The urban-rural divide fuels America’s eldercare crisis. Lessons from Minnesota’s history offer understanding and a path forward.
By Anais Froberg-Martinez
America’s eldercare crisis is rooted in the urban-rural divide. Minnesota, which has grappled with that divide for generations, could be a model for innovative approaches moving forward.
The urban rural divide has been looming over America for decades, and only now as the rural aging crisis takes up an increasingly urgent place on the national political stage are we beginning to realize that we’ve severely miscalculated the depths of this divide.
Without fully understanding the historical timeline of the growing global economy, political strategists have scrambled to paint a dramatic picture of this divide, characterizing it as a cultural warfare fueled by a fire of resentment and rural rage. Political theorists have finally taken a step back to give a careful look at the fundamental economic divides at the root cause of these hotly-debated cultural and political conflicts.
Minnesota’s divided history
“Metropolitan residents resented the political clout of the outstate legislators… but rapid population growth in the urban area […] reversed the roles,” wrote William E. Lass.
Lass might sound like a contemporary scholar, but he wrote those words more than forty years ago in his book, Minnesota: A History. According to Lass, the state divide has deep roots.
He extracts an economic basis for Minnesota’s early political reversal nearly a decade before the rest of the nation would witness the same pattern. The Clinton-era frenzy to promote the global economy established urban areas as the center for new sectors. Conservative voters who were historically at the forefront of industrial advancements now found themselves casting a blue ballot for new international initiatives. With metropolitan areas being propped up by this economic support, urban residents were invited into the vast opportunities of cities and their global worldviews.
Keith Orejel, an Associate Professor of history at Wilmington College, makes an economic case for the divide. The new Democratic party’s embrace of free trade agreements and technological sectors had a “devastating impact on rural manufacturing,” he wrote. Rural “brain drain” ultimately heightened the wealthy, opportunistic environment that distinguished cities from rural areas. Young people were attracted to the rising demand of the global economy, leaving behind older retirees and an understaffed workforce to meet their eldercare needs.
The decline of rural nursing homes is a culmination of the growing role that these older retirees play in the politics of the rural-urban and Republican-Democrat debate. Seniors are a rapidly growing age group in the United States, and a plethora of rising costs and staffing shortages within the healthcare system have hit rural areas the hardest. The Biden administration sought to push a CMS staffing mandate; Republican politicians have looked to save rural nursing homes from closure by easing regulations.
The Trump effect
The Trump administration’s previous actions–such as its 2017 attempts to ease fines on smaller facilities–have led to growing public predictions that Republicans will rescind the Biden administration’s staffing mandates. The rule was published in 2024 and was meant to gradually be implemented in three staggered waves until 2027, with rural areas being given additional time until 2029.
The core of Trump’s rhetoric to save rural America from “unfunded mandates” ultimately ties back into the rural response to the global economy, with communities being convinced that they can have a long-due revival of their declining economies by undoing the burden of taxes and regulation.
Additionally, Trump’s promotion of Medicare Advantage promises lower costs and privatized healthcare that will prevent rural residents from having their tax dollars end up at urban front doors. By boasting measurable benefits of at-home care incentives and transportation, Trump has advertised an immediate, radical change that could bring the rural American economy back to a simpler time. However, such incentives often include complex cost-cutting measures and priorities leave rural seniors dealing with upcoding and extensive prior authorization once emergency strikes.
Restricting illegal immigration is another way that Trump has promised to reduce federal spending on Medicare and Social Security. But both legal and undocumented immigrants represent a significant portion of the healthcare workforce in rural areas, which could end up putting more financial strain on rural communities. Trump’s rhetoric about illegal immigrants has also created tension between white rural residents and their immigrant neighbors.
Rural Minnesota’s culturally diverse landscape has been shaped both by past and present waves of immigration. As of 2020, 68.7% of Indigenous people live in rural Minnesota, and they experience the added weight of historically complex cultural dynamics alongside the rural fight against the forces of “the metro.” These contributing forces have led to a greater openness from the state’s legislators. Both parties have been open to working with immigrant solutions to improve staffing shortages, such as breaking down language barriers on staff evaluation tests, as well addressing the importance of sustaining an immigrant healthcare workforce.
Rep. Samantha Sencer-Mura (DFL-63A) worked alongside Republican legislators to author a bill on multilingual nursing home staff evaluation tests, which eventually passed as part of a larger omnibus. She says that it feels like the solutions addressing the decline of healthcare facilities are doing “a lot of tinkering at the edges.”
“Our healthcare system is broken, and so anything that is touching that system is trying to work within a super flawed system,” she added.
In Minnesota, it’s not all conflict
Notably, Republicans and Democrats are generally united in the belief that for-profit organizations are enemies to the quality of care for seniors. Trump has previously taken an aggressive stance on antitrust issues during his 2017 presidency, and his stance likely will remain the same.
The interference for-profit companies on healthcare is unfortunately a hole in the fabric of an advanced global economy, suggesting a new form of “capitalism on steroids” that both Democrats and Republicans see as having destructive economic consequences.
However, Trump’s villainization of the global economy has contributed to significant divides beyond economics, including immigrant communities as he promises policies that will keep rural America from withering away.
Rural voters have grown to see pages of complex terminology shoved into omnibus bills only complicate their economic situation, and older retiree populations doubt whether these high-brow policies really reflect the return in industrial power that they want to see.
As a result, Republicans who have only been seen eye-to-eye by politicians who advertise a simple solution are lamented as “voting against their own interests” by Democrats.
From careful analysis of the New Democrat years, economists have gradually begun to realize the significance of rural retirees’ unease towards any policies that might cause their remaining nursing homes to be ransacked to fuel the wealth of the urban elite. They might remember the unpredictable cycle of their economy, from the rural renaissance to the economic downfall of their small towns. Although Minnesota will still face a challenge of avoiding a divide being furthered by mineral resource depletion and a host of national factors, it has built upon its unique historical experience grappling with this divide. As the dynamics of the modern rural economy cement themselves across the country, Minnesota looks to challenge the fixed notion of rural-urban competition by showing how immigrants and young people can have space in the rural economy.
Unless they want to perpetuate the myth of rural resentment by widening the divide of rural-urban America, politicians shouldn’t focus on an all-or-nothing approach to the global economy– whether to reverse it or to let it control our political ideologies. Urban politicians can break the notion of the urban political epicenter by reassuring rural areas that their economy is sustainable, gradually gaining mutual trust through economic stabilization measures that they can see and feel, and ultimately making space for them to have a uniquely rural place amidst the global economy. And maybe some notes from a Minnesota history book could offer a blueprint to ending the divide for good.
Anais Froberg-Martinez, a sophomore at Minnetonka High School, produced this editorial through ThreeSixty Journalism’s Capitol Reporting Workshop sponsored by the Saint Paul & Minnesota Foundation in February 2025. Anais worked with Sahan Journal reporter Katelyn Vue to complete her story.
