[Congressional Record Volume 169, Number 196 (Wednesday, November 29, 2023)]
[House]
[Pages H5970-H5975]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                      NATIONAL RURAL HEALTH MONTH

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 9, 2023, the gentlewoman from Hawaii (Ms. Tokuda) is recognized 
for 60 minutes as the designee of the minority leader.


                             General Leave

  Ms. TOKUDA. Mr. Speaker, I ask unanimous consent that all Members may 
have 5 legislative days in which to revise and extend their remarks and 
include extraneous material for the Record.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentlewoman from Hawaii?
  There was no objection.
  Ms. TOKUDA. Mr. Speaker, it is my honor to rise today as co-chair of 
the Bipartisan Rural Health Caucus to commence hosting the Special 
Order hour in celebration of National Rural Health Month.
  Every year, National Rural Health Month is a time for us all to bring 
attention to the unique healthcare needs in rural America and honor the 
incredible efforts of rural healthcare providers, organizations, and 
other stakeholders.
  It has been more than a decade since Congress last had a bipartisan 
coalition focused on promoting and advancing healthcare solutions for 
our Nation's rural and remote communities.
  Sadly, during that time, the prognosis and progress has only gotten 
worse for those who live in rural America. The health and wellness of 
our people has not improved.
  Especially given the divisions in our country and in Congress today, 
we need to find more ways that we can come together around common 
issues and common ground and develop solutions that ensure rural 
Americans do not get left behind.
  That is one of the reasons why earlier this year, I re-launched the 
Bipartisan Rural Health Caucus with my distinguished colleague from the 
great State of Tennessee, Diana Harshbarger.
  Earlier this year, we came together with a shared desire for Congress 
to play a more active role in improving and promoting life and access 
to healthcare in rural America.
  Today, nearly 50 Members of Congress, Republicans and Democrats, have 
joined the Bipartisan Rural Health Caucus, representing rural areas 
across the country from Guam to West Virginia to the Upper Peninsula of 
Michigan down to central Texas.
  Whether political, demographic, or geographic, the diversity of our 
caucus is our strength because rural America is America.
  I yield to the gentlewoman from Tennessee (Mrs. Harshbarger), my 
distinguished co-chair.

[[Page H5971]]

  

