folks. If we can provide a service locally, people are happier there. I mean, we think that about the more services we can be providing at home, the longer you can keep, say, an aging person at home, we think people are happier. Extend that kind of metaphor to your local hospital, I think it remains true. So, you’re right. I hope that my local hospitals don’t take advantage of this because they have that path to profitability, which means sustainability here. But the chair of our Health Policy Committee, chair Collie, is the one who kind of put this on my radar.
Rachel: She’s been on the podcast. You can go look for her episode.
Andrew Fink: And in fact, I hope to succeed her as a representative for a very small portion of Lenawee County. She has most of Lenawee County now, and the district I’m running in going forward includes a small portion of Lenawee County, the city of Hudson. And so, it’s been nice to be on a committee chaired by one of my immediate neighbors, the neighbor to my east. And so, she and I have a great relationship, and she suggested that I take a look at this issue as a member of the Health Policy Committee from a very rural part of the state. I have arguably the most rural district in southern Michigan. The northern Michigan districts are even larger, but I’ve got a very expansive district. It takes a while to get across it. And so, the issue of a spread-out population that’s acutely felt here on this issue and others.
JJ: Sure.
Andrew Fink: And so, I looked at myself as a good advocate for this because although I don’t want my local hospitals to bear this to go this direction. What I do want is for our policy to always be responsive to the differences between. Say. Rural communities and urban communities. Or especially rural communities and suburban communities. Where I think people sort of think if you’re in the city. Then it’s one way. If you’re not. It’s another way. There’s a lot of nuance there. Yes, that’s sort of a beat of mine another issue. I bet I’ve used this example before, but I just think it’s really a good one because it just brings the whole thing into stark relief. We’ve done some funding in the last year in a couple of different ways. We try to do it. It’s not out the door yet, I don’t think, but to increase the funding for school resource officers. These are police officers in our schools. Yeah. So, if you are in a large suburban, if you’re in Oakland County or probably Portage or someplace, you likely already have one police officer whose point in place of duty on an average day is in the high school. That’s a very common arrangement, and I think it’s generally a productive arrangement, build some relationships, maybe helps keep some kids who are sort of facing a crossroads when they’re in high school of what direction they’re going to take their lives. I think it provides some opportunity there. I support that concept. I think it’s great. But it’s not realistic. That Camden frontier, which the metaphor here is, if you play eight-man football, you probably don’t have the budget for a school resource officer to be in your school full time.
Rachel: Right.
Andrew Fink: You’re probably too small of a district. And there are 13 school districts. I think that who’s superintendent works in my district. That doesn’t include the fact that, like Addison and Columbia and whatever else aren’t even in my district, but some of the kids are. So, we’re talking about a lot of small districts here. How are those districts going to take advantage of the funding on an equal footing? It won’t be the exact same way, but there’s got to be an answer to how Camden Frontier in Waldron and Union City and Litchfield are going to benefit similarly from those appropriations to Portage, which, again, where it’s very simple. What would we do there? Well, we pay for part of the school resource officer we already have. All right. What’s it going to look like in Waldron? That’s a good question. We’re going to have to treat a handful of schools in the county as sort of one entity here when they’re looking to make a grant application. So that the sheriff’s department four or five districts. Yeah. Maybe have a deputy who’s trying to do 2 hours a day at four districts. That would make some sense. Honestly, it’s not as good. But then again, this is the reality we’re living in. We’re spread out, our population is lower. How are we going to take advantage of this? So anyway, that’s a long way of saying, yeah, this doesn’t apply to my district today. But if you’re talking about issues of being a voice for rural Michigan, it doesn’t need to be directly in my district for me to say, this is very important to me. It’s very important that we have strong voices underscoring how important it is to support our rural communities. Our smaller towns are places where I’ve got townships in my district of fewer than 1000 people. But those people are citizens. Michigan every bit as much as somebody living in a city of $100,000. So, making sure that those considerations are present on this and every issue that’s.
JJ: Important for me, that’s a great analogy. It really is.
