[Congressional Record Volume 169, Number 142 (Tuesday, September 5, 2023)]
[Senate]
[Pages S3871-S3873]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                              Rural Health

  Mr. President, I spent the August recess in my crisscrossing the 
State of Illinois, which was a pretty big operation. One tip to the 
other is about 350 miles and a couple hundred miles across. I tried to 
make a point of not only visiting the population center--Chicago and 
the suburbs around it--but to go Downstate too. My focus Downstate was 
to visit small towns and rural areas and to go to the hospitals and sit 
down with the administrator and ask him what was going on with that 
local hospital.
  The Acting President pro tempore knows this from the State he 
represents. These small-town hospitals are really the lifelines for 
these communities. They are great sources of pride. They are great 
sources of employment. They are there for critical medical care, and 
God forbid you lose one, it really is devastating to a community.
  I found, as I went around the State and sat down with hospital 
leaders and public health officials and other healthcare providers, 
that several messages came through loud and clear. We spoke about the 
struggling rural hospitals, and it applies to the hospitals in the 
urban areas as well. Not only are they lifelines for emergency medical 
care but they are the backbones of the local economies of these 
communities. Nationwide, rural hospitals, in particular, are really 
struggling. Half operate in the red. They are losing money, and more 
than 300 across the Nation are at immediate risk of closure.
  I had a memorable visit to Iroquois County, IL--that is south of 
Chicago, south Kankakee--and I went to the hospital that has been there 
for decades and is a great source of pride. They were really worried 
when they contacted our office that they wouldn't be able to keep the 
lights on in that hospital. So we worked to help them obtain something 
called ``critical access hospital'' status under Medicare. Several of 
the community leaders, when I went there to make the announcement that 
they had been approved, said that we saved the hospital with that 
common effort.
  I have a bipartisan bill with Senator James Lankford. Senator 
Lankford and I are as opposite politically as they come in this 
Chamber. He is a Republican from Oklahoma and is very conservative, but 
he has joined me in extending the lifeline to additional rural 
hospitals that are facing closure. Our bill would create some 
flexibility around the strict Federal definitions that a hospital must 
be literally 35 miles or more away from others to qualify for payment 
designation. Senator Lankford and I believe that characteristics of the 
hospital and its role in the community should also be factors in 
determining eligibility.
  I hope the Finance Committee will take this up now and take it 
seriously. We can save dozens of hospitals nationwide by preserving 
vital access to healthcare for patients in rural areas.
  But my No. 1 takeaway from hospitals in the city of Chicago, in the 
suburbs, and in Downstate was very

[[Page S3872]]

simple. We are facing a dramatic shortage of healthcare providers--
doctors, nurses, dentists, mental health providers, EMTs, and lab 
techs. Across the country, we will face a shortfall of 120,000 doctors 
over the next 10 years. A recent survey found that 100,000 doctors left 
the field during the pandemic and that another 800,000--800,000--are 
planning to retire soon. This is particularly dire in rural 
communities.
  I do want to give a shout-out to Illinois State University, located 
in Bloomington-Normal. They just opened a nursing school in my hometown 
of Springfield, IL. It is called the Mennonite College of Nursing. It 
has a great reputation, and it is going to be a success, I am sure, 
because we need them desperately. They anticipate graduating over 90 
nurses a year. We need them in Central Illinois.

