The Grassroots Organizing Revival in Rural Washington

Newhouse, a hops farmer who owns a 850-acre farm in Sunnyside, was first elected to represent Washington’s 4th Congressional District in 2014. Reaching down to the Oregon border and all the way up to Canada, the district spans nearly 20,000 square miles in central Washington. With the exception of Yakima and the Tri-City area, the district is overwhelmingly rural.

According to the Cook Partisan Voting Index, the 4th district is also the most Republican district in the state. No Democratic presidential candidate has carried any county in the 4th district since 1992, when Bill Clinton carried Okanogan County. Yet, of Washington’s 10 congressional districts, Newhouse’s contains the highest percentage of constituents who rely on Medicaid. As of 2025, 278,000 residents in the 4th district, or 33%, of the district’s population were enrolled in Medicaid, just under half of whom are children.

Nine rural hospitals in Newhouse’s district, Three Rivers Hospital among them, were identified on a national list shared with Congress before last July’s vote as at-risk of being forced to curtail services or even close entirely. Two out of three hospitals in Okanogan County became at risk of closing or losing funding.

Besides losing money for the last three years, Three Rivers Hospital is among the top 10% of rural hospitals serving the highest percentage of Medicaid recipients nationally.

Historically, Medicaid has reimbursed hospitals at rates far below the services they provide. Known as “Medicaid shortfall,” the difference between actual costs and payments received by hospitals from Medicaid nationally in 2023 was $27.5 billion.

Days after the Big Beautiful Bill cuts were made official, Scott Graham, Chief Executive Officer of Three Rivers Hospital explained the predicament at a news conference. “Many of the folks who come here … are relying on Medicaid to be able to cover the costs of the care that they receive … the legislation essentially guts Medicaid for the care that we provide.”

Josh Corsa, the ER director at Three Rivers Hospital, put it bluntly:

I’m tired of rationing medicine based on what my patients can afford. I’m tired of watching my patients decide between life-saving treatments and housing. And I’m tired of sleepless nights hoping and praying our hospital finds enough revenue to stay open just a little bit longer. This is not how it’s supposed to be in America.

A heated exchange

In the soft grass next to the Three Rivers Hospital parking lot, the KHQ news team waited for Rep. Newhouse, brandishing microphones and video cameras. Alongside them were members of Rural People’s Voice, a north central Washington-based (Okanogan, Douglas and Chelan counties), advocacy organization started by former social workers Elana Mainer and Adrianne Moore.

Since its 2020 founding, Rural People’s Voice has become a force to be reckoned with. The group’s goal: mobilize rural working families to achieve economic justice. Its blend of paid organizers, narrative strategists, campaign leaders and volunteers have spread out across north central Washington in a symbiotic web.

To his credit, Newhouse acquiesced to the impromptu press conference and stood before the cameras for 10 minutes, mildly fielding questions and rebutting hostile accusations. A video of the encounter was filmed by journalist-filmmaker, Kevin Teeter.

Corey Troiani, senior director for Rural People’s Voice told Newhouse, “Hardworking people are going to lose health care and hospitals may need to close. That is a direct result of your vote.”

“The goal of the program,” Newhouse said, “is to make sure that Medicaid and those services that people rely on are available on into the future.”

“But you’re making them less available,” Troiani said.

“That’s not the goal of the program,” Newhouse said. “Not at all.”

Goal or no, the $1.1 trillion in federal cuts to Medicaid ensure the end of subsidies that would otherwise allow tens of thousands of Medicaid recipients in Washington’s 4th district access health care.  

Washington Gov. Bob Ferguson (D) has predicted that at least 330,000 Washingtonians are expected to lose Medicaid insurance.

This 4% of all Washingtonians, newly uninsured, can be expected to continue seeking medical care as personal health dictates. Rural hospitals will most certainly be expected to continue providing medical care regardless to changes in the federal Medicaid reimbursement amounts. Less federal money though, equals less services available in rural communities. Sooner or later, potential closures of rural hospitals become a concern.

The Washington State Hospital Association described the passage of the Big Beautiful Bill by Newhouse and his Republican colleagues as “punching someone in the face and offering them a Band-Aid.”

A voice in the wilderness

Elana Mainer, executive director and co-founder for Rural People’s Voice, was born in northeast Washington, in the town of Chewhela in Stevens County. Ringed in a valley by evergreens and snow-topped mountains, for out-of-staters, the misty Washington landscape recalls the show Twin Peaks.

Hardscrabble Okanogan County, more than four times larger than Rhode Island, sits 95 miles to the west in central Washington. It is one of the poorest counties in the state, with 27% percent of the county’s children living below the poverty line.

