Chasing Those ‘Elitists” Away

Even policies that are adopted after extensive research and thoughtful debate often generate unanticipated consequences, so it shouldn’t be a surprise that a policy based on rejection of relevant evidence and refusal to engage in debate is rapidly degrading access to medical care in Red states.

I’m referring, obviously, to the abortion bans that were enacted (or triggered) immediately after the Dobbs decision overturned Roe v. Wade.

In November, Timothy Noah reported that warnings of an eventual “brain drain” caused by those bans had the timing wrong: it wasn’t “eventual”–it was already occurring. Red state culture wars aren’t only creating medical care “deserts,” they’re driving other college-educated workers— teachers, professors, and more—out as well.

Noah began his article by telling the story of a married same-sex couple, both Ob-Gyns practicing in Oklahoma. They now live in Washington, D.C.–a move that doubled their housing costs and reduced their pay. (It turns out that Red states, which have fewer Ob-Gyns, pay doctors significantly higher wages than states where there are ample practitioners.)

Kate Arnold and Caroline Flint are two bright, energetic, professionally trained, and public-spirited women whom Washington is happy to welcome—they both quickly found jobs—even though it doesn’t particularly need them. The places that need Kate and Caroline are Oklahoma and Mississippi and Idaho and various other conservative states where similar stories are playing out daily. These two fortyish doctors have joined an out-migration of young professionals—accelerated by the culture wars of recent years and pushed to warp speed by Dobbs—that’s known as the Red State Brain Drain.

Abortion restrictions have turbocharged that brain drain, but state laws restricting “everything from academic tenure to transgender health care to the teaching of ‘divisive concepts’ about race” are making these states uncongenial to other knowledge workers.

The number of applications for OB-GYN residencies is down more than 10 percent in states that have banned abortion since Dobbs. Forty-eight teachers in Hernando County, Florida, fed up with “Don’t Say Gay” and other new laws restricting what they can teach, resigned or retired at the end of the last school year. A North Carolina law confining transgender people to bathrooms in accordance with what it said on their birth certificate was projected, before it was repealed, to cost that state $3.76 billion in business investment, including the loss of a planned global operations center for PayPal in Charlotte. A survey of college faculty in four red states (Texas, Florida, Georgia, and North Carolina) about political interference in higher education found a falloff in the number of job candidates for faculty positions, and 67 percent of the respondents said they would not recommend their state to colleagues as a place to work. Indeed, nearly one-third said they were actively considering employment elsewhere.

Here in Indiana, school corporations are experiencing dramatically higher teacher vacancies, and like other Red states, Hoosier rural residents struggle to find medical care–and not just prenatal care. It seems it isn’t just Ob-Gyn practitioners who are abandoning Red states.

Family doctors are also “reassessing” their options–and training availability.

Researchers from the Person-Centered Reproductive Health Program at the University of California San Francisco have found there is reason to be concerned about training for family physicians in ban states as well.

A study published in the November-December issue of the Annals of Family Medicine found that 29% or 201 of 693 accredited family medicine residency programs in the U.S., are in states with abortion bans or significant restrictions on abortion access. The study used publicly available data from the American Medical Association to conduct the analysis, and found 3,930 residents out of 13,541 were in states where abortion is banned or heavily restricted.

For practitioners who remain in those states, the training they are now able to receive deprives them of the skills they need to deal with miscarriages and various problems in pregnancy. Residents in those states no longer have access to comprehensive reproductive health training because they’re not experiencing it within their state context. As the lead researcher explains, “they cannot see abortions, cannot perform them, cannot learn how to care for patients after abortions in the same way they would be able to if they were working in a state where abortion was unrestricted.” As she points out, early pregnancy loss is very common, and the skill set for caring for that and first trimester abortion are very similar.

It bears repeating that the exodus of educated citizens isn’t limited to medical professionals. (MAGA Republicans are actually applauding the exit of the teachers and professors they distrust.) Ironically, the rural folks these MAGA lawmakers disproportionately represent are the ones first experiencing the “unintended consequences” of their misogyny–the absence of teachers and doctors.

It will only get worse…..