  In every single Illinois rural county--in every one--we face a 
shortage of medical professionals; for example, mental health providers 
and recovery experts. And while there are 90 doctors per 100,000 
residents in the urban parts of my State, in the rural counties, we 
have only 45 physicians for every 100,000. That is 50 percent.
  What is the consequence of this shortage of medical professionals? It 
is very real, and it is very personal.
  We have a new mayor in Carbondale, IL. Her name is Carolin Harvey. 
She worked for Southern Illinois University at Carbondale for her 
working life. She retired there and then went to work on the city 
council and became the mayor.
  I sat down with Mayor Harvey, and I said to her: OK. You have a U.S. 
Senator sitting in your mayor's office in Carbondale, IL. What is your 
ask? Everybody has one.
  She shocked me. Her ask was not for money, and it wasn't for anything 
particular to the community infrastructure. She said one thing: We need 
dentists for children, pediatric dentistry.
  I heard from Shawnee Health, which is the community health clinic in 
her hometown of Carbondale. They treat nearly 50,000 low-income 
patients each year. Just for the record, those are 1,000 a month they 
are treating in this clinic. They recently, after the pandemic, lost 15 
oral health professionals. They have a waiting list of 120 children for 
access to dental care, most of whom are under the age of 8.
  This means that a 3-year-old girl in southern Illinois who has 
trouble sleeping because of severe tooth decay has to wait more than 1 
year for treatment. What does treatment consist of at the end of 
waiting for a year for a little kid? It consists of going into an 
operating room in a hospital, under general anesthesia, and finding a 
medical professional to extract a bad tooth. Think of the complications 
and the drama that are a part of regular oral care in that region.
  Here is another story they shared with me about a
4-year-old boy who had an abscessed tooth. Have you ever had a 
toothache and needed a dentist? Have you had a kid at home who couldn't 
sleep because of a toothache? You won't forget it, Mom and Pop. I 
don't. It is the part of life that you hate to go through. You have as 
much pain as they do in just watching them suffer.
  Now imagine this issue if you will. He is 4 years old. His mother 
tried for months to get him in to a dentist who could relieve his pain, 
but he was unable to see someone. The family was from outside the 
general service area of Carbondale, so they had to travel several hours 
for every appointment. Plus, the mother just couldn't take time off 
work to take her son to all of the appointments. The little boy was 
visibly nervous and afraid, as most 4-year-olds would be, but he was in 
pain, and he knew he needed help.
  After the procedure was completed, the young boy began to cry, and 
the dentist asked him what was wrong. All the little boy could say was 
``thank you.'' Not only was his pain gone but the stressful journeys 
back and forth for the appointments were ending as well. He was 4 years 
old.
  How is this suffering possible in my State of Illinois and in this 
great Nation? Well, first, the United States ranks 43rd in the world in 
the number of dentists per capita--43rd in the world. It is 
particularly outrageous in rural areas. In Illinois, 10 of our 102 
counties have one dentist. In Lawrence County, IL, there is only one 
dentist for 15,000 people--15,000. That is 11 times worse than the 
national average.
  These statistics should ring alarm bells in Washington. Now, I have 
been in the Senate for a few years and was in the Congress for a few 
years before that, and I have said many times that I have to be careful 
when I say I am going to do something about this, but I am sure as hell 
going to try. When I think about that little boy who was waiting for a 
year for dental care, it is unimaginable to me as a father and as a 
grandfather.
  So I am challenging myself, the Illinois delegation, our Federal 
Government, the Illinois State Dental Society, and all of the elected 
officials at this end of my State to come together, to put politics 
over here, and to do something about dental services.
  Mayor Harvey of Carbondale, IL, is right. This is beneath the dignity 
of a great nation to have this sort of thing within our borders.
  Thankfully, there is a Federal program that might help. It is called 
the National Health Service Corps. It provides scholarships and loan 
repayments to doctors, nurses, dentists, and mental health providers 
who work in areas of need. It is the primary Federal program that is 
intended to build a pipeline of healthcare providers and address 
shortages.
  I recently met Dr. Dana Ray, a first-generation college graduate and 
the chief medical officer of Crossing Healthcare in Decatur. She told 
me that the only reason she was able to pursue her career was with the 
loan repayment offered by the National Health Service Corps.
  You see, it costs a fortune to go to medical school or to dental 
school. They literally graduate with debts of $100,000, $200,000 and 
up. Then they have to take a job to pay off their loans. It is obvious. 
Can they go to the areas of great need? They can't get paid as much 
there. The National Health Service Corps makes loan forgiveness part of 
the program. If you will go to a community that needs a dentist, that 
needs a doctor, they will forgive your loan.
  I will make another mention while we are on the subject here. Senator 
Marsha Blackburn of Tennessee and I have a bill. The current National 
Health Service Corps program provides up to $50,000 loan forgiveness if 
you will sign up for 2 years. Well, she and I want to add to that and 
create an incentive for those who do 5 years in a community--and they 
would have up to $200,000 of debt forgiven.
  Why 5 years? We happen to believe that the dentists and doctors who 
will practice in that area for a period of time will develop an 
attachment to it and will start to think in terms of their families and 
their futures there as well so that they will be likely to stay after 
the 5 years is over.
  It is another bipartisan bill. Senator Blackburn is a Republican, a 
conservative from Tennessee, but we see eye to eye on this.
  The National Health Service Corps is the strongest program we have in 
America to tackle the shortages of dentists, doctors, and nurses. The 
Senate HELP Committee is negotiating on this program now. I urge my 
Republican colleagues to join Democrats in doing something.
  Let me add, while we are at it, that there are many health 
professionals around the world who desperately want to come to the 
United States. You know who they are. You see them in the hospitals. 
They are foreign-born physicians, they are medical professionals and 
nurses who come here, and they are there in our moment of need. We have 
a program to do that, but the program is too small, and it doesn't 
allow as many to come to this country who are qualified and ready to 
serve, as it should.
  What does it mean to a hospital in a rural area to lose nurses? Here 
is an example I was given when I visited one of these hospitals.
  They had four critical care nurses. Two of them announced they were 
leaving. Why were they leaving? Because they were going to become 
traveling nurses. They would go to hospitals around the country and be 
paid two or three times as much as they were at this hospital.
  The hospital stepped back and took a look at it and said: If they 
leave, it is going to threaten the future of our emergency room and the 
future of