  Mrs. HARSHBARGER. Mr. Speaker, I rise today to recognize National 
Rural Health Month and to highlight the work of the congressional 
Bipartisan Rural Health Caucus, which I am proud to cosponsor with my 
colleague, Representative Tokuda from Hawaii.
  Over 60 million hardworking, everyday Americans live in rural 
communities throughout the United States. As my co-chair, 
Representative Tokuda, is fond of citing, nearly 97 percent of our 
Nation is designated as rural.
  Compared to their counterparts living in urban and suburban areas, 
rural Americans experience lower life expectancy, poorer health status, 
and more difficulty accessing quality and affordable healthcare.
  Rural patients face these challenges due to a limited number of rural 
healthcare providers and professionals, higher rates of uninsurance and 
underinsurance, and long journeys to care providers, sometimes lacking 
transportation entirely.
  Having served as a community pharmacist for over 30 years in east 
Tennessee, which is a rural area, I understand the unique healthcare 
challenges and obstacles faced by our patients and healthcare providers 
each and every day.
  It is crucial that Congress takes action to address the issues that 
rural healthcare providers grapple with such as workforce shortages, 
supply scarcities, reimbursement challenges, limited access to 
telehealth, and difficulties ensuring their patients receive the care 
they need.
  The congressional Bipartisan Rural Health Caucus is here to provide a 
forum for Members of Congress to advocate for legislative action that 
will help increase access to quality, affordable healthcare and mental 
health services for all rural Americans.
  As co-chair, I will continue my work to advocate for legislation and 
policies that will ensure long-term sustainability of rural 
communities.
  Earlier this year, I introduced the bipartisan Rural Physician 
Workforce Production Act, which improves Medicare reimbursement and 
enhances the current structure of the Medicare-funded graduate medical 
education program, bringing more medical residents and doctors to rural 
areas in need.
  I also worked with my fellow colleagues from the Tennessee delegation 
to introduce the Rural America Health Corps Act, which would provide 
incentives for healthcare professionals to work in rural health 
facilities in exchange for forgiving medical student loans.
  In addition to these bills, I am a proud cosponsor of the Save Rural 
Hospitals Act, bipartisan legislation that will aid in curbing hospital 
closures in rural communities by ensuring fairness in Medicare hospital 
payments.
  This legislative work is absolutely critical and complements House 
Resolution 870, which I introduced with the majority of the Members of 
the Bipartisan Rural Health Caucus to support the goals and ideas of 
National Rural Health Day.
  National Rural Health Day, the third Thursday of each November, was 
established to honor rural communities and the contributions and 
efforts of rural healthcare providers to address the unique challenges 
faced by the patients they serve.
  Given the aforementioned healthcare disparities faced by rural 
Americans and the continued difficulty experienced by rural healthcare 
providers in keeping their doors open, it is vital that Congress 
prioritizes improved patient care and access in rural areas.
  Our rural healthcare professionals and patients showcase a selfless 
and community-minded spirit. It is altogether fitting and proper that 
we celebrate rural healthcare providers and the millions of Americans 
that rural healthcare providers serve, and to express a commitment to 
advancing policy to improve healthcare accessibility and affordability 
in rural areas in our country.
  Mr. Speaker, I thank Representative Tokuda and my colleagues for 
joining in this cause.
  Ms. TOKUDA. Mr. Speaker, mahalo to my co-chair, Representative 
Harshbarger, for providing leadership and insight for many, many years 
in this particular area and serving on the front line as a pharmacist 
in her own community.
  Mr. Speaker, I yield to the gentleman from Washington (Mr. Kilmer).
  Mr. KILMER. Mr. Speaker, I thank my colleague for yielding.
  Mr. Speaker, 49 years ago in Port Angeles, Washington, I was born in 
what was then called Olympic Memorial Hospital. Over the years, members 
of my family and I received good, quality care from what is now known 
as Olympic Medical Center and its well-trained physicians and nurses, 
and from a staff that genuinely cares about the community.

  The future of healthcare in rural communities faces extraordinary 
challenges that threaten the ability of folks to access the care that 
they need and that they deserve.
  Unfortunately, the reality for many Americans in rural areas when it 
comes to healthcare is a story of gaps and barriers.
  This isn't just a problem for the Olympic Peninsula. Rural 
populations often bear the brunt of healthcare disparities. They are 
usually older, have less income, and often have complex health issues.
  These factors burden rural hospitals, many of which are already 
buckling under pressure. In fact, today the rural hospital closure 
crisis threatens more than 400 rural hospitals nationwide with imminent 
closure.
  For folks on the Olympic Peninsula, quality care should be readily 
accessible, not a service only available in the shadow of the Space 
Needle.
  No matter who you are or where you are from, you ought to be able to 
find quality, affordable medical care close to home.
  This rural-urban healthcare divide is a crisis that demands attention 
from Congress. An important piece of the puzzle is addressing the site 
neutral payment policy, which has significantly impacted rural 
hospitals like Olympic Medical Center.
  This policy, originally intended to equalize payment rates between 
hospitals and outpatient clinics, often disadvantages rural hospitals, 
which rely on higher reimbursement rates to maintain operations and 
provide essential services.
  By advocating for an exemption for rural Sole Community Hospitals 
from this policy, we can ensure these vital institutions receive 
adequate funding.
  In addition, in July I introduced a bipartisan bill known as the 
Rural Hospital Technical Assistance Program. This bipartisan effort 
would provide targeted, in-depth technical assistance to vulnerable 
hospitals and communities struggling to maintain healthcare services.
  That means helping to prevent closures, strengthening essential 
healthcare services in rural communities, and improving financial and 
operational performance.
  Our bill seeks to alleviate the strain felt by many rural providers 
by authorizing new Federal funding to support improvements to these 
crucial facilities, aiming to ensure that everyone, regardless of where 
they live, can stay just as healthy as someone living in a big city.
  Consider the hypothetical, but very real situation, of an older 
patient in Port Townsend who receives chemotherapy multiple times a 
week at Jefferson Healthcare or the pregnant mother in Elma receiving 
prenatal and obstetric care at Summit Pacific Medical Center.
  Without strong rural hospitals, these patients and others may face a 
long and burdensome commute to an urban hospital or go without care 
entirely.
  The Rural Hospital Technical Assistance Program aims to mitigate 
these very real scenarios and keep facilities open and thriving, 
ensuring that everyone can access medical care near home.
  Our bill is important in bridging the gap of healthcare disparities 
that we see every day. It aims to prevent the unfortunate and 
unnecessary closure of rural hospitals and to ensure that folks in 
rural communities receive the care that they need and that they deserve 
without the necessity of long-distance travel or facing financial ruin.
  It isn't just about keeping open facilities like Olympic Medical 
Center in Port Angeles and Peninsula Community Health Services in rural 
Kitsap, Mason, and Pierce Counties.
  It is about keeping people healthy, employed with good-paying jobs, 
and improving care in rural areas where the need is most critical.