“Aging downtowns, gravel-road neighborhoods, you see a whole lot of people struggling to make ends meet,” says Mainer.

Nearly 14 years ago, Mainer, who had worked in the social services sector since she was 18, took an executive director position at an organization called Room One, in the town of Twisp, in Okanagan County. 

Named for the room number in the community center where it was founded, Mainer likened Room One to a one-stop social services shop offering a reproductive health clinic, Women Infants and Children family planning, (WIC), foster care visitation, and one-on-one in-house social services (DSHS) support.

Here, Mainer met Adrianne Moore, who served as executive director before her.

From a little town outside Davenport, Washington, Moore, the daughter of a Methodist Minister, moved every couple of years with the church—to Toppenish, to Hilltop, to Tacoma.

Moore became a mother when she was 19, and she worked her way through college on the night shift at a domestic violence shelter. “I had a real passion and heart for helping folks who were not too different than the folks I had grown up with,” Moore says.

By 2020, Moore and Mainer had long noticed that elected officials serving their communities—county commissioners, state legislators and even city councils—were actively turning away state dollars because they believed in small government.

“And these were people we knew. These were our neighbors,” Moore says. “They were not bad people, but their values around what government should do, and what our people needed and deserved, were different.”

“No matter where you sat on the political spectrum,” Mainer says, “at a time when most people were worried about health care, about their public schools losing funding or about affording the cost of a caregiver, our representatives weren’t showing up for those fights.”

Culture war issues were taking up all the oxygen, Mainer says, which weren’t relevant to the economic bottom line of rural people’s lives.

To imagine people actively participating in the governing of their communities, Mainer says, required “tectonic shifts on all sides.” The only path forward they could see was to organize a movement themselves.

In 2020, they resigned their jobs at Room One. Choosing political immersion, they joined campaigns to elect others while they practiced a trial and error of community organizing. A series of losses followed.

“What we saw was there was no infrastructure for recruiting and developing new leaders,” Moore says. “There was no campaign expertise. There was no organizing muscle. The community just had not flexed those muscles in a long time.”

They decided to run Adrianne Moore for public office.

Lessons learned

In November of 2020, nearing the end of the most intense year of the pandemic, Moore’s race against incumbent Republican Keith Goehner for the Washington State House of Representatives saw 71% of registered voters in the district turn out to cast their ballot. Out of 76,000 votes cast, Moore lost by 15,000. They consider the experiment a success.

Moore and Mainer’s motivating theory held that by organizing a large group of people and bringing them into the decision-making structure in order to promote their voices, better campaigns could be run going forward. Neighbors would be more invested, the political divides notwithstanding.

“In that campaign we really tried to learn what it takes to win seats for a decision-maker who will actually get us the things that most working-class people need,” Mainer says. “What are we up against in a place like ours? What do we need to start building and organizing our base?”

Moore’s campaign raised around $125,000, $93,000 of which came from individuals. Despite Moore’s loss, Rural People’s Voice had begun to build its base.

“People were hungry for what looked like a more joyful, working people’s campaign that talked about things that really mattered to them, like housing and health care and schools and safe streets and neighborhood,” Moore says. “You know, we were talking about kitchen table economic issues at a time when lots of Democrats weren’t. And I think that really resonated with a lot of rural folks that wanted something different.”

A perception had grown in the district that the Democratic Party was a party of elite consultants and technocrats who no longer had a working-class base informing their strategies or policy platform.

“As labor unions sort of waned in their power,” Moore says, “particularly in rural areas, [Democrats] became less of a voice for working class people— particularly working-class rural people.”

Mainer and Moore had found through Moore’s campaign that the contest was one of defining the narrative for the rural working-class voter in the face of organized efforts of opposition.

Moore says that most people—left, right and center—agree with one another about the underlying economic inequalities. “The working class has to be purposefully divided on things like immigration and race and guns and abortion, or whatever culture wars, so that we don’t pay attention.”

“The far-right has organized so effectively in rural areas,” Moore says, “You will hear their messaging in workplaces, in churches, on every social media feed, on the radio waves that still air in rural Washington, on the TVs that still play. Far right messaging dominates.”

Moore says while the conservative go-it-alone storyline built around individualism is false—and always has been— it remains compelling because nostalgia is compelling. Pull yourself up by your bootstraps. Do it the hard way. Make your way in this world and find success, winning in spite of the odds.

“It’s this long American storyline that has become increasingly untrue—and it is a hard narrative to come up against and rewrite,” Moore says. “We have to somehow recenter the conversation around the issues that both unite us and actually have tangible benefits for working class, rural, multiracial families.”