[[Page S3873]]

many of our departments--these critical care nurses. They offered them 
a generous, generous financial incentive to stay, and they stayed.
  The hospital said it was an easy calculation to make: how much more 
we need to pay in bonuses versus shutting down critical services in our 
hospital for a year because of lack of nurses.
  That is the reality of what hospitals are facing all over the United 
States, not just nurses but many other medical professions.
  While we are at it, I also want to put in a word for the rural EMS 
agencies, the first responders that we all depend on.
  A few years ago, I had a visit from Mark Kennedy. He is an emergency 
medical technician from Nauvoo, IL. In his county, Hancock County, his 
ambulance service is critical. It is life and death to get people to 
their nearby hospital, which is 40 or 50 miles away. He told me about 
challenges that they had with their volunteers, by and large, running 
this agency--this ambulance agency--and keeping up with the equipment 
that is needed to make sure that they could save lives. So I joined 
with then Senator Pat Roberts of Kansas, who was the ranking Republican 
in the Senate Ag Committee that was writing the farm bill.
  I convinced Pat Roberts to look the other way on the question of 
jurisdiction and to put this bill, which we called the SIREN Act, into 
the bill--into the farm bill--as a possible way of helping rural 
communities.
  We have now enacted it into law through Senator Roberts' efforts and 
my own, and we have sent $38 million to emergency medical services 
agencies across America, including many in my State but all across the 
United States. This is an equally important part of medical care and 
our future.
  Now that Senator Roberts is retired, Senator Susan Collins and I are 
doing the bill together, again on a bipartisan basis, to reauthorize 
this program. I ask any Senator who has a question as to whether this 
is money well spent to contact that ambulance service in your own State 
and ask them what it means to have up-to-date equipment to save the 
lives of people that they are called on to help. I hope we can pass it 
out of the Senate this month.
  The solutions to many of our pressing healthcare challenges are at 
hand. The question is whether we can find a bipartisan commitment to 
move them forward. After the month of August, in which I journeyed 
around my State, I sincerely hope that we can.
  I yield the floor.
  I suggest the absence of a quorum.
  The ACTING PRESIDENT pro tempore. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. CORNYN. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.