[[Page H5972]]

  The Rural Hospital Technical Assistance Program is a commitment to 
equity, a promise of access, and a crucial step toward ensuring that 
going forward, quality healthcare isn't a privilege confined to big 
cities.
  We deserve a future where care is not constrained by geography but is 
easily affordable and accessible for all. Again, I thank my colleague 
for organizing this Special Order.
  Ms. TOKUDA. Mr. Speaker, I yield to the gentleman from California 
(Mr. LaMalfa).

                              {time}  1600

  Mr. LaMALFA. Mr. Speaker, I thank my colleague and friend from Hawaii 
for yielding.
  I would chime in as well on the importance of improving and expanding 
rural health and the challenges faced in the most rural areas of our 
country, including my own northern California district.
  We have several high country hospitals that are out on their own 
pretty much. The connectivity that they need and the challenges that 
pertain to some levels of equality on reimbursements is extremely 
important, so I would be happy to join with Representative Tokuda's 
efforts and that of the Rural Healthcare Caucus.
  Indeed, as we expand and get more and more telehealth opportunities, 
something that has worked pretty well for us in our district is 
teaching health centers; getting young folks as students, and maybe 
young doctors, interested in working in our communities here, as well.
  It just helps extend the opportunities for people that do live in 
these rural areas and don't have nearly the choices. That is part of 
the cost, I guess, of living in a rural area.
  We have done a lot of good work with the USDA, expanding fiber optic, 
getting more and more connectivity. We need to keep doing that in order 
to be more successful for rural America.
  Mr. Speaker, I appreciate this effort, and a bipartisan effort it is.
  Ms. TOKUDA. Mr. Speaker, I say mahalo to Representative LaMalfa, and 
I will extend a great deal of gratitude for helping to guide us through 
a crisis that is hitting rural America far too often, natural 
disasters, as we are seeing it.
  I look forward to also now working with you to make sure that when a 
disaster strikes, our healthcare system will be able to support them 
every step of the way.
  Mr. Speaker, I yield to the gentleman from Pennsylvania (Mr. 
Thompson), who often says ``food is medicine.'' I appreciate his 
guidance and wisdom on this particular issue.
  Mr. THOMPSON of Pennsylvania. Madam Speaker, I thank the gentlewoman 
for her leadership with this bipartisan Rural Healthcare Caucus.
  It is incredibly important and really defines my life. Prior to 
coming to Congress 15 years ago, I spent 28 years working in rural 
healthcare as a nonprofit community healthcare therapist, rehab service 
manager, a manager within rural hospitals, and a licensed nursing home 
administrator. I witnessed firsthand the challenges that individuals 
that live in rural America, rural communities face when it comes to 
healthcare.
  I am acutely aware of the challenges many face when it comes to 
obtaining reasonably priced healthcare. It is especially critical for 
rural America, much like the 15th Congressional District of 
Pennsylvania that I have the privilege of serving today.
  As a Member of Congress representing nearly one-third of the land 
mass of Pennsylvania, one of the most rural districts east of the 
Mississippi, I am keenly aware of the problems my constituents face 
when accessing medical services.
  I always say that when I see rural hospitals in dire challenges, and 
we are struggling with some of that right now in our district, that the 
end results in a commute that can mean the difference between life and 
death to be able to get the services they need within the time frame 
that is required.
  I saw that firsthand, quite frankly, as a volunteer firefighter and 
emergency medical technician for several decades. The importance of 
being able to get from that accident scene or from their home to a 
healthcare setting, a hospital setting in a timely manner, especially 
for those eventually requiring some type of surgery.
