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In mid-March, my family headed south to Moab, Utah, for spring break. While we were there, the outlines of the risks from COVID-19—uncertain just days earlier—became starkly clear: Moab has only three critical care beds and was expecting more than 6,000 tourists to arrive the coming weekend, many from Colorado resorts where clusters of infections had already appeared. The county health department pleaded with the city and county to close hotels and campgrounds and ask people to go home. The order was delivered March 17.

Moab’s concern is justified: Rural recreation counties experienced rates of infection four times higher than other rural counties early in the spread of the virus. Colorado’s cases rose first in mountain resorts where tourists converge from across the globe and wealthy urbanites sought refuge in second homes and vacation rentals. It is not a surprise that Bozeman—with a busy airport, ski areas, access to Yellowstone, and spring breakers like our family also traveling out—is the epicenter of COVID-19 cases in Montana.

Rural recreation counties are not only more exposed to risks of spread early in the pandemic, but are less able to respond. Health care in rural areas is largely delivered by public hospitals and health districts operated by local and county governments. Low patient volume makes a for-profit model cost-prohibitive. Public hospitals use general tax revenue to ensure services are available when they are needed. For example, Madison County has 20 hospital beds that are operated and financed by local government tax revenue (one of 11 Montana counties with 100% public hospital beds). In the western United States, 46% of rural counties rely entirely on public, local government hospital beds.

The trend toward privatization of hospitals and anti-tax sentiments, particularly in rural areas, has eroded capacity and services. Public hospitals and health districts have the authority to levy taxes but are limited—like all local governments—by state restrictions on taxation, spending and saving. In general, local governments cannot deficit-spend, cannot save funds for downturns or emergencies, and their tax revenue is exposed to volatility, particularly in communities dependent on natural resource- or tourism-related revenue. Compounding the problem, rural recreation counties at greatest health risk are the same places that will see their economies—and resulting tax revenue—drop most severely due to social distancing policy. As a result, these counties enter the pandemic without capacity or budget tools to respond rapidly and face long-term risks of declining revenue.

One-time relief payments will help. But after these funds are spent, states should rethink how local governments are allowed to finance services and build capacity to better deal with health emergencies, natural disasters and economic transitions. Montana has two interim committees studying the state’s tax structure. Colorado, Utah, Washington and Wyoming also began fiscal studies or reforms before the outbreak. Their work is more important now than ever.

The federal government can help with reforms to payment programs that compensate local governments for non-taxable federal lands such as PILT and Secure Rural Schools. These payments are intended to deliver assistance to rural counties with limited tax bases and high demand for services due to recreating tourists. A long-term fix was discussed in the current stimulus but was ultimately left out. The urgency and need remain.

Economists and public health experts are rightly saying the most important for the economy is to stop the spread of the virus. Moab needed my family to leave to mitigate against an acute crisis.

But once the crisis has passed, Moab and other rural recreation counties want us back. We will return with a new appreciation of the special vulnerabilities of rural communities tasked with keeping us safe. We must design new public health and fiscal policies matched to the risks and rewards that public lands and recreation present to the rural West.

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Mark Haggerty is an economic geographer with Bozeman-based Headwaters Economics.