  1. It’s time to remind those in care deserts that Justice Alito said we all have the vote, if we want a different outcome. I hope we all keep that in mind this November. Vote Blue! Vote Blue! Vote Blue!

  2. First, I have to apologize to everyone on this blog for being so intensely negative the last few times I’ve written something. But it’s hard to find a silver lining for an idealist like myself.

    Second, today’s article is another negative brick in my wall of political despair. Republicans are NOT conservative and haven’t been for 40 years. Clearly, the cancer that is eating away at our democratic republic is that nearly half the people seem to have lost not only their minds, but their hearts and souls too. Sam Alito (Bush II) and Clarence Thomas (Bush I) are two examples of how puppets for presidents can bring long-term negativity to our nation.

    The mindless attack on women’s rights and health care is an almost tragically poetic indictment of the right-wing movement. Women are supposed to be the givers of life, love and caring, yet Republican politicians seem to believe that controlling their minds and bodies is the thing to do. Pure insanity.

    Then, yesterday, I saw that the brain-dead Steve Scalese endorsed Trump for president. Fasten your seat belts. It’s going to get worse.

  3. When progressive-leaning individuals leave red states, that diminishes the chances of people voting to change the red to blue. I don’t blame them for choosing to leave, but as it happens the reds get redder and the blues get bluer, and we become even more polarized.
    I know, another “Thanks Mr. Obvious”…

  4. I recently read a NY Times article where the life expectancy in the reddest states is going down compared to the bluest states. I think there is somewhere between one and two years shorter life expectancy.

    The politics of grievance has real world consequences, and unfortunately as James pointed out, the real world consequences just feeds the polarization.

  5. The obvious solution, then, is to impose right-wing policies at the national level. It’s not fair for blue states to have such unfair advantages in attracting educated and productive citizens.

  6. Just released annual study of states people are moving out of in 2023. Not much RED there:

    New Jersey
    North Dakota
    New York

    Top “moved to” states. Not much BLUE here:

    Washington, D.C.
    South Carolina
    Rhode Island
    North Carolina
    South Dakota
    New Mexico
    West Virginia

    Data, please…..

  7. And a bit more from 2023:

    Texas experienced the largest numeric change in the nation, adding 473,453 people, followed by Florida, which added 365,205 residents. South Carolina and Florida were the two fastest-growing states in the nation, growing by 1.7% and 1.6%, respectively, in 2023.

    Eight states saw their population fall in 2023: California (-75,423), Hawaii (-4,261), Illinois (-32,826), Louisiana (-14,274), New York (-101,984), Oregon (-6,021), Pennsylvania (-10,408), and West Virginia

  8. Hey Lester — how about providing some data on economics of those states. High tax states — people move out; low tax states — people move to. High tax states — more social services. Low tax states — limited social services. I live in SC and I hear all of time “I had to move because of the property taxes up North. ” Then a few sentences later “Up North we always had X, Y and Z. Why not here?!?!” Duh!!!

  9. Men- particularly us white men, need to wake up! We feel “safe” much of the time. Black Women- lack the “luxury” we have. Example: Men for Equity and Reproductive Justice- 2 1/2 years ago we started out with 4 of us deeply committed. Take a guess how many men we have today?

  10. Kathy M. – you are right…so…people doing “ok or better” would rather not pay taxes and don’t need support. It is our quasi-narcissistic culture. Why would they bother voting if they are fine living under Abbutt or DeDantaclaus?

  11. I’ve talked about this before and I think it bears repeating: I moved from low tax Indiana and Ohio to insanely high tax Madison, Wisconsin. My property tax is punishingly high. But, I’m ok with that because, at least until the Walker administration, I knew that my taxes went to provide great schools, a great environment and city services that actually work.

    However, with Walker, the low taxes uber alles crowd has taken over and they’ve cut funding for schools, cut out teacher’s right to strike, constantly find ways to interfere with our county’s environmental policy (and the rights of anyone who stood in the way of someone making money- ask the folks up north who suddenly learned that they had no right to say that frac sand mines couldn’t be built next to their farm).

