[Congressional Record Volume 170, Number 171 (Tuesday, November 19, 2024)]
[House]
[Pages H6099-H6103]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
NATIONAL RURAL HEALTH MONTH
The SPEAKER pro tempore (Mr. James). 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.
Ms. TOKUDA. Mr. Speaker, as co-chair of the bipartisan Rural Health
Caucus, I am proud to lead my colleagues today in celebrating National
Rural Health Month.
With 61 million people, roughly 20 percent of the United States
population, living across 97 percent of the country's landmass,
delivering healthcare to every corner of America has required unique
and innovative approaches and remains an ongoing challenge.
As the primary growers and producers of the food, fuel, and fiber
that keeps our country running, rural Americans are also quickly
becoming older and more ethnically diverse, dealing with the challenges
of keeping up with a world increasingly dependent on broadband activity
to support all aspects of life, including healthcare delivery, can be a
challenge.
Since 2011, National Rural Health Day has been recognized annually on
the third Thursday of November--coming up soon, on November 21--to
highlight the dedication of healthcare providers and communities in
addressing the healthcare needs of rural Americans.
For those of us representing rural and remote parts of this country,
every day is Rural Health Day, as we fight to provide access to even
the most basic care services and to work to improve health outcomes and
the life expectancy of our constituents.
Mr. Speaker, I yield now to the gentlewoman from Illinois (Ms.
Budzinski).
Ms. BUDZINSKI. Mr. Speaker, I thank the gentlewoman for yielding to
me. I rise today to celebrate National Rural Health Month and bring
attention to rural healthcare challenges.
In the communities that I am so proud to represent in central and
southern Illinois, independent pharmacies are a lifeline. However, for
too long, predatory drug middlemen, called PBMs, have squeezed
independent pharmacies out of business through their unfair,
anticompetitive practices.
I recently hosted a roundtable, where I heard from several
independent pharmacists throughout my district, including Michelle
Dyer, the owner of Michelle's Pharmacy in Carlinville, Illinois. In
2022, as PBM s consolidated, she was forced to close multiple
locations of her business, leaving three rural towns in Macoupin County
without access to a reliable pharmacy.
Our conversation made clear that we must take action to rein in PBMs,
who have gone unchecked for far too long. We must pass the Pharmacists
Fight Back Act to provide transparency, accountability, and guardrails.
We need to protect independent pharmacists and support the health of
our rural communities.
Ms. TOKUDA. Mr. Speaker, I yield to the gentleman from Kansas (Mr.
Mann).
Mr. MANN. Mr. Speaker, I thank the gentlewoman for hosting this
Special Order hour and for yielding me some time.
This month, Americans celebrate National Rural Health Month, where we
believe every American should have access to quality, affordable
healthcare regardless of their ZIP Code.
The Big First District of Kansas is made up of 60 primarily rural
counties and is home to more critical access hospitals than any other
district in the Nation, several rural emergency hospitals, and a number
of rural health clinics, community health centers, and federally
qualified health centers. This network of care facilities is an
essential pillar for providing everyday health services and lifesaving
care to Kansans.
I am committed to supporting this network and networks like it,
removing red tape that handcuffs providers from providing care to rural
communities, advocating for increase in telehealth services, and
supporting programs that provide a safety net for rural America.
While this still is very much a work in progress, we celebrate the
dedicated rural healthcare workers, hospitals, and service providers
who provide care day in and day out to rural America. We are incredibly
grateful for their service this rural healthcare month and every month.
Ms. TOKUDA. Mr. Speaker, I yield to the gentleman from Michigan (Mr.
Bergman).
Mr. BERGMAN. Mr. Speaker, I am honored to join my colleagues today in
highlighting the accomplishments and ongoing challenges facing access
to high-quality healthcare in rural and remote parts of our United
States.
Healthcare providers in areas like Michigan's First District work
every day to provide the best possible care for patients while
overcoming struggles unlike anything facing those in urban or suburban
areas.
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Unfortunately, we have seen a significant increase in rural provider
closures, and many of those still operating today are doing so at the
razor's edge of financial viability and stability.
In my own district, Aspirus Ontonagon Hospital ended all hospital and
emergency room operations earlier this year and consolidated into a
rural health clinic. A single provider closing their doors could result
in patients having to travel hundreds of miles further to receive
treatment, including lifesaving emergency care.
In 2020, Congress took an important step to address this crisis by
creating the Rural Emergency Hospitals, or REH designation. Under this
designation, rural hospitals receive direct financial support, more
than $3 million annually, and increased Medicare reimbursement in
exchange for maintaining 24-hour emergency departments, as well as
observation beds and other key health services.
