[Congressional Record Volume 165, Number 187 (Thursday, November 21, 2019)]
[House]
[Pages H9157-H9159]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                 RECOGNIZING NATIONAL RURAL HEALTH DAY

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 3, 2019, the gentleman from Arizona (Mr. O'Halleran) is 
recognized for 60 minutes as the designee of the majority leader.


                             General Leave

  Mr. O'HALLERAN. Madam Speaker, I ask unanimous consent that all 
Members have 5 legislative days to revise and extend their remarks and 
include extraneous material on the subject of my Special Order.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Arizona?
  There was no objection.
  Mr. O'HALLERAN. Madam Speaker, I rise today in honor of National 
Rural Health Day.
  To mark this important day, my colleagues and I will discuss the 
unique challenges that rural America faces when seeking quality 
healthcare close to home or as close to home as rural America has it.
  I am proud to represent Arizona's First Congressional District in the 
House of Representatives. Our district is actually larger than the 
entire State of Illinois, and it is one of the most rural in the 
country.
  This year, I have held 26 town halls across this vast and diverse 
district. At each and every one I hear from rural residents struggling 
to access quality healthcare, especially emergency care. Many of my 
constituents must spend hours traveling hundreds of miles to access any 
kind of care, let alone specialist care or maternity care.
  Since I was elected, I have worked with my colleagues on both sides 
of the aisle to identify legislative solutions to the issues our rural 
residents are facing. This year I introduced the CHIME Act, legislation 
to extend the Community Health Center Fund and the National Health 
Service Corps for 5 years and increase funding for priority areas.
  Community health centers are critical to serve hundreds of thousands 
of patients every year just in Arizona. In my district, and many rural 
areas, community health centers are often the primary care facility for 
a large portion of the population. If funding for community health 
centers in Arizona were to lapse, just in my district, tens of 
thousands of rural residents would be left without access to critical 
care.
  My language to extend this funding was included in this week's 
continuing resolution, but it is at risk of expiring if we cannot come 
together to fund the government. We need a long-term solution. I will 
continue to work with my colleagues on both sides of the aisle to pass 
this bill into law permanently, so our communities have the support and 
certainty they need.
  Additionally this year, I introduced the GME, graduate medical 
education amendment, to the Lower Drug Costs

[[Page H9158]]

Now Act. My amendment would instruct the Department of Health and Human 
Services to establish a grant program for hospitals in rural and 
medically underserved areas. We must act now to ensure that rural 
communities have the resources they need.
  According to the Association of American Medical Colleges, our 
country will suffer a shortage of over 120,000 physicians by 2032. 
Rural areas will be hit especially hard. We must do what we can now to 
prevent this from happening and to mitigate the effects. My amendment 
would help incentivize doctors to stay and practice in our rural 
communities. We know very well that, when a resident comes to a rural 
community or any other community, there is a higher percentage that 
want to stay in that community after their residency.
  This May, after years of work with stakeholders, community leaders, 
and veterans' advocates, I was able to secure Federal funding for the 
construction of veterans nursing homes in Flagstaff, in my district, 
and Yuma in western Arizona. We found out during that time that you 
can't build a facility like that on Tribal lands, so we have a bill 
that is trying to change that so the many Tribal nations in our country 
and nations like the Navajo Nation that are as big as West Virginia can 
have a nursing center close to the many veterans that they have.
  For too long these rural construction projects were unfairly 
penalized by an outdated VA funding formula that left too many families 
without the help that they deserve.