    And the refrain I always hear is, “well if you don’t like it, leave.” and the thing is, I did leave. I left a state with shitty education, shitty environmental rights and increasingly shitty healthcare. I moved to a place that had the things I wanted and I knew that those things would come with a cost. And then an bunch of folks decided that they want lower taxes, and they say I’m the one who needs to move. No. You move. Indiana and Ohio and Florida and Texas are all right there, looking for folks who want low taxes just like you. So you go be with your people, leave me and mine alone.

  12. Certainly more polarized!
    Maybe, somewhere down the line, the increasingly deprived populace in the red states will wake up and rebel, voting out the desert-creating politicians? Just maybe?
    Vernon, no need to apologize, at least not to this idealist. I’m the one, in any case, who tends to comment that humanity may, simply, not live past the end of the century.
    Our emotional systems are still based on ancient once life saving reactions/responses to threats from fierce animals in the environment, and marauding “other” bands of people. Despite the idiocy of wars still being waged, most of humanity does not need to be wary of “Them immigrants,” and the like; the concept of race is a myth, and the degenerating of anyone’s blood lines is as well.
    On a global scale religion, is, as Pam referred to yesterday, just another way to create an “Us/Them” divide.

  13. If there are more people leaving blue states for red, how will they affect the voting outcomes? Will those deep red states begin to turn purple?
    Do those moving in stay until they get sick and have to travel for healthcare or can’t get homeowner’s insurance because of natural disasters and are forced to rent?
    What demographic is moving in? Retirees who don’t need a job for income or want to escape the cold winters? Snowbirds from Canada can go back to their more progressive country to avoid the heat and humidity. They leave big holes in the local economies when they leave with their money.
    If tfg is elected and removes 10M immigrants, what demographic is going to replace those workers. Retirees and those unwilling to pay for public services? Of course, there will be lots of job openings for camp administrators and law enforcement, to say nothing of military support personnel, so there is that.
    Lots to contemplate.

  14. I’d like to see a breakdown on the demographics of the people who are actually moving from red to blue and from blue to red states, excluding population changes due to immigration and birth rate changes.
    I suspect that the historical movement of retirees from colder to warmer areas is still happening and is responsible for a portion of the population changes Lester mentions. There are a multitude of reasons that cause people to move from one area of the country to another and without more data about what is prompting those moves, conclusions will be shaky at best.
    The researchers Sheila cite are attempting to provide that data and should not be discounted by the raw numbers provided by Lester.

  15. Some of the red states moved to from blue states may turn purple with such influxes and purple states moved to may turn blue with such influxes, so all is not lost; and when the new rationale for moving adds abortion, anti-fascism and reasons other than taxes for moving from states run by cavemen the overall picture brightens. Personally, I left my retirement home in Naples, Florida, with the election of DeSantis, a fascist doing his best not to be called a “ruler” while on the campaign trail in the face of his Don’t say gay and destruction of higher education record which is resulting in an exodus of professional educators to be replaced by his political know-nothings. See New College and his curriculum re-writes, especially of those in re race, where he says slaves got a break in being taught means of making a living. What’s next with this race-mongering fascist? Shall he demand with his re-write of history that the successors of such slave enlightenment be required to reimburse the successors of their slave-masters for such free education?

    I here suggest that it’s not only the professionals who are leaving Maga states and thus that the data are misleading. It depends upon who is coming and who is leaving. With historic unemployment levels due to Biden’s FDR efforts for workers, I expect workers, especially skilled tradesmen, to become mobile and vacate states like Florida. With increasing population but shortage of such skilled tradesmen the costs of living in Florida will go up as those remaining tradesmen can and will demand more money for their services, thus offsetting the state’s ballyhooed no state tax propaganda.

    I also expect millions of Republican and Independent male voters to join women in voting against the Republican view of women’s reproductive health, and a Republican vote is a two for oner, i.e., a vote we get and one the Republicans don’t get – and that’s a yes.

  16. One thing is sure: red with natural attractions (oceans, mountains, etc.) will still draw people, while blue will draw others. Indiana will draw no one and will continue its decline.