  We talk about the golden hour. It is not an hour in many parts of 
rural America. We are facing a healthcare crisis in our Nation's rural 
areas. These often disadvantaged populations are still struggling to 
access affordable, quality care. Many remain uninsured. Most are 
underinsured. However, access to quality care remains the largest 
challenge.
  Even if it is not the bricks and mortar, and we have seen so many of 
those closed over the past 15 years, it is the talent, the skill, the 
expertise within that bricks and mortar, the physicians, the nurses, 
the technicians. It is difficult.
  As someone who used to participate in recruiting this talent into our 
rural hospitals, it is very challenging to get that, to be able to be 
successful with that. That is why I am a big fan of telemedicine.
  I am really excited about the advances that we have made in 
telemedicine over the past decade or so. There is more that needs to be 
done.
  Even when people gain access to health insurance, it does not equal 
access to healthcare. Rural hospitals across the country are closing, 
leaving patients without access to the emergency rooms and long-term 
care facilities. Quite frankly, where they are not closing, they are 
always struggling for staff. If you don't have access to qualified 
healthcare professionals, I don't care how we pay for healthcare, what 
kind of shiny package, what ribbon we put on it, there is no access to 
healthcare without those qualified, highly skilled providers.
  Mr. Speaker, I am proud to work with the gentlewoman as a part of 
this caucus, and proud to be a founding member of the Rural Health 
Caucus. I am proud to work with the gentlewoman as a great member of 
the House Agriculture Committee, where under the Rural Development 
title, we support facilities like nursing homes and rehabilitation 
centers and hospitals and provide communities reasonable funding to be 
able to address that need.
  This is a problem. It is a multidimensional problem that requires 
multidimensional solutions. I think that the formation of this caucus 
is one of the first best starts to address this.
  This bipartisan group will bring awareness to these unique 
challenges, to other members, and actively work to find solutions to 
these problems.

  Ms. TOKUDA. Mr. Speaker, as you can see, we have strong leadership 
across this great country that is making sure that the health and 
wellness of rural America is taken care of. I am so appreciative of all 
the members of our caucus that have stepped forward and stepped up, not 
just now but in so many years past and will definitely be part of that 
leadership going forward.
  Mr. Speaker, it looks like it is a great day for the great State of 
Pennsylvania.
  Mr. Speaker, I yield to the gentlewoman from Pennsylvania (Ms. Wild).
  Ms. WILD. Mr. Speaker, I thank the co-chairs of this caucus for 
forming the Rural Health Caucus, something that is long overdue and 
very much needed.
  Mr. Speaker, this Rural Health Month, I am thrilled to join my 
colleagues in the bipartisan Rural Health Caucus to advocate for 
quality, affordable healthcare in every community. Our neighbors living 
in rural areas face unique health challenges, a substantial one of 
those being medical personnel shortages.
  In the Commonwealth of Pennsylvania, 26 percent of residents live in 
federally designated Health Professional Shortage Areas, meaning that 
nearly one-third of Pennsylvanians live in an area without sufficient 
medical personnel.
  I don't know the last time you went to Pennsylvania, but it is a big 
State. If you are in a part of the State that doesn't have a lot of 
healthcare professionals, you are looking at long drives before you can 
get to a doctor or hospital.
  Preventive care is critical to overall health and well-being, and 
access to preventive care relies upon having an adequate number of 
medical professionals. Having an adequate number of medical 
professionals relies upon not being penalized for serving as a teaching 
hospital.
  It is unbelievable to me that this is a problem that Pennsylvania 
rural hospitals are facing. That is why I

