Yesterday the Senate passed H.R. 4213, The Tax Extenders Act of 2009.  The bill, which would primarily extend unemployment benefits to jobless Americans, was amended by Senator Max Baucus to include the extensions of the Medicare add-on payments for rural America that NRHA has been fighting for over the past year.  Also included in the bill was the SGR “Doc Fix” a provision that would prevent 21% cuts in Medicare reimbursement for doctors.  Most of the add-on payments have been extended until December 31, 2010 or January 1, 2011 while the “Doc Fix” has is only extended through September 31, 2010 when Congress will presumably work to find a permanent solution to this problem.  H.R. 4213 passed the senate by a final vote of 62-36, garnering the votes of six Senate Republicans.  The bill must now go back to the House of Representatives and be passed as amended by the Senate before it can be signed into law. 

NRHA continues the fight to reinstate serveral crucial Medicare programs that expired at the end of 2009.  If these programs are not renewed it will result in health care access problems in rural America.  NRHA and 13 other health care associations have sent a letter to both Senate and House leadership urging immediate action to reauthorize these important Medicare Extenders. To see the letter please click here.

Today, the President released his health care reform proposal in preparation for the upcoming health care summit.  To see a summary of  the Administration's proposal click here.

The National Rural Health Association (NRHA) is pleased to announce the winners of the 2010 NRHA Legislative Awards, which recognize outstanding leadership on rural health issues by both U.S. Congressional members and Congressional staff. This year's recipients are Chairman Max Baucus, Rep. Earl Pomeroy, Rep. Greg Walden and Congressional staffers Erik Komendant and Hayden Rhudy. Additionally, Chairman Edward M. Kennedy received NRHA's Lifetime Achievement Award. Award winners were honored during NRHA's 21^st Annual Policy Institute in Washington, D.C.

The Senate voted for passage of the Patient Protection and Affordable Care Act at 7am by a party-line vote of 60-39.  The bill must now be combined the the House's Affordable Health Care for America Act in conference and will then be voted on again before it could be ready for the President's signature.  A tentative goal to have the bill on President Obama's desk before the State of the Union address has been discussed, but Congress is on recess until January.

On December 16, President Obama signed into law the Fiscal 2010 Consolidated Appropriations Act, funding the rural health programs for the rest of the fiscal year.  The legislation would provide $446.8 billion in discretionary spending (and $1.1 trillion overall) for the six bills funded by the measure: Commerce-Justice-Science, Financial Services, Labor-HHS-Education, Military Construction-VA, State-Foreign Operations, and Transportation-HUD.

The bill included increases for rural programs of about 7% over FY 2009.

The Office of the National Coordinator for Health Information Technology (ONCHIT) announced Dec. 2 the creation of the Beacon Community Program, which will provide $235 million in grants for HIT incentive payments to eligible providers. The ONC will begin accepting letters of intent to apply for the program, funded through the American Recovery and Reinvestment Act (ARRA), immediately, with the deadline for this set at January 8. Actual grant applications are due on February 1. Awards will be announced in March, with the program's official start set for April.

The Senate has finally released their blended version of the health reform bill, HR 3590. While there are many positive provisions for rural America, NRHA still believes there are additonal steps that need to be taken for health reform to be effective in rural America. The access to care crisis must first be resolved; it does not matter if patients have access to insurance if they do not have access to a provider. To resolve the access to care crisis in rural America, health reform must resolve the workforce shortage crisis in rural areas and eliminate long-standing payment inequities for rural providers. 

Rural America has historically been underrepresented on the Medicare Payment Advisory Commission (MedPAC) despite a statutory requirement for proportional rural representation on its board. Recognizing this inconsistency, Congressman Greg Walden (R-OR) successfully added two amendments to the House Energy and Commerce Committee's markup of H.R. 3200, the House Tri-Committee's original health reform legislation. The amendments were to ensure proportional representation on both the MedPAC board of Commissioners as well as the Health Benefits Advisory Committee proposed in the current bill.

In response to the recent H1N1 (swine flu) outbreak, President Obama and HHS Secretary Kathleen Sebelius have officially declared a national state of emergency, which, among other things, will allow critical access hospitals (CAHs) to file a request to CMS that would temporarily waive the daily limit of twenty-five occupied beds for CAHs.

On Sept. 25, the Senate Finance Committee continued marking up the America’s Healthy Future Act. NRHA scored several victories with the acceptance of rural amendments.

