To win reelection, Donald Trump is relying on the continued support of rural Americans, 62 percent of whom voted for him in 2016 compared to 34 percent for Hillary Clinton. But while rural Americans do continue to favor Trump, this time it’s by a much smaller margin. Among the roughly 60 million people who live in rural areas of the United States, Trump boasts only a thirteen-point lead over Joe Biden.

It can’t have helped Trump that rural America has struggled mightily with health care access throughout the coronavirus pandemic, a failure that more than a few rural voters are likely to lay at Trump’s feet.

A new report measuring the impact of the coronavirus pandemic on rural America shows just how bad the situation is. Conducted by NPR, the Harvard T. H. Chan School of Public Health, and the Robert Wood Johnson Foundation, the report finds that 24 percent of rural households report that someone in their household was “unable to get medical care for a serious problem when they needed it during the coronavirus outbreak.” Of this group, 56 percent report “negative health consequences as a result.”