[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.
____________________