Mainer says she the experience of building and pushing Moore’s campaign was like a lightning [bolt] hitting the ground and illuminating the landscape around them. “And that’s what catalyzed us into Rural People’s Voice.”

The hedge fund manager

In the winter of 2022, Rural People’s Voice came into their own. 

That year, hedge fund manager Brian Heywood created a SuperPAC called Let’s Go Washington to oppose “stupid, overly aggressive, radical progressive policies,” as he told Fox 13 Seattle. Heywood donated $6 million of his own money to finance six statewide ballot initiatives, which were then supplied to the state legislature.

The initiative that galled Mainer the most sought to repeal a 7% capital gains excise tax that had been imposed one year on the sales of long-term capital assets over $250,000. Less than 4,000 people out of Washington’s 8 million residents qualified to pay that 2.9% surcharge.

The tax generated over $900 million in 2021, which the state used to fund school construction, early learning and child care.

“He paid a signature company to collect signatures to try to repeal the capital gains tax,” Mainer says. “I mean, it targets only the wealthiest folks in Washington State who make a massive amount of income on the sale of stocks and some massive capital gains each year.”

In 2024, in the run up of the initiative being put before voters in November, Rural People’s Voice launched an organizing strategy built by and for rural communities.

“We had six paid organizers, four paid canvassers, 12 interns, probably 60 volunteers,” Mainer recounted. “Our social media ads probably reached 25,000 people. We sent out 60,000 mailers and 900 yard signs. Ran 10 billboards in our area. Neighbors canvassing neighbors, we went out and knocked on 10,000 doors.”

Mainer says her experience most of the time was that people were very open to talking.

“They don’t want to talk politics because who does?” says Mainer. “But, when you explain that you’re here to talk about how we can make things more fair, most people are with you. Most people, if given the choice between fighting with their neighbors over a tiny pot or coming together with their neighbors to demand and call for a bigger pot, the vast majority are going to choose option two.”

In the final tally, 64% of Washington voters rejected the hedge fund manager’s initiative to repeal the capital gains tax. In the 4th District, 54% of voters rejected the ballot initiative. In Okanogan County the number was 58%.

The next fight

Three months after Rep. Newhouse’s unscheduled parking lot press conference, Newhouse announced his retirement from a decade of service in the United States Congress—capped last July with his vote to cut Medicaid.

If there’s a silver lining to Newhouse’s vote, Mainer says it’s that cuts to Medicaid have catalyzed conversations about whether the state will be able to prop up rural hospitals without reforms to Washington’s tax system.

Washington has the second most regressive state and local tax system in the United States. The 20% of citizens with the lowest incomes (those making under $33,000) pay 14% of their household income per year in taxes, while the top 1% (those making more than $841,000) pay only 4% of their income.

A de facto tax haven for the wealthy, Washington only moved out of dead last in the regressive tax system rankings because of the voters’ successful defense of the capital gains tax in 2024.

In order to prop up Washington’s 44 rural hospitals, the state received a $181,257,515 infusion in Rural Health Transformation funds for 2026. It hasn’t been announced whether or by how much the nine rural hospitals in danger of seeing services cut or closure in Newhouse’s 4th congressional district will benefit.

But with Washington Gov. Bob Ferguson’s announcement that there was a $2.3 billion hole in the state’s budget, advocates of progressive taxation are heartened that the governor has indicated he would support a 9.9% tax on personal income over $1 million annually.

“The way to fill that budget gap,” Mainer says, “has to be something that finally starts to level the playing field and calls in the wealthiest people in our state to contribute their fair share.”

The legislation as it’s written would be expected to raise near $3.5 billion in its first year and would affect approximately 30,000 citizens.

“Governor Ferguson said he could only sign this bill if there’s real relief for working families,” Mainer says. “It’s beyond time to tax millionaires,”

While Mainer anticipates the millionaire’s tax will be brought before the voters on the November ballot, even if it’s voted into law, court challenges of the tax are inevitable, dragging out its implementation over the course of years.

For now, Rural People’s Voice plans to convene a leadership cohort of “probably 35” members which have been identified as natural leaders since 2024.

“People that we met in the last couple of election cycles, or in between, who we know have the kind of natural leadership that it takes to bring and engage more people.”

Under the persistent stewardship of Elana Mainer and her team of dedicated organizers and volunteers, Rural People’s Voice is only growing louder.

Rokosz MostMore by this author →

Rokosz Most is an itinerant word farmer currently toiling in New York’s Hudson Valley where he contributes to both mainstream and obscure outlets, including Hudson Valley One and HV1’s Almanac, as well as the Times Union of Albany. Read his substack at rokoszmost.com.