[[Page H5973]]

partnered with Representative Meuser to introduce the bipartisan 
Fairness for Rural Teaching Hospitals Act.
  This bill would allow rural hospitals, including St. Luke's Hospital 
Easton Campus in my district, and St. Luke's Miners Memorial Hospital, 
a stone's throw away, to receive fair reimbursements from the Centers 
for Medicare and Medicaid Services.
  This legislation is critical for allowing our rural hospitals to 
attract, train, and retain talented healthcare professionals to our 
communities.
  I firmly believe that access to high-quality, affordable healthcare 
should not depend on your ZIP Code, and this bill is a step toward 
making that a reality.
  I am so proud to join my colleagues in the bipartisan Rural Health 
Caucus to find ways to ensure that Americans in every corner of our 
Nation have access to the care and resources they deserve. I will keep 
up the work until that mission is fulfilled.
  Ms. TOKUDA. Mr. Speaker, unfortunately, the sad reality is that if 
you are living in rural America, you are more likely to experience 
lower health expectations, lower health quality, and lower life 
expectancy simply because of your ability to access healthcare that you 
need.
  I have sat with constituents in my community of Wainiha who have 
asked me if it was fair that people that live right down the road in 
urban Honolulu live 10 years longer than they do. While at times it may 
seem that they may require more medical attention and care, rural 
Americans often have more access to healthcare because of such things 
as you have heard of today: physician shortages, lack of reliable and 
affordable transportation options, insufficient health insurance 
coverage, and an increased exposure to environmental and occupational 
hazards.
  As a Representative in Congress for one of the most rural and remote 
districts in the country, I know that many of my constituents are often 
just one diagnosis away from a serious illness and the difficult 
financial and family decisions that often come with this.
  Across the country, more than 60 million Americans, about one in five 
Americans live in rural areas. While they make up just 18 percent of 
the total U.S. population, they are scattered, as we have heard, across 
97 percent of our country's land area.
  Rural Americans face numerous health disparities as compared with 
their urban counterparts. Rural Americans are more likely to die from 
heart disease, cancer, unintentional injury, chronic lower respiratory 
disease, and stroke, as compared to their urban counterparts.
  Unintentional injury or death. You heard Representative Thompson talk 
a little about this and the ``golden hour.'' They are more likely, by 
50 percent higher rates, to die in rural areas as compared to urban 
areas often because of their ability to access emergency care when 
involved in a motor vehicle crash or opioid overdose.
  There are so many steps that we can continue to address, but I would 
have us hear from another part of our great country and a rural caucus, 
that of the great State of North Carolina.
  Mr. Speaker, I yield to the gentleman from North Carolina (Mr. 
Davis), another distinguished member of our Rural Health Caucus.
  Mr. DAVIS of North Carolina. Mr. Speaker, I thank the gentlewoman and 
our co-chairs for leading this Special Order.
  Mr. Speaker, I rise on behalf of eastern North Carolina to address my 
highest legislative priority: improving access to healthcare in rural 
America.
  In honor of National Rural Health month, I join my colleagues here to 
speak about how we can fund commonsense bipartisan solutions to the 
most pressing challenges facing our healthcare system.
  Since taking office in January, healthcare has been my number one 
legislative priority, having led, co-led, or cosponsored more than 60 
bills in this space.
  As we are here today, the people of eastern North Carolina are 
hurting, and at the root of this pain is the lack of access to 
healthcare.
  To tackle these health disparities, I joined two colleagues in 
restarting the State Medicaid Expansion Caucus to demonstrate the 
overwhelming public support for basic access to healthcare.
  After more than a decade of waiting, or in some cases dying, over 
95,000 eastern North Carolinians will gain access to lifesaving 
healthcare starting this Friday, December 1.
  As co-chair of the State Medicare Expansion Caucus, I will continue 
leading the charge in Congress to expand Medicaid across the country.
  Beyond Medicaid expansion, I have championed the cause of rural 
hospitals. In the past decade, four rural hospitals in eastern North 
Carolina stopped operations, creating significant barriers to 
lifesaving medical care.
  Martin General is the most recent example of suspending operations in 
the East.
  While we have limited tools at our disposal, especially in 
communities where the payer mix skews toward Medicare and Medicaid, the 
Rural Emergency Hospital Designation Authority is a critical part of 
the solution.
  As eastern North Carolinians grapple with limited access to care, the 
opioid epidemic continues to plague the region.
  To combat this crisis, I introduced bipartisan legislation with 
Congressman   John Rutherford to stem the flow of counterfeit 
substances, including fentanyl, that have flooded the drug market.
  H.R. 4988, the Modern Authentication of Pharmaceuticals Act, will 
come down hard on counterfeit controlled substances by requiring on-
dose identifiers to guarantee the legitimacy of pharmaceuticals. I urge 
my colleagues to support this legislation and put a dent in the 
fentanyl crisis.
  While eastern North Carolinians and Americans across the country 
suffer from opioid addiction, patients recovering from injuries face 
their own barriers to treatment.
  To ensure our most vulnerable patients get the care they require and 
deserve, I will soon introduce legislation to cut red tape for physical 
and occupational therapists, streamlining the delivery of care for 
patients recovering from debilitating injuries.