                              {time}  1315

  We must continue to expand access to healthcare for rural Americans, 
but I know these are merely first steps. There is much work to be done 
and many hurdles that must be crossed before we ensure that our 
veterans, seniors, and families across rural America have access to 
quality healthcare that is close to home.
  Just quickly, rural America is probably tied closer to urban America 
than many people know. But the families who we need there--who supply 
the food, the water, the energy, everything that makes urban America 
survive--won't be there if we don't have people who want to and are 
able to live there.
  That means we have to have good schools, good healthcare, and good 
job opportunities.
  We want our children to move back to rural America, and we will not 
have that if we do not address the appropriate concerns.
  Madam Speaker, I yield to the gentleman from New York (Mr. Brindisi), 
my colleague.
  Mr. BRINDISI. Madam Speaker, I thank the gentleman from Arizona (Mr. 
O'Halleran), my friend, for yielding to me.
  Madam Speaker, I rise in honor of National Rural Health Day.
  I am proud to represent a rural district in upstate New York. These 
are strong communities of hardworking men and women, but too often, I 
hear about the challenges facing these families.
  I recently heard from farmers at a roundtable about the stress of 
losing a farm that has been in the family for generations and the 
barriers to reaching out for help when you are in distress.
  Rural Americans too often face long travel times to access healthcare 
and a lack of adequate resources locally.
  Tragically, the CDC reports that the suicide rate in rural America is 
45 percent higher than in urban areas.
  We need to do better.
  That is why I am proud to work with my colleagues Representative 
Katko and Representative Craig to introduce the Seeding Rural 
Resilience Act. This bipartisan bill will direct more resources to 
reduce the stigma around mental healthcare and help connect farmers 
with available resources.
  It shouldn't matter if you live in New Berlin or New York City: You 
deserve access to quality, affordable healthcare.
  It is time for Congress to act to deliver more access to affordable 
healthcare across our rural communities.
  Madam Speaker, I urge consideration and swift passage of my bill and 
other actions to help address the specific needs of rural Americans.
  Mr. O'HALLERAN. Madam Speaker, I thank the gentleman for his remarks.
  Madam Speaker, I yield to the gentleman from New Jersey (Mr. Van 
Drew).
  Mr. VAN DREW. Madam Speaker, I thank the gentleman for yielding.
  I am honored to be joined by my colleagues today on National Rural 
Health Day to express the importance of rural healthcare across 
America.
  Nearly 57 million Americans, or about one out of five, call their 
communities rural communities, and they call these places their home. 
That includes many residents of my district in south Jersey.
  The State of New Jersey Department of Health defines a rural 
community as an area within the State that has a population density of 
fewer than 500 persons per square mile. Most of these areas tend to not 
only have a lack of healthcare but more need for accessible, affordable 
care.
  The populations in rural communities tend to have more households 
with people over 65 years of age, many of whom live alone. 
Additionally, they have higher rates of suicide, cancer, diabetes, 
asthma, and obesity. Most do not have any health insurance at all.
  We must act on health legislation that not only supports the 
development of community health centers and their accessibility but 
also finds creative ways to support these rural communities. 
Ultimately, we will save their lives.
  It is important that we address these life-threatening rural health 
concerns and foster available and accessible health services for all of 
these rural Americans.
  Mr. O'HALLERAN. Madam Speaker, I thank the gentleman for his 
comments.
  Madam Speaker, I yield to the gentleman from California (Mr. Costa), 
my colleague.
  Mr. COSTA. Madam Speaker, I thank Congressman O'Halleran for leading 
this Blue Dog Special Order on a very important issue affecting rural 
America.
  The Blue Dogs, obviously, represent the breadth and width and 
diversity of our country, but many of us represent rural areas. 
Healthcare for every American is a critical need, a critical issue.
  In 2010, before the Affordable Care Act became law, in the district 
that I represent in California, in the San Joaquin Valley, 22 percent 
of my constituents had no healthcare insurance whatsoever, and 17 
percent were underinsured.
  The Affordable Care Act has a number of areas where we could provide 
improvements if we could get bipartisan agreement, but the fact is that 
we have the ability to protect individuals who have preexisting 
conditions; children can be on their parents' healthcare insurance 
until the age of 25; things have really expanded with Medicaid and 
Medicare; and, what often gets overlooked, $8 billion was provided in 
the Affordable Care Act for rural healthcare clinics across America.
  What does this mean in my district, a district that represents one of 
the richest agricultural regions in the entire country and the world? 
We have gone, in 9 years, from 22 percent underinsured to 10 percent 
underinsured. We have cut the number of people who have no insurance by 
more than half. We have reduced the level of those who are 
underinsured.
  In addition, clinics in my area, Camarena, Livingston, Golden Valley, 
Clinica Sierra, to mention at least four or five, have all expanded 
their rural healthcare clinics to provide more healthcare for people 
who live in rural areas, from prenatal to elderly and everything in 
between.

  In addition, they have done innovative things like other clinics 
across America. They have put healthcare clinics in high schools and 
middle schools, which has provided greater access to healthcare.
  We have made a difference. We have improved the level of healthcare. 
But the reality is this: For three decades, the number of hospitals in 
rural areas in our country has declined at a steep pace. Among the 50 
rural hospitals in California, more than a dozen have closed since the 
early 2000s.
  It also has been devastating not only to the level of healthcare but 
to the residents who live in those communities, hardworking people who 
contribute to our economy every day, part of our farm communities.
  I think it is important to note that for every 1,000 people in the 
place I

