U.S. Sen. Claire McCaskill draws questions from a crowd to answer during her town hall visit last week at Texas County Memorial Hospital. An attendee who promised she'd never vote for McCaskill randomly picked the forms for the senator to answer. McCaskill, who traveled to West Plains later that afternoon, spoke for about 90 minutes.

Democrat U.S. Sen. Claire McCaskill — deep in red territory that overwhelmingly supported Republican Donald Trump in November — held her 48th town hall on Monday of last week at Texas County Memorial Hospital in Houston and most of the questions centered on the nation’s troubled healthcare system.

Rising premiums, struggling rural hospitals and challenges with the pharmaceutical industry and veterans care were among the questions received at the forum, which was attended by about 150 on the hospital’s campus.

McCaskill — with deep family roots in Texas County on her father’s side and who lived here as a toddler before the family moved to Lebanon — acknowledged that she wouldn’t be winning “politician of the year” awards here. But she said she has a firm commitment to rural areas and understands the challenges they face.

For McCaskill, the rural Missouri meeting was a chance for her to highlight her willingness to find compromise in a Republican Congress that is counting votes to pass sweeping tax reform. McCaskill said she couldn’t support the bill in its current form, which she said is heavy on corporate goodies and wouldn’t provide much relief for middle-class families attempting to pay for college tuition and healthcare costs.

McCaskill, facing a tough re-election bid next year, will need to siphon off rural votes to return to Washington. Her expected opponent will be Republican Josh Hawley, the state’s attorney general who was elected last year.

The forum was mostly friendly and allowed residents to write a question for McCaskill, who looked to the crowd at the start for a person who would never vote for her. The unidentified woman pulled questions from a container. A staffer passed them on to McCaskill.

AGRICULTURE, RURAL ISSUES

She said she supported the confirmation of former Georgia Gov. Sonny Perdue as agriculture secretary and expressed concern that a dismantling of NAFTA would cause turmoil for an agriculture community that needs strong export markets to Mexico and Canada.

She predicted that the president’s budget draft, like many of his predecessors, would face changes — including an omission of funds for USDA Rural Development. The agency has funded several projects over the years in Texas County, including a major facility upgrade at the hospital.

HEALTHCARE

McCaskill, a former state auditor, expressed support for rural health systems and worried that a removal of the individual mandate on insurance (included in the U.S. Senate version of the tax bill) will cause more citizens to become uninsured and raise rates for everyone else. Uncompensated care already is a problem at the emergency room at TCMH, where no one can be turned away per federal law.

A local delegation — TCMH CEO Wes Murray and board member Omanez Focker — visited with legislators in Washington, D.C., recently about the challenges the rural institution faces. Both attended last Monday’s meeting.

Healthcare issues have reached a concern level, she said, where Republicans and Democrats should join to fix the system. The comment drew applause. The irony of rural healthcare systems under extreme strain is that those areas were among the strongest supporters of the Trump candidacy, she said.

TCMH says the problem was compounded by the state legislature’s failure to enact an insurance exchange for poor residents paid primarily by federal funds, which McCaskill says she doesn’t understand why legislators didn’t see value. Thirty-two states participate.

She said more attention needs to be placed on the quality of care — rather than quantity, citing blood tests completed four times by doctors in a short period when her mother was in the last stages of life. She noted changes aimed at reducing readmissions to hospitals are resulting in better outcomes for patients who are counseled to prevent readmission.

BROADBAND INTERNET

Called for improvements in rural Missouri, where Internet speeds are often slow. McCaskill said the problem needs to be tackled as an economic development issue and should be examined as part of an overall infrastructure package.

STATE BUDGET

She said because the state income tax system is linked to the federal tax code she noted a huge hole — estimated at $1 billion — would need to be corrected by state legislators if federal tax reform occurs. Among those looking on was Missouri Sen. Mike Cunningham, R-Rogersville.

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