                              {time}  1615

  If passed, the legislation would ease the burdensome plan of care 
requirements that currently prevent payment for physical therapy 
services until the therapy provider receives a physician-signed plan of 
care within 30 days of a first evaluation. No patient should ever have 
to wait unnecessarily for vital healthcare services, including 
outpatient services.
  As a member of the Bipartisan Rural Health Caucus, you can count on 
me to champion the causes of patients, healthcare workers, and 
providers alike.
  We all have a responsibility in the greatest Nation on Earth to 
deliver a standard of healthcare befitting this greatness.
  Ms. TOKUDA. Mr. Speaker, as you heard, across our country, we have 
strong leadership on rural health, much action to be taken, and many 
opportunities that we need to make sure that we seize.
  We have talked a lot about rural America, from California to 
Pennsylvania to North Carolina. I would like to bring us back to Hawaii 
now. It is the most isolated archipelago in the world, with the nearest 
landmass over 2,300 miles away. I can tell you, it is a long distance, 
given that I travel it pretty much every weekend, crossing that great, 
beautiful, blue Pacific Ocean.
  My district represents all the islands in Hawaii. On our neighboring 
islands, patients often have to fly to Oahu, our main island with 
Honolulu, to get emergency or even routine medical, dental, or mental 
health care. Many Oahu-based providers often spend their weekends, if 
they can even reach the availability of air transportation, traveling 
back and forth between our islands just to try to make sure our 
patients get the medication and services they need to survive.
  I know a lot of people are thinking we have telehealth now, so that 
should be no problem. Again, consider the remoteness of our islands and 
the remoteness of so many of our rural communities. Broadband speed and 
access are not equal everywhere across this great country and our 
territories. Oftentimes, people are just asking folks