However, when Congress created this designation, REHs were not
included as eligible facilities under the 340B drug discount program.
Mr. Speaker, 340B provides significant revenue for critical access
hospitals and other rural providers, helping them improve access to
prescription drugs and essential health services in underserved and
underinsured areas.
This oversight has severely hindered the usefulness of the REH
program and made it less likely for rural hospitals facing potential
closure to keep their emergency departments open.
That is why I introduced H.R. 8144, the Rural 340B Access Act of
2024, along with my colleague from Michigan, Congresswoman Debbie
Dingell. This bipartisan bill will make a commonsense correction and
include facilities under the rural emergency hospitals designation as
eligible for 340B.
This will further our work to stop rural hospital closures and ensure
patients in rural and remote areas can continue to receive essential
emergency care. Our rural and remote health 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 in the way of that future success.
Ms. TOKUDA. Mr. Speaker, I will now make remarks about this very
important month and some of my own experiences I have had in my
district.
Coming out of the pandemic, the health workforce shortage crisis in
the U.S. remains one of the greatest challenges to healthcare, and we
must take immediate transformational action to address it.
Increasing the number of healthcare professionals is critical to
expanding access to care in rural areas and keeping rural hospitals and
clinics open, just as my colleague was talking about.
One way to address this issue is by ensuring providers are adequately
compensated for their services. The Medicare Physician Fee Schedule is
fundamentally broken. The Medicare payment rates have fallen by 29
percent over the last two decades, while the cost of running a practice
is estimated to have increased by 3.6 percent.
We need longer-term solutions that provide greater stability and
certainty to our clinicians. Congress must pass legislation to
stabilize Medicare physician pay so that doctors receive adequate
reimbursement to cover the actual costs of providing care, especially
in areas of rural America where these costs are higher.
For doctors in my district, I am also advocating for increasing
geographic adjustments to ensure provider pay more accurately reflects
the uniquely higher cost of healthcare delivery in remote areas like
Hawaii.
That is why I am introducing the Protecting Access to Care in Hawaii,
or the PATCH Act, which would provide a roughly 24 percent increase in
Medicare physician payments to Hawaii physicians so that they receive a
similar boost to their counterparts in other remote States like Alaska.
For family physicians like Dr. Michelle Mitchell, higher
reimbursements could have made the difference with helping her keep her
practice in Hawaii and serving the community she cared for and loved.
From 2008 to 2021, Dr. Mitchell owned Hawaii Family Health in Hilo,
Hawaii, where she provided primary care services and offered specialty
services, like nutrition intervention and behavioral health to meet the
needs of her patients.
However, at the end of the day, after covering her overhead,
including paying staff, utilities, and rent, she would only bring home
enough money to qualify for food stamps, but she persisted. In an
effort to lift herself out of poverty, she started conducting
telemedicine visits for patients on the continent where reimbursements
were much higher, but this was not sustainable.
In the midst of the pandemic, she left Hawaii and moved to Kansas
where she can have a more sustainable practice, leaving behind patients
who have struggled to find a new doctor to care for them.
In rural places like Hawaii, we lose too many good doctors, and as a
result, too many loved ones who can't get the care they need to
survive. Nationally, the United States is facing a shortage of 40,000
to 60,000 physicians, and the shortage is expected to grow to 139,000
physicians by the year 2033.
In my home State alone, the shortage of physicians is 757 statewide,
and this is only expected to get worse. Over the past year, we have had
42 physicians retire, 4 have passed away, 55 moved away, and 212
decreased their work. Over 22 percent, nearly a quarter, of our
physicians are already over the age of 65, meaning they should be
retiring soon, or will be retiring soon. The sad reality is that they
can't retire because there are too many lives literally at stake to
lose even just one more doctor in Hawaii.
Unfortunately, given the low physician reimbursement levels in Hawaii
along with the high cost of living and limited affordable housing
options, it remains a challenge just to recruit and retain new
physicians to our State and encourage our own, quite frankly, our
``children,'' our ``keiki'', to join the profession too.
That is why it is so vital we fix physician payment models for rural
places like Hawaii and to really make sure that we support our rural
communities throughout this great country.
For my constituents from the island of Lanai, they say it is
difficult to be born and to die in the place that they call home, in
the place that they love. That is because of their inability to see the
appropriate provider and get the care that they need for their health.