On Aug. 18, USDA rolled out the new rural tour web site to enhance public engagement and share information from the road. There has been such positive reception for the rural tour events that USDA needed an additional way to connect with individuals across the nation. 

Each year the NRHA membership produces a Legislative and Regulatory Agenda that details the policy agenda of the association. As we prepare for 2010, we ask all members to take some time to read the 2009 Agenda and suggest any needed additions, changes or amendments. You can submit these changes via an online form.  Submissions are due September 3.

On July 24, the House passed H.R. 3293, the appropriations bill for the Departments of Labor, Health and Human Services, and Education by a vote of 264 to 153. The bill matched NRHA’s requests for rural programs and also provided increases for other programs important to rural health. Longtime rural champion Dave Obey (D-WI-07), chairman of the House Appropriations Committee, said that the bill “makes vital investments to train people for jobs, shores up health and social safety nets to provide relief for millions of hard-working Americans caught in a struggle for economic survival, and provides the educational opportunities that are critical to the nation’s longer-term prosperity.”

The National Rural Health Association attended the Obama Administration’s Rural Community Health Forum on July 20 in St. John Parish, Louisiana. The forum, which is a part of the larger Rural America Tour, was hosted by four of the Administration’s top secretaries: Kathleen Sebelius, Department of Health and Human Services; Tom Vilsack, Department of Agriculture; Hilda Solis, Department of Labor; and Eric Shinseki, Department of Veterans Affairs. The purpose of this forum was for government officials to hear the perspectives of local residents and discuss solutions to the health care problems our nation’s rural communities face. 

The National Rural Health Association is pleased to express support for Dr. Regina Benjamin, President Obama’s recent selection for the position of United States Surgeon General. Benjamin, a family doctor from the small town of Bayou La Batre, Alabama, is a nominee who brings a wealth of experience working in many facets of health care to this position. As founder, CEO and family physician at Bayou La Batre Rural Health Clinic, Benjamin knows the challenges rural health care providers face and has the skills to help overcome them.

On June 25, Senator John Barrasso (R-WY) and Senator Ron Wyden (D-OR) introduced S. 1355, the Rural Health Clinic Patient Access and Improvement Act of 2009. The bill addresses long-standing underpayments to rural health clinics, introduces a quality improvement program to RHCs, and provides incentives to recruit and retain medical professionals to rural areas.

On June 24, the National Rural Health Association held one of its three annual Government Affairs Committee meetings in Washington, D.C. The timing for the meeting couldn't have been better, with Congress currently debating monumental health reform legislation.

The Senate Health, Education, Labor and Pensions (HELP) Committee began today what is expected to be a three-day hearing to markup its health reform legislation, the Affordable Health Choices Act. NRHA sent comments to Chairman Ted Kennedy (D-MA) and Ranking Member Mike Enzi (R-WY), as well as the other Committee members, commending and suggesting improvements to the bill’s rural health workforce provisions. The letter urges all Committee members to ensure the unique health needs of rural America are not forgotten during the bill's deliberations. 

For a copy of the letter, please click here.

For a summary of the bill, please click here.

For a full text version of the bill, please click here.

Senator Ted Kennedy (D-MA), chairman of the Senate Health, Education, Labor and Pensions (HELP) Committee, released a draft this week of his health reform legislation, the "Affordable Health Choices Act." Included in the draft are strong provisions supporting much-needed rural health services, with increased funding for the National Health Service Corps, Federally Qualified Health Centers, Area Health Education Centers, and the 340B prescription drug program. Additionally, the bill's workforce component (Title IV) provides many improvements to rural America's health care infrastructure, but NRHA believes it can do better to support these crucial services. For this reason, we have provided comments to key HELP Committee members asking for a stronger emphasis on the unique health needs of rural America.

NRHA applauds House and Senate rural health champions for recent comprehensive bipartisan legislative efforts aimed at stabilizing our nation's rural health care infrastructure.  S. 1157, theCraig Thomas Rural Hospital and Provider Equity Act of 2009 (R-HOPE) and the Health Care Access and Rural Equity (H-CARE) Act, soon to be introduced in the House, would correct deficiencies that jeopardize rural health care systems and beneficiaries.

On Wednesday, June 3, legislation was introduced in both the Senate and the House to allow states to waive the mileage designation to grant critical access hospital (CAH) status to hospitals that meet all other criteria. Senators Mark Pryor (D-AR) and Sam Brownback (R-KS) introduced S. 1171, "The Critical Access Flexibility Act of 2009," and Congressman Mike Ross (D-AR) and Congressman William "Mac" Thornberry (R-TX) introduced H.R. 2692, "The CAH Designation Waiver Authority Act of 2009." The legislative language is the same in each bill.