[[Page H5974]]

to pick up a phone to be able to triage and immediately start to 
provide care and scrips, which, in many cases, people need because they 
are living in isolated and remote parts of rural America.
  As in many other parts of this country, in Hawaii, we are seeing 
providers, hospitals, and clinics struggle to keep their doors open 
because of high operating costs and insufficient reimbursement rates. 
As was alluded to earlier in this discussion, since 2010, 155 rural 
hospitals have closed their doors, making the difficult decision to 
leave their patients behind.
  Often these patients aren't just patients. These are family members, 
neighbors, and friends. With limited healthcare options and access, we 
know that for many of these individuals, those hospitals, those 
providers closing their doors, it is a life sentence.
  You would think, after these last 15 or so years, that we are out of 
the woods. Well, think again. Over 40 percent of all rural hospitals 
are operating with negative margins and are vulnerable to closure. This 
is on top of the fact that rural communities often have fewer 
healthcare providers. Over 50 percent of rural communities and counties 
have no access to hospital-based maternal care. That means just being 
able to go somewhere to be able to have your child safely. Seventy 
percent are lacking even a single psychiatrist in their county.
  Looking at the stats, when we think about it, just basic physicians, 
general internists, and doctors in rural communities, you have 13.1 
physicians per 10,000 people as compared to 31.2 in urban areas, less 
than half the amount that urban America is able to enjoy.
  When we are talking about specialist care, think of our own 
situations and how often you would need that specialist or a loved one 
has needed a specialist to provide lifesaving care for them. Rural 
America has 30 specialists per 100,000 individuals as compared to 263 
specialists per 100,000 people. We can see the disparity, and sadly, we 
can see the great need that exists in rural America right now.
  High costs have also proven to be a significant barrier. Whether it 
is providing housing for recruiting and retaining healthcare workers in 
our State, covering medical transport via medevac airplane or 
helicopter, considering even the wages of professionals, these are all 
things, as you have heard today, that we have legislative bills we are 
trying to focus on, making sure that these barriers no longer exist and 
reducing the challenges to accessing healthcare in rural America.
  Mr. Speaker, we will soon hear from another great State in this 
country, so let me at this particular time take this back to my home 
State of Hawaii.
  As I mentioned earlier when Mr. LaMalfa came up, we have seen such 
devastation in my district with the Maui fires. The response in the 
wake of this disaster has really highlighted to us the importance of 
making sure we have a strong and robust healthcare system. From 
critical access care personnel and medical countermeasures and 
supplies, you have to have them ready and onsite because in so many 
cases in our rural communities, whether you live on islands or there 
are hundreds of thousands of miles that separate you from the nearest 
access point, help can often be days away.
  At the onset of our fires, I remember our chief of police telling us 
that we have often been told--sadly, now we see it--that if we are in a 
crisis, we are 72 hours away from help. We have to make sure, 
especially when it comes to critical access care and healthcare, that 
we have the supplies and personnel in all of our communities to be able 
to help respond to disaster once she strikes.
  My district also has one of the most racially and ethnically unique 
populations in the country, and these communities often experience, 
sadly, some of the highest healthcare costs and suffer from some of the 
highest health disparities that we see across the country.
  Mr. Speaker, again, one of the wonderful aspects of this caucus is 
that it is both bipartisan and represents all of America.
  Mr. Speaker, I yield to the gentleman from Michigan (Mr. Bergman).
  Mr. BERGMAN. Mr. Speaker, it is so interesting to walk in and wonder 
if you have walked into the middle of something.
  Mr. Speaker, I appreciate the gentlewoman for yielding, and I am 
honored to join my colleagues today in highlighting the accomplishments 
and ongoing challenges facing high-quality healthcare access in rural 
and remote parts of our country. Believe me, it covers a lot of our 
geography.
  Healthcare providers in areas like Michigan's First District face 
unique struggles in maintaining financial stability while providing the 
best possible care, struggles unlike anything facing those in urban or 
suburban regions.
  As a result, we have seen a significant increase in rural clinic and 
hospital closures over the past decade, and many of those still 
operating today are doing so at the razor's edge. A single provider 