I look forward to working with my colleagues to finally fix our
Nation's broken Medicare payment system. When we give our doctors a
fighting chance to serve, we give their patients, our constituents, a
better chance to live and to thrive.
Mr. Speaker, I yield to the gentlewoman from Tennessee (Mrs.
Harshbarger), my co-chair for the Bipartisan Rural Health Caucus, an
amazing individual, and a leader in the field of health and pharmacy.
Mrs. HARSHBARGER. Mr. Speaker, I thank my friend and co-chair,
Representative Tokuda. You know, there is not a whole lot of
difference--there is as far as distance--between Hawaii and Tennessee,
but we have the same health challenges in rural health to be exact.
Mr. Speaker, I rise today to recognize National Rural Health Day and
to highlight the work and cause of the Congressional Bipartisan Rural
Health Caucus, which I am proud to co-chair with my colleague,
Representative Tokuda of Hawaii.
Over 60 million hardworking, everyday Americans live in rural
communities throughout the United States, and as my co-chair,
Representative Tokuda, is fond of citing--with nearly 97 percent of our
Nation being 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 the limited number of
rural healthcare providers; higher rates of people being underinsured
and uninsured, and long journeys to healthcare providers, sometimes
people lacking transportation entirely.
Having served as a community pharmacist in rural east Tennessee for
over 37 years, I understand the unique
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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 and patients grapple with, such as workforce
shortages, supply scarcities, and 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 to work to advance the cause of ensuring
the long-term sustainability of rural communities.
This Congress, I introduced the bipartisan Rural Physician Workforce
Production Act, which improves Medicare reimbursements 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 in 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 school 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. This week, I am pleased
to help introduce with Representative Tokuda and other members of the
Bipartisan Rural Health Caucus a resolution supporting the goals and
ideals of National Rural Health Day.
National Rural Health Day is the third Thursday of every November,
and it 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 healthcare disparities faced by rural Americans and the
continued difficulty experienced by rural healthcare providers in just
keeping their doors open, it is vital that Congress prioritizes
improving patient care and access in rural areas.
Our rural healthcare professionals and patients showcase a selfless
and community-minded spirit, and it is altogether fitting and proper
that we celebrate rural healthcare providers and the millions of
Americans that rural healthcare providers serve.
In recognizing and celebrating National Rural Health Day, we join a
diverse coalition of rural healthcare stakeholders to express a
commitment to advancing policies 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, as you have seen here today, both Democrat
and Republican, it doesn't matter which side of the aisle that we may
sit and serve on, but at the end of the day, it is about taking care of
all of our constituents and everyone that lives in rural and remote
America.
Mr. Speaker, 80 percent of rural America is considered medically
underserved and faces significant barriers to care, including
geographic distances and lack of reliable transportation, fewer
healthcare providers and medical facilities, lack of primary care and
specialty services, and limited insurance options. As a result of these
barriers, rural residents often experience worse health outcomes than
their urban counterparts simply because of their inability to access
healthcare.
Rural residents have a higher risk of dying early from cancer,
chronic lower respiratory diseases, heart disease, stroke, and
unintentional injuries. Many of these deaths are absolutely 100 percent
preventable.
In my district, Native Hawaiian and Pacific Islanders experience
greater rates of heart disease, hypertension, and diabetes, and Asian
Americans often experience higher rates of late-stage cancer diagnoses.
To ensure people living in rural and remote communities have access
to quality healthcare, we must do more to keep more rural hospitals and
clinics open, increase capacity and support for rural providers, and
eliminate barriers to care for our rural patients, all things you have
heard from my colleagues today.
Before the end of the year, Congress has a long to-do list for rural
health. As we go home to celebrate the Thanksgiving weekend, let's keep
a few of these important, critical actions in mind for our
constituents.
Number one, extending critical rural health programs.
Congress must pass legislation reauthorizing a number of rural health
programs that are set to expire at the end of 2024. This includes
extending key programs like: The National Health Service Corps, which
helps recruit and train aspiring health professionals to rural and
underserved areas;
The Community Health Center Program, which supports 1,400 clinics to
provide comprehensive health services to more than 31 million
Americans, regardless of their ability to pay; and
The Medicare Flex Program, which provides technical assistance to
help struggling, small rural hospitals increase quality of care and
improve hospital operations. These programs play an important role in
strengthening the rural health safety net.
Number two on Congress's to-do list: Safeguarding telehealth.
During the pandemic, telehealth flexibilities allowed providers to
care for their patients remotely through the use of a computer or a
telephone.