Rachel: Well, and also, some of that money we were talking about that was appropriated to one of these hospitals in particular that essentially said we need a bridge until the Rural Emergency Hospital designation goes into effect federally January 1. But without this bill that you’ve put forward in the state of Michigan, they wouldn’t even be able to do that. So, it really has to go hand in hand with that funding that was appropriate. But let’s talk about you’ve alluded to this a little bit. But there have been some redistricting, some differences in the maps lately for the state of Michigan. How does that affect the state legislature? How does that affect how the two houses work together? How does that affect how constituents engage with their representatives?
Andrew Fink: Well, that’s a really good question. So, the short answer is it will degrade all of those relationships unless the elected officials, the legislators, are diligent. And even then, I am concerned that even a diligent member in a given case will suffer, will struggle to be as attentive to their relationships in their districts as they would be with smaller numbers of municipalities involved. So just by way of example, I’ve got a colleague up north whose current district is contained within one county. His new district has parts of seven counties.
Rachel: Wow.
Andrew Fink: So today, if there’s an issue that affects sheriff’s departments or road commissions or anything where the policy is primarily carried out at the county level, he’s got one relationship or one set of relationship, the road commission or county commission or ever one set of relationships there, how much less able will he be to manage those relationships when it’s parts of seven counties? Right. A diligent guy will still struggle to have seven relationships as good as the one. Sure. In my case, I have two full counties right now, and that’s pretty manageable. I’m not complaining about having two full counties. In fact, it’s kind of ideal. The counties are the same size. I’m sure I’ve said this on this podcast before. I got the best district in the state. Of course, every member says that, but I can explain why. I’ve got the entire Tri-County area, Ohio, Indiana, meet in my district. At the edge of my district, I’ve got two counties that are very similar in a lot of demographic ways. City of Cold Water is slightly larger than hills. Basically, you’re talking about counties of around 40 to 45,000 people surrounding a city of around 10,000 people. A couple of smaller cities, US. Twelve, goes through the entire district from stem to stern. There are distinctions between the two places, the two counties that. Are represent now. But there are a lot of similarities that make it simple for me to conceive of my district. And the only change to my district is the addition to the city of Hudson. City of Hudson is very similar in size to, say, Bronson or Jonesville. Right. And demographically, in terms of income and what the workforce is like, and it being a small city nestled among the rural area, all of that is consistent with the district I have now. So, it doesn’t raise any concerns. What might is the fact that it’s in a different county. And so, it’s a tiny adjustment to my district. But it means I have three prosecutors’ offices to be in touch with, or three again, county commissions or three political parties or whatever it is, whatever you do at the county level. And I’ve got three. Well. And if you look at the Senate districts. Where maybe today our state senate district has three counties. And now Hillsdale County is in two different Senate districts. That means that not only do those members of the Senate they have to be diligent. But those of us who live here in Hillsdale County when we’re dealing with an issue that the state legislature impacts. It’s still just me. Or I hope it’s still just me. But it’s still just the one state representative.
Rachel: Right.
Andrew Fink: But it’s not two senators.
JJ: Correct.
Andrew Fink: So, it actually creates more work for the locals as well. So those are my concerns about the way that this all showed out. And I guess maybe I should set the table here and say that this is the first time that districts have been designed not by the legislature itself, but by these independent citizens. Ridiculously. So, I think that being in the hands of the legislature what were the concerns before? Well, that it’s political, that you’re doing it all to protecting companies. Okay, fine. I can conceive of all those complaints. I didn’t support the creation of the independent registering commission, but the voters voted. And then one of the downsides that I don’t think I talked about a lot was the lack of experience as a legislator means you don’t necessarily understand what I just said of how the district, if you haven’t lived through it, then you don’t necessarily know what it’s like to say, well, all right, we got this bill that affects county clerks. I have two phone calls to make, and this easily could have happened to me. I could easily enough have a district that had part of Calhoun County, part of Jackson County, a sliver of Washington County, and eight townships, and you’re making five calls. Am I going to make those five calls?
JJ: No.
Andrew Fink: I mean, I would try to, but.
JJ: It’s impossible because there are twelve others.
Andrew Fink: Issues, you know, it’s going to happen less often. Yeah, there’s only so many hours, 30.
JJ: Superintendents, and you name it.