closing their doors could result in patients having to travel hundreds 
of miles farther to receive any kind of care.
  While the situation remains serious, we have seen promising 
improvements for rural health, especially when it comes to 
telemedicine. The pandemic underscored the need for and the efficacy of 
telehealth, especially for those in rural areas who would otherwise be 
forced to travel multiple hours just to receive a routine checkup or 
consult with their doctor.
  Congress must act to permanently extend pandemic telehealth 
flexibilities, help providers and their patients get the tools they 
need to utilize telemedicine, and continue to reduce government-imposed 
barriers.
  Let me also highlight the importance of the 340B drug pricing 
program, which provides discounted pharmaceutical products to providers 
that care for a disproportionate share of uninsured and at-risk 
patients.
  In my district alone, we have 20 340B hospitals helping to care for 
our most vulnerable populations. These hospitals provide the best care 
available.
  The 340B program has been a critical component of healthcare for so 
many Michiganders since its inception, and I hope to continue to work 
with my colleagues to ensure its lasting success, especially as the 
program faces new challenges that threaten its integrity.
  I know our rural and remote providers will continue to do everything 
in their power to provide top-of-the-line care to their patients. In 
turn, Congress must continue to address rural health priorities and 
remove the barriers to their success.
  Ms. TOKUDA. Mr. Speaker, you have heard today so many tales of 
tragedy and disparity across our country in rural America, but also 
through the legislation, bills, and advocacy that we have seen from our 
Bipartisan Rural Health Caucus members, so many opportunities for us to 
do good by rural America.
  As I close today, I appreciate all of our Members who have come 
forward to share their stories from across this great country. Let me 
highlight an article that was recently run in The Washington Post that 
focused on the fact that more people in Puerto Rico are dying at higher 
rates because of these healthcare disparities and lack of access to a 
health system.
  As we take a look at the numbers, as we know, Puerto Rico has been 
devastated by natural disasters, compounded by COVID-19 already 
stressing a very strained healthcare system. They are lacking 
professionals in the community to be able to serve their residents. The 
fact is that they only have one working ambulance for 25,000 people in 
a town. Too often, by the time the call is made and the ambulance shows 
up at the home, those people have already passed away.
  The fact is that they had 35,400 deaths last year in 2022 for a 
population of 3.3 million, thousands more than researchers could ever 
have expected, historical highs that they are seeing compounded as a 
result of a strained healthcare system that is unable to take care of 
its people.
  There are stories and examples of veterans who have served and fought 
under our flag that you stand before right there not being able to 
access the critical care or even the basic care that they need, 
deserve, and fought for.
  Too many people are dying as a result of a lack of access to 
healthcare. When we take a look at the numbers, there are disparities 
in terms of increases in Alzheimer's, substance abuse, mental health 
conditions, and chronic health conditions like blood pressure, 
diabetes, kidney failure, respiratory failure--all of these things.

[[Page H5975]]

  To me, when I read this article and all the problems they cite--lack 
of facilities, lack of professionals, too many of the young ones 
leaving their community to go to work in the United States or take on 
other professions--this was a cautionary tale to all of rural and 
remote America that if we don't get our act together soon in our States 
and our territories to make sure that no matter where you live in this 
great country, especially in rural and remote America that makes up 
over 97 percent of this great country's land mass, we will continue to 
see people die.
  The stakes could not be higher when it comes to making sure that the 
Bipartisan Rural Health Caucus continues to stay together and fight for 
those most basic things for every single one of our constituents. No 
matter where you live, no matter what district, each one has a touch of 
rural. We need to make sure that the healthcare access and mental 
health services they need will be there for them when they need it.
  Mr. Speaker, I thank you for allowing us this critically important 
Special Order hour to highlight rural health in our country. I look 
forward to working very closely with all of my colleagues to make sure 
that rural America has the healthcare that they need and deserve.
  Mr. Speaker, I yield back the balance of my time.

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