The utilization of telehealth and telephonic care in rural areas has
been vital to reducing the challenges and burdens experienced by both
rural patients and their providers. That is why we must support
extending COVID-era flexibilities beyond 2024 and even making them
permanent so that patients can receive timely access to care beyond
brick-and-mortar settings.
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We must also take action to prevent an impending 3.37 percent
reduction in Medicare reimbursements to patients. If Congress does not
act this year, Medicare payments will have been cut by almost 10
percent in the last 4 years alone, which is simply unsustainable and
could force providers and medical groups to eliminate services,
furlough staff, and implement hiring freezes.
Congress must act to ensure Medicare providers have the financial
support they need to care for our Nation's seniors in rural America and
across this country.
Mr. Speaker, I have a few more points to make, but at this time it is
my pleasure to yield the floor to my colleague.
I yield to the gentleman from New York (Mr. Langworthy).
Mr. LANGWORTHY. Mr. Speaker, as a proud member of the Rural Health
Caucus, I join my colleagues in celebrating Rural Health Month. I want
to highlight the great work of rural healthcare providers across my
district.
I represent rural communities across western New York and the
Southern Tier, the counties along the Pennsylvania line. Many of my
constituents will tell you that their access to high-quality,
affordable healthcare is a lifeline, whether it is preventive care,
managing chronic conditions, or emergency treatment.
In rural areas, healthcare providers are often the first and
sometimes the only line of defense against serious illness.
One example in my own district is an innovation by Roswell Park
Comprehensive Cancer Center with their mobile lung cancer screening
facility that they call EDDY, which I had the opportunity to tour
earlier this month. This program and vehicle takes healthcare directly
into our rural communities, offering screenings that catch lung cancer
earlier and improve survivor rates.
It is not the large medical centers doing this alone, but community
health centers across my district that are stepping up to fill a gap,
like the Southern Tier Health Care System based in Olean or Schuyler
Hospital in Montour Falls or the Chautauqua Center with locations
across the Southern Tier. There are too many excellent rural healthcare
providers to name them all.
These centers are the cornerstone of rural healthcare, providing
essential services like primary care, mental
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health support, and preventative education to populations that might
otherwise go without care.
I also want to speak to the importance of our community pharmacists.
They play a critical role in rural healthcare. These local pharmacists
are often the most accessible healthcare providers for rural residents
that they have the most access to, offering guidance for everything
from medication to chronic disease management and advice on
appointments.
However, our rural communities and their healthcare providers face
significant challenges. For many families, the nearest hospital or
specialist could be hours away. It makes it difficult and sometimes
impossible to get timely care. At the same time, rural areas struggle
to recruit and retain skilled doctors and nurses and other
professionals, leading to shortages and burnout.
On top of that, many rural hospitals and clinics operate at razor-
thin margins, and too many have been forced to close their doors. When
these facilities shut down, entire regions, counties, and communities
lose access to essential services, forcing residents to travel even
farther for care.
That is why I will always fight for commonsense policies that
strengthen rural healthcare, ensuring that no one is left behind
because of where they live.
I am proud to lead the Rural Telehealth and Education Enhancement
Act, which reauthorizes critical funding for programs that expand
telemedicine and distance learning in rural areas. This bill, which is
included in the House Republicans' farm bill, would invest in new ways
for patients to connect with medical experts, improve access to
specialized care, and enhance health outcomes in our communities.
Mr. Speaker, I thank every single healthcare provider who has
dedicated their time and talents to serving Americans in rural
communities. The work they do saves lives and makes our country
stronger.
Ms. TOKUDA. Mr. Speaker, I yield to the gentlewoman from Illinois
(Ms. Kelly).
Ms. KELLY of Illinois. Mr. Speaker, I rise in recognition of National
Rural Health Month.
Everyone, no matter where they live, deserves access to high-quality
healthcare, but I have heard so many stories from my constituents in
rural areas who have to drive for hours to the nearest hospital or they
don't have reliable internet for healthcare for telehealth.
Today, though, I will share a story celebrating the positive impact
of rural healthcare. This mother and her family thrived because they
had access to obstetric care in their rural hometown.
A local woman from Danville, a town in a rural county of my southern
Illinois community, successfully delivered preterm twins because they
lived by a hospital with a full labor and delivery unit. The mom and
her babies remained at OSF Sacred Heart Medical Center with both of the
babies in a level 2 nursery where they could receive 24/7 care.
The parents were able to spend the maximum time to bond with their
babies while the mom recovered from the delivery. The dad was able to
go to work because the hospital was close to their home. The mom could
be with their newborns and focus on breastfeeding with one-on-one
lactation support.