[[Page H9159]]

live, we have 0.9 physicians. Anywhere else in California, for every 
1,000 people, there are 2.2 physicians, twice as many physicians.
  While this is an important part of improving healthcare, we also need 
to get medical schools. That is something that I have worked on. I have 
worked on trying to get additional medical schools not only across the 
country but in the San Joaquin Valley.
  We know that if you get a medical school there, it provides an 
opportunity for students who graduate from that medical school to 
practice in the area in which they have graduated.
  We have proof of that. We have residency programs that I have been 
very supportive of with the University of California, San Francisco, 
UCSF, which has over 280 residents who are being trained in the valley 
right now. Over half of those physicians over the last 40 years who 
have graduated from that residency program have stayed to practice in 
our valley. So a medical school is an important part of an overall 
strategy.
  As Blue Dogs, we want to continue to support expanded healthcare 
throughout our rural areas. This is something I believe Democrats and 
Republicans can come together on in a bipartisan manner.
  These are many ways in which we can work to ensure that rural America 
gets reliable, affordable healthcare that they deserve, like every 
other American. That is why Blue Dogs are speaking out on this issue 
today.
  Since taking office, this administration, sadly, has made repeated 
efforts to eliminate the Affordable Care Act without putting anything 
in its place. That makes no sense. That makes no sense whatsoever.
  Just this week, we voted on a continuing resolution to keep 
government open for the next 6 weeks. We should have a real budget in 
place at this time. It is irresponsible to ever, as the President did 
earlier this year, shut down government. But in this continuing 
resolution, we have funding to ensure that our community health centers 
keep receiving the funding they need to stay open and serve their 
patients.
  This year alone, Congress has voted on 10 different proposals to 
improve healthcare and stabilize the Affordable Care Act for American 
families. They are over in the Senate right now. Sadly, instead of 
taking action, Senator Mitch McConnell refuses to bring up these good 
measures.
  We could be lowering the cost of prescription drugs, which affects 
all Americans, whether you live in rural areas or urban areas, and 
ensuring that we protect those who have preexisting conditions, 
preexisting conditions of heart disease, cancer, diabetes.
  These bills, sadly, are collecting dust on the majority leader's 
desk.
  I want to close by saying, as a 15-year member of the Blue Dog 
Coalition, our caucus stands together to try to improve healthcare for 
all Americans.
  For those of us who represent rural America, like Congressman 
O'Halleran, myself, and many others, it is important to note that we 
must improve our healthcare system for the people who live in our rural 
areas.
  It is time for the Senate to do their job and pass these important 
bills.
  We will continue to work to try to expand access to healthcare in 
rural areas with our clinics and to create medical schools in areas 
that are significantly underserved.
  While we continue to patiently ask the Senate to act, I know the Blue 
Dogs will continue to advocate for policies that improve access to 
healthcare for all Americans, especially for those rural Americans we 
represent.
  Madam Speaker, I thank the gentleman for his leadership in this 
important area as the legislative chair for the Blue Dog caucus. The 
citizens of Arizona are fortunate to have a good Representative.
  Mr. O'HALLERAN. Madam Speaker, California is, too.
  Mr. COSTA. Madam Speaker, I thank the gentleman again, and I wish him 
a happy Thanksgiving.
  Mr. O'HALLERAN. Madam Speaker, I thank all of my colleagues for 
joining me to participate in this important show of support by the Blue 
Dog caucus for rural healthcare and access across America today.
  A couple of quick examples: First of all, when you are traveling 
across the country from urban America through rural America, this 
hospital issue, this medical issue, is your issue because the hospitals 
that we have are the hospitals you are going to be taken to. The 
ambulances that have to take an hour or 2 hours to get to the site 
where you are at are the ambulances that you are going to be taking, 
too.
  People on dialysis in rural America, whether it is a Tribal community 
or another community in rural America, some of them have to drive 2 
hours one way to get their treatment and then 2 hours back home. 
Sometimes they do 3 days a week, sometimes up to 4 days a week, sick 
people traveling hundreds and hundreds and hundreds of miles to get 
this type of treatment so they can live.
  Cancer is the same way. Cancer patients have to find a way to get 
that treatment. It is very scarce in rural America.
  Rural communities make up the very fabric of America. Their success 
is our Nation's success.
  I am committed to fighting to improve access to healthcare for rural, 
Tribal, and other underserved communities, for hardworking families and 
veterans who often travel hundreds of miles for basic care.
  As I stated before, my district is rural for the most part, and we 
have 60,000 veterans within the district.
  For rural healthcare to be totally successful, we must improve 
broadband and expand it so that telemedicine is meaningful for the 
people who live in rural areas across America.
  Improving access to care is not a partisan issue. We must come 
together across the aisle and continue to work to identify legislative 
solutions to the barriers our rural residents face.
  Madam Speaker, I yield back the balance of my time.

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