COVID-19 may have arrived in urban areas first, but rural communities face unique challenges as the virus spreads.

People who live in rural communities often have higher rates of chronic health conditions; work in food production and other sectors that are at greater risk for infection; live in areas where it's challenging to find healthy food; have to travel further to access medical care and lack reliable, high-speed internet access, said Sen. Debbie Stabenow, D-Michigan, ranking member of the Senate Agriculture Committee, in a Thursday conference call outlining a new report, Rural America and COVID-19: Small Towns and Rural Communities are at High Risk.

The report outlines what Democrats are calling for including:

Health care challenge

The rural health care system was already strained and coping with a lack of resources before COVID-19, said Sen. Joe Manchin, D-West Virginia.

One in four rural hospitals was at risk of closure before COVID-19, said Sen. Tina Smith, D-Minnesota.

And hospitals are closing. More than 128 rural hospitals have closed since 2010, including eight already this year, Stabenow said.

Federal legislation has failed to address Medicaid, a federal program that serves low-income people. Rural providers need increased reimbursement for patients on Medicaid, Manchin said, and they need to be reimbursed for providing care by telephone.

Food assistance

With school out for the rest of the year in many states, it's also important to keep food going to hungry children, he said.

"This started out as a health crisis, it is turning rapidly into a financial crisis," Manchin said. "We must stay ahead of it. We have to work together as Americans . . . this should not be about politics and the next election, it should be about saving lives and the next generation."

COVID-19 is also causing headaches throughout the food supply chain. COVID-19 hotspots have occurred at packing plants where workers stand close together, focusing plant closures.

“The consolidation we’ve seen in the cattle market for a long time is being exacerbated by this pandemic," said Sen. Jon Tester, D-Montana, who called in from his tractor cab while seeding in central Montana. "There are critical short-term fixes that will continue to allow independent cattle ranchers to sell their product, but in the long term, we need to address the consolidation that makes it possible for the failure of a just handful of plants to compromise the security of our food supply. Rural America feeds this country, and if we don’t get these folks the resources to weather this storm, we are going to be looking at problems bigger than a financial crisis."

Internet access

As people across America are urged to stay home to slow the spread of COVID-19, it's inflicting damages on communities of all sizes, Smith said. For the 300,000 Minnesotans without home internet access, the stay-at-home order is especially challenging.

She highlighted an article chronicling a northern Minnesota family who drives 30 miles roundtrip at least once a day so the children can do their homework using the McDonalds wi-fi. In Minnesota, 16% of rural residents don't have access to high-speed internet. Nationwide, 26% of rural residents lack broadband access.

Manchin said rural broadband is a utility and should be treated in much the same way electricity was with the Rural Electrification Act that brought electricity to the countryside.

Heroes Fund

The Heroes Fund would provide premium pay to frontline workers during the pandemic. It consists of two major components:

A $25,000 pandemic premium pay increase for essential frontline workers, equivalent to a raise of an additional $13 per hour from the start of the public health emergency until Dec. 31, 2020; and a

$15,000 recruitment incentive for health and home care workers and first responders to attract and secure the workforce needed to fight the public health crisis.