Alabama has seen eight hospitals close in rural areas since 2011, creating concerns about access to medical services and drawing attention to the state’s refusal to expand Medicaid for poor people.

AL.com asked the 18 candidates – 11 Democrats and seven Republicans – in the race for the 2nd Congressional District about healthcare.

All of the Republican candidates in next Tuesday’s primary responded to our questions. We have responses from 10 of the Democratic candidates in a separate story.

The 2nd District is much different than it was for the last election two years ago, when it covered the southeast portion of Alabama, from the Montgomery area southward.

In October, a federal court approved a map extending the district from Montgomery to Mobile, from the Georgia line to the Mississippi line. Black residents now make up 49% of the voting age population in the district, changing it from a safe Republican district to one where a Democrat could win, potentially becoming the second Democrat and second Black member in Alabama’s seven-member Congressional delegation.

According to the Alabama Hospital Association, the closed rural hospitals include one in the 2nd District, Georgiana Medical Center in Butler County. Another hospital in the district, Monroe County Hospital, stopped its labor and delivery services last year.

AL.com asked the candidates three questions about the top issues and priorities. We will report what the candidates in both parties said on each question. This story is about the Republican candidates’ answers to the first question.

Some of answers have been edited for clarity and brevity. The candidates are listed in alphabetical order.

Question: Rural hospitals, as well as maternity services, have been closing across Alabama. Do you feel healthcare is a critical issue in District 2? And what could you do in Congress to help?

Greg Albritton

Greg Albritton has represented a south Alabama district in the state Senate since 2014. He is a retired officer in the U.S. Navy and was an attorney.

Yes, rural hospitals and rural health care are critical in south Alabama. I have worked on these issues in the Senate and made some progress.

One of the most unfair practices of the current Medicare system is that rural hospitals are paid less than urban hospitals for the same procedure; I would change this unfairness and have the payment be based upon the procedure, not the location. This one change should have a major effect on rural services and economic viability.

Dick Brewbaker

Dick Brewbaker represented a Montgomery-area district in the state Senate for two terms and did not seek reelection in 2018, keeping a term-limit pledge. He owned and operated car dealerships in Montgomery for many years.

Health Care is an issue across the board, but especially in a rural area like congressional district 2, and it will continue to be as long as prices for services continue to rise, and quality of service becomes more scarce depending on where you live.

In fact, we have fantastic health care in each region of the state – Montgomery has two world class hospitals in Baptist and Jackson, University of South Alabama is the largest employer in Mobile County because of their recent acquisition of a hospital system there, and the eastern portion of the district is served by both East Alabama Medical Center in (Opelika) and by the hospitals in Columbus, Ga. We have numerous VA clinics and just about every county has their own hospital.

All of these organizations are hamstrung by red tape, new regulations, Obamacare and being over indexed in administration and under indexed when it comes to qualified physicians, PAs, nurses and even home health aids and the like. Many who seek to become doctors, or work as a healthcare provider, leave areas like our district for schooling, and never come back.

The solution to our issues with healthcare are the same as the solutions to most of our issues as a country: we need to cut red tape and regulations, incentivize investment and job training, and get government out of the way of good people creating and performing jobs and opportunity. Specifically, I would look at removing some current obstacles to qualified individuals who trained out of state from practicing in Alabama, particularly in the area of mental health and particularly if they are willing to practice in underserved areas of the state.

Caroleene Dobson

Caroleene Dobson is an attorney from Montgomery who grew up on a farm in Beatrice, a town in Monroe County.

Healthcare is a critical issue, and Monroe County Hospital, in my home county, is one of the rural hospitals that lost its maternity ward this past year. I want every Alabama family to have access to high quality, affordable healthcare coverage.

Jobs are the most effective way we can ensure Alabamians have proper coverage. The best way we can ensure Alabamians have jobs is through a strong economy. In Congress, I will vote for bills that expand our economy and curb government overspending.

Karla DuPriest

Karla DuPriest is a businesswoman who lives in Mobile and is owner of Chris & Carla’s Heavenly Ribs. DuPriest ran for the Republican nomination for the U.S. Senate in 2022, the race won by Katie Britt.

Yes, (healthcare is a critical issue in the district). Public health in rural areas is complex and underfunded. I would establish a hub-and-spoke model to look into hospitals closures to measure equal risk care.

As with all challenges, partnership and collaboration with public, private, government and nonprofit organizations can address risk appropriate care despite barriers.

(DuPriest said she would promote the use of midwife-led birthing and telehealth.)

Rural hospitals are being forced to close because they’re not paid enough to cover the cost of delivering care to patients and rural areas.

Telehealth services delivered via phone or videos can address some of the limited provider availability in rural areas.

DuPriest also said she would support, “Legislation to address poverty, unemployment, low education and inadequate transportation” because those conditions “are also known to contribute to poor health.”

Hampton Harris

Hampton Harris is an attorney and owns a real estate company in Montgomery.

Healthcare is critical and it is appalling in this district. My grandfather is an Air Force veteran and he cannot get proper emergency care as he needs it because of the failing healthcare system in Montgomery. There is a shortage of doctors and the VA is a mess.

Healthcare must be addressed for everyone and for veterans it is important that congress addresses the care they receive through funding. Veterans have given so much to us and we need to be sure that we take care of them in return.

Stacey Shepperson

Stacey Shepperson grew up in Washington County and is a math instructor at Bishop State Community College and a business owner.

Yes, I do feel healthcare is a critical issue in District 2. Being from a rural area in the district, I know first hand the critical need for access to health care. We have a longer commute just to access services, which is dangerous for someone needing critical care.

Also, for areas with hospitals currently, several are at risk of being shut down right now. These closures will be catastrophic for those communities as it would negatively impact these communities both medically and economically . As your representative, I would work to provide incentives for public-private partnerships in bringing/maintaining hospitals, urgent care or other healthcare providers.

I would also support student loan relief programs for medical doctors willing to practice within rural areas. Lastly, I would seek to collaborate with local leaders on providing medi-mobile services to make basic health care more accessible.

Belinda Thomas

Belinda Thomas is a farmer and business owner and a member of the city council in Newton in Dale County.

Absolutely. (health care is a critical issue in District 2.) Alabama has the third-highest maternal mortality rate and fifth-highest cancer mortality rate in the country. This is unacceptable. I will work to cut through unnecessary government red-tape in order to provide adequate and affordable healthcare options to all Alabamians.

Read more: Key takeaways from GOP candidates forum in Mobile

AL.com staff writers Roy S. Johnson and John Sharp contributed to this report.