Andrew Fink: Exactly right. So that is my concern with our new district. I happen to think that we’re going to have very diligent representation from our senators here based on who I expect them to be. Again, my own district, I’m not one of the people paying the price all that highly. But I am concerned that it’s going to take some time here for whether you’re a small rural nonprofit like we are sitting in the walls of here or county government itself or in some cases even local governments that got divided. One precinct of such and such township is in this district and the other four precincts are in another. I do have concerns that it’s going to take some getting used is to get some patterns built up and people are going to there’s going to be a transaction cost here of settling in. So again, I just think that the watchword here is to be diligent both as the constituent and as the member. You’re going to have to be intentional about keeping those relationships strong if you’re going to be in the kind of communication with the local entities in your district that are affected by your legislation every day. That’s what I think the lesson is here.
JJ: Yeah.
Rachel: So, for other maybe folks who are listening to this, if they’re seeing something similar happen in their state legislatures or in a scenario like this where you’re going to have more demands on you now because you have more to your point, more individuals to serve or more entities within your district to serve. So with that in mind, how do the rural hospital folks like us because we are selfish and care about us right now, make sure that we keep the attention of our legislators when they’re being spread more thinly than maybe they were before?
Andrew Fink: So, it’s a great question because there are other states that have adopted similar models and it’s a popular concept. And I guess just to kind of complete my critique of it at the highest level, you cannot take the politics out of politics. Everyone should stop trying. But if it’s going to happen among the standards that your redistricting commission uses in Michigan, political geography, existing political subdivision lines is a factor. But it’s like fifth or something on the list. It should be more clear that the preference with some kind of heightened standard here should be to maintain the integrity of political subdivision lines. Now, people live in these communities, the term in Michigan that’s been used as communities of interest. I will just say that I think that counties create communities of interest. People get used to living in the same districts, same school districts, same county commission districts, knowing same townships, whatever, knowing their neighbors have similar concerns to them. You want to minimize the times when a neighbor is surprised to find out that I’m in this district and you’re not. We live right by at least using accounting line. Nobody is surprised by that because you already have a different share. If you already have a different commission, you already have different expectations about a lot of things, probably different school districts, whatever. So, I would say that make sure that political subdivisions are a part of any conversation. If you were going to shift away from the legislature doing the math’s, which I don’t really think you should, but even if you were going to, certainly you should maintain some of what’s been a normal part of that process. And it’s not designed to be political. It’s just designed to be reflective of community values being represented. That’s what representative government is supposed to be like. And then secondly, it’s actually not just a rural issue. So, if you look at the city of Detroit right now, I think there’s six or seven districts that are all or almost all in the city of Detroit. I don’t remember the number, but it’s like 15 or partially in the city of Detroit. Well, I think that the concern there. I know it is there were lawsuits filed over at least one. A concern there is that the voice of Detroit, which also has unique interests in our state, in some cases actually probably more similar to rural areas than people realize, and in other cases very different, but still unique compared to the surrounding area. I often say that there’s almost like it’s almost like the suburbs form sort of a wall on both sides.
Rachel: It’s like Texas, Austin, the blueberry and the tomato soup. It’s like a very clear differentiation at one point that you see there is a difference in kind of a close geographic area.
Andrew Fink: Yeah. But I guess in this case, Rachel, what I’m saying isn’t so much that the political preferences I’m not naive to the fact that Detroit in my area vote very differently, almost as differently as possible, but the pressures on the people of rural areas that are not by and large part of the most recent rapid development of the modern economy. You got similar issues in the aging cities in the Rust Belt. Okay. So that’s not unique to Detroit and Michigan. I would say the same thing is happening in Buffalo, or has happened in Buffalo, probably Cleveland and Milwaukee and other cities that are considered by a lot of folks to be kind of past their prime. There’s still hundreds of thousands of people living there and they often feel that they’re being left behind and diminishing their political representation or making it harder for them to count on their representatives because they’re now also representing just as many people in the suburban city. Well, that sounds a lot like what I’m saying about rural areas right now, too.
Rachel: Yeah. You’re diluting their voice in a way.
Andrew Fink: Yeah. So, I would not sell short the concern that I’m raising about representation in rural areas. There are actually versions of that happening in traditionally urban areas too. And in both cases, what you have, I think, is a concern that the way of life that has been handed down is not cared about by the folks who don’t need it. People in affluent suburbs. I think the perception, and I share it from rural areas in our state and very urban areas in our state, is that those folks don’t need to think about, they don’t have the same level of concern, they’re going to be fine either way on a given question.