A nearby medical center was especially valuable to these parents who
had limited resources and the additional challenge of a language
barrier. If OSF Sacred Heart didn't have a birthing center, the mom's
only choice would have been a hospital almost an hour away.
Imagine going into early labor with twins, driving to an emergency
department, and then being told you have to drive even farther. No
mother should have to go through that nightmare. I am so grateful that
this mother was able to safely deliver her healthy babies.
We can hear more success stories when there is a greater access to
maternal healthcare in every corner of our Nation. As co-chair of the
bipartisan Maternity Care Caucus, I introduced the Rural Obstetrics
Readiness Act to support the creation of rural healthcare facilities.
As a healthcare equity champion in Congress, I commit myself to
deploying additional digital tools in Danville, across my district, and
our Nation to supplement rural health in-person care.
Ms. TOKUDA. Mr. Speaker, to continue now my long to-do list for
Congress that needs to get done by the end of the year for our rural
and remote Americans to make sure that they have the healthcare that
they need, number three, we need to fund the government for fiscal year
2025.
The House and Senate appropriation bills contain roughly $730 million
for grant programs and initiatives that directly address the growing
healthcare crisis in rural America.
Rural health discretionary spending is vitally important for
preserving and improving access to care for individuals living in rural
America. This funding includes resources to support rural hospitals,
cybersecurity, including funding to help small, rural hospitals
purchase health IT and equipment and address the growing threats on
digital patient records. We read about this every single day in the
newspaper. They need the support to be able to safely maintain both
their health records and take care of their patients.
This funding also includes funding for community health
interventions, including to address the various crises facing rural
America in maternal health, as we have just heard from our colleague,
opioid abuse, and mental health.
That is why I will keep fighting to ensure we pass a final spending
bill that preserves increased funding for rural healthcare programs.
Lastly, number four, Congress needs to pass a disaster aid package.
Earlier this week, President Biden submitted a request to Speaker
Johnson on urgently needing funding to support the Federal response to
Hurricanes Helene and Milton and other natural disasters, including the
August 2023 wildfires on my island of Maui.
Over the past year, rural communities in the United States have been
inundated by several natural disasters, including 17 storm events, 4
tropical cyclones, 1 wildfire event, and 2 winter storms.
In June, New Mexico faced two major wildfires, and Iowa experienced
record flooding from the Big Sioux River, which caused mudslides,
washed away roads, and required evacuations. In September, Hurricane
Helene caused catastrophic flooding, power outages, and property
destruction in North Carolina.
Rural communities are on the front lines of natural disasters, which
can have far-reaching effects on health and well-being in the immediate
aftermath. In the long-term, generationally, it has impacts and trauma
that are felt.
Damage to infrastructure caused by storms can compromise emergency
response efforts, limit access to basic needs, and disrupt access to
necessary healthcare and prescription medication.
Storms can also have long-lasting mental health impacts. That is why
it is critical Congress pass a disaster supplemental package this year.
The President's disaster aid request includes a total of $2.7 billion
for the Department of Health and Human Services, of which $260 million
would be used to support health center infrastructure and ensure
continued access to high-quality healthcare services in impacted areas.
This funding request also includes $244 million to expand substance
use and mental health prevention and treatment services and $159
million to restore services needed by people with disabilities and
older adults.
Across the country, natural disasters have devastated communities,
homes, farms, and businesses and disproportionately impacted rural
America, which is why I am urging all of my colleagues to support a
disaster aid package that addresses both the immediate and long-term
needs of impacted rural Americans.
Mr. Speaker, today, you have heard from our colleagues on both sides
of the aisle. The bipartisan Rural Health Caucus is now entering its
second year and proudly going into its second Congress, having been
restarted by myself and Representative Harshbarger, and proudly boasts
64 members on both sides of the aisle and quickly growing.
In closing, I want to reiterate our shared commitment to ensure rural
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health remains a priority as we wrap up this 118th Congress and head
toward the 119th Congress in January.
We will continue working with our colleagues to ensure that we finish
our to-do list for rural healthcare this year, continue our bipartisan
work in the years ahead, and make sure that every Member of this
Congress understands the plight, the need, the challenges, but, yes,
the opportunity and the hopes of rural America.
Together, we can and must ensure everyone, regardless of where they
live, how much money they have, or their life circumstances, has access
to high-quality, affordable, lifesaving healthcare.
Mr. Speaker, I yield back the balance of my time.
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