  17. RE: Red vs. Blue interstate population movements.

    A recent Forbes article ( ) reveals that the aggregate state-level tax bite for low and middle income taxpayers is higher in Texas than in California.

    Most of the people leaving California for other states are leaving either because the cost of housing here is too much to bear, or because they’re very high income households looking to shelter wealth.

    Full disclosure: We left Indiana for California in 1997, and promptly bought a modest home. Now both retired and comfortably settled, we are probably here for the duration.

  18. Restrictive State laws are driving valuable workers away in droves, as some States are considering laws to keep pregnant women from leaving. Texas, Arkansas and South Dakota are in the works to enact laws that make it illegal for a pregnant woman to leave their state for healthcare. Where do these “independent type legislatures” get the idea that they can ban a US citizens freedom to travel across state lines? Truly moving toward the society depicted in Margaret Atwoods “The Handmaids Tale”!

  19. Lester. I read the census bureau article you linked and found it interesting. However, I did not see how the statistics in it can be related to the issue addressed by Sheila today, i.e. brain drain from red states due to antiabortion or other laws. There are no categories in the census questions that would reveal such information. Specifically, no data about education level of the people moving is shown. In regard to the reasons given for moving, again there are no categories that relate to the issue in question. There was a 2% increase in “work” being given as a reason for moving in 2022 over 2021 which might or might not include reasons related to brain drain.

  20. These “anti-woke” policies ensure that our educational dreams will never come to pass. There won’t be better childhood education leading to more well-rounded, thoughtful adults. Instead, they are ensuring the indoctrination of core MAGA beliefs will be unchallenged, which _will_ lead to more MAGA adults. It’s transparent; it’s insidious.

  21. And tech does not include doctors, nurses, school teachers, university professors, writers, artists, most research scientists, etc. In short, the “brains” that the rest of society depend on for so much of what secures and enriches our lives.

  22. There are many reasons to emigrate from different places. They are all functions of time. Some occur rapidly, may eventually peak, then recede. Some are very long-term trends.

    For instance, the original great migration of homo sapiens away from Africa into other areas, and some eventually out of those areas into still others, lasted almost 200,000 years.

    It has continued based on other factors related to governance and economics since. Things like war and opportunities to survive or flourish, the drivers of economics.

    Of course in near future times the big driver will be the effects of overserving ourselves cheap energy, over polluting our nests, and following conditions that are somewhere on a scale from less threatening to more comfortable. Global climate change.

    Will those be a big enough issue to sacrifice liberal democracy?

    Personally, I don’t envision our species that dysfunctional.

  23. Sharon, Lester, and others – First, thank you for the link, Lester. I like facts.

    But, it shows multiple factors may be involved, doesn’t show multi-reason constellations, and doesn’t distinguish between in-state and out-of-state. It also doesn’t show demographic changes due to birth and death versus movement.

    Yes, closing factories emptied many cities in the “rust belt” and subservient, non-union workers drew some new factory locations, but that doesn’t address the more recent “anti-woke” movement’s effect in the opposite direction.

    As for new tech hubs, part of the reason that Georgia became “purple” is the migration of the more liberal, more educated workforce for the new jobs. The same is happening in Arizona. Columbus and Raleigh are blue bastions in red states and NC would (and may still) become “purple” if the state government doesn’t destroy their universities.

    Also, the statistics (especially new tech hubs) don’t count voters. When I switched careers to IT, we were afraid that our jobs would be sent to India. Now, I work for an India-based company on a team of nine where I am the only citizen. Some of the Indian workers (or their children) may become citizens, but at the moment I am the only one (and the only one not in California).

    Human behavior is really hard to analyze. I remember when my post-doctoral advisor said he liked DNA sequencing because it gave a clean answer. From what we know now, he was way off the mark. Behavior has even more variables, so we have to be careful about our conclusions.

    Sometimes there is a compromise. My wife want to move someplace warm (TX or FL) and I want to move nearer to family (IL or MI), so we are staying here in Indiana. I used to say “at least it isn’t Mississippi”, but now I can add Florida to that.

    If I hit the lottery, the compromise may be California (warm weather and family). I’m not holding my breath for that.

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