Rachel: Yeah. And yes, there is kind of an urban rural divide and oftentimes it sure puts us at odds with folks, no doubt. But in another sense, there’s actually a commonality between, say, all blue-collar areas of the state where the concern is are we going to be left behind? And that’s when I talked to all those things I said about rural issues and needing to be attended to them. You could give a version of that talk. I think from a perspective response of all essentially areas that are not on the cutting edge of the 21st century economy shares a lot of the same, I think justified anxieties here. And so, if you’re talking about how do we make sure that our small communities are represented, there’s actually a surprise. I don’t know that everybody sees this, but there’s a commonality, I think, in making sure that all voices that fear being underrepresented should share and attentive citizens in different environments would see that there’s actually a concern. Everybody should want all of us to have strong voices. The small towns, the rural areas.
JJ: I.
Andrew Fink: Think folks in, again, the kind of aging rust Belt centers of our state, they should see that our voices are actually important to them because we actually wind up bearing a lot of the same concerns, a lot of the same burdens. So, in the context of the Redistricting Commission, I actually think that’s who feels like they got to shorten the stick most frequently. And I think there’s some reason for that.
JJ: Great commentary. And certainly, we are grateful for your time here today and the time has passed and we could spend probably hours talking about these type of rule issues. But certainly, your perspective is very important to us, not only because you represent us, because what you have done recently and the legislature has proven that you care about Michigan and you care about rural communities, not just Hillsdale, branch parts of Lenovo, but you care about all of them. And I want to thank you for your contribution to our community and to the state of Michigan and for your steadfast commitment to rural health and for advocating for the right thing. So Representative Fink, thank you for joining us. We’re hopeful to say that you’ll be with us a fourth time in the future. But thank you for joining World Health Rising.
Andrew Fink: Thanks for having me on.
Rachel: And before we close today, I do just want to give a special shout out to Kenji Olmer, our audio engineer. Kenji is getting married this Sunday. So, just as a very important part of our show, for those of you who may or may not know, we quite literally could not put this podcast out every week without Kenji. He edits the show for us. He makes sure that all the sound is good, he takes out the air conditioner in the background if it turns on at an inopportune time. So really, without Kenji, this podcast would not exist. And we are very happy for him and very excited for him to be getting married and starting this next chapter of his life, though, Rural Health Rising will still, of course, be a part of it. So that is just our little note to say thank you to Kenji for all of his hard work. And also, congratulations on your nuptials.
JJ: Next time on Rural Health Rising, we’ll have another great conversation with another great guest, so be sure to tune in.
Rachel: And with that, don’t forget to subscribe wherever you get your podcast. And if you like what you hear, leave us a five-star review on Apple podcasts and tell others why they should listen to your feedback helps more listeners find Rural Health Rising.
JJ: And you can now find us on Twitter. I’m at Hillsdale. CEO JJ Rachel is at Rural Health Rage. And you can also follow the podcast at Rural Health pod. Until next time, stay safe, stay healthy, and stay strong.
Rachel: Rural Health Rising is a production of Hillsdale Hospital in Hillsdale, Michigan and a proud member of the Health Podcast Network, hosted by JJ Hodshire and Rachel Lott. Audio engineering and original music by Kenji Olmer. Special thanks to today’s guest, Michigan State Rep. Andrew Fink, serving District 58. For more episodes, interviews and more information, visit ruralhouthrising.com.
Andrew Fink: JJ.
Rachel: We talk about health policy constantly on Rural Health Rising and how important it is for rural hospitals and health care providers to have a seat at the table.
JJ: That’s right, Rachel. There are many ways to have an impact on health policy, but for our listeners who really want to gain experience in policymaking at the federal level, we have a great opportunity to share.
Rachel: The Robert Wood Johnson Foundation Health Policy Fellows Program seeks out mid-career professionals who are interested in federal health policy to learn how to improve the health of our nation and ensure everyone has a fair and just opportunity for health and wellbeing.
JJ: The program starts in September and runs for one year. Applications are open now and close on November 7, but you’ll need at least a few weeks to get your materials together, so don’t wait.
Rachel: If you’re interested in learning more or applying to this prestigious program, visit Health Policy Fellows.org. That’s health policy, fellows.org.