National Rural Health Association, in partnership with AgriSafe Network, the National Association of Rural Health Clinics, the National Association of Rural Mental Health, the National Cooperative of Health Networks, the National Organization of State Offices of Rural Health, and the National Rural Recruitment and Retention Network, has sent a letter to the Chairmen and Ranking Members of the Senate Finance Committee, Senate Health, Education, Labor and Pensions Committee, the House Ways and Means Committee and the House Energy and Commerce Committee to urge them to remember to "champion rural America within Congressional health reform discussions." They also pledge to provide Congress with the data, background information and research that they need to make the case that rural America can lead in health care reform.

To read the letter to Senate Finance, click here.   

The Senate Finance Committee has released three papers summarizing possible options for health system reform, coverage reform and financing reform. Finance Committee Chairman Max Baucus (D-MT) said,“Health care reform must preserve the things Americans like about our health care system, but it must also begin to slow the rapid increases in health care costs that take up more and more of the budget for American families and businesses.” The papers, which summarize a large variety of potential reform mechanisms, are part of Chairman Baucus' and Ranking Member Chuck Grassley’s (R-IA) health reform effort. 

The summaries of the American Recovery and Reinvestment Act of 2009 offered at NRHA's "Accessing Stimulus for Your Community" mini-conference May 5 are now available online.  

For the rural health provisions booklet, click here.

For the full summary,  click here.

On May 7, President Obama released the details of his FY 2010 spending request, including increases to rural health programs. To reflect the president's belief in increasing access to health care and improving the quality of health care in rural areas, the budget includes $73 million for a new "Improve Rural Health Care" initiative. This initiative includes such vital rural health programs as the Rural Health Outreach and Network grants ($55 million), the State Offices of Rural Health ($9 million) and the Telehealth grants ($8 million).

On May 4, the White House Office of Health Reform hosted a Health Care Stakeholder Discussion concerning rural health. NRHA was invited to participate, and President-elect Denny Berens and CEO Alan Morgan represented the Association. Director of the White House Office of Health Reform Nancy-Ann DeParle, HRSA Administrator and former NRHA member Mary Wakefield, and Representatives Ross and Pomeroy met with farmers, ranchers and fishermen to discuss their struggles accessing high-quality, affordable health care in America's rural heartland.

Participants, including NRHA, discussed the high cost of health care and health insurance for small businesses and the independently employed and the challenge of the lack of access to local health care providers in rural communities. They also offered ideas and suggestions on how to reform the health care system.

On April 29, the House adopted the conference reporton the $3.5 trillion budget resolution by a 233-193 vote, with the Senate later agreeing to the measure 53-43. The five-year spending and tax blueprint, which most importantly sets congressional spending and other budgetary limits for fiscal 2010, does not have to be signed by the president. The House and Senate had previously passed their own budget resolutions and reached a compromise on April 27. The budget includes language creating a health care reserve fund intended to serve President Obama's priorities in health reform. It also includes significant increases for Community Health Centers, health professions, and the National Health Service Corps within HRSA.

On April 22, Hilda Heady, NRHA board member and Associate Vice President of Rural Health at the Robert C. Byrd Health Sciences Center at West Virginia University, testified before the Senate Committee on Veterans’ Affairs (VA) on the health care needs of rural veterans.

On April 2, the Senate approved Amendment #799 to the Budget Resolution, S. Con. Res. 13, to create a budget-neutral reserve fund to address the systemic inequities of Medicare and Medicaid reimbursement that lead to access problems in rural areas, including access to primary care and outpatient services, hospitals and an adequate supply of providers in the workforce. The amendment also prioritizes eliminating those inequities as a part of health care reform - a very positive step toward achieving equity for all who call rural America home. The amendment was introduced by Senator Bennet (D-CO) and Senator Roberts (R-KS) and will not only protect the fragile rural health care safety net, it will make health care more accessible and affordable for all rural Americans. After voting on all the amendments, both the House and Senate are expected to adopt budget resolutions later today. 

Graham Adams, NRHA board member and South Carolina Office of Rural Health CEO, testified before the Health Subcommittee of the House Committee on Veterans' Affairs on March 19. Adams recommended ways of closing the gaps in health care for rural veterans. These recommendations included building on current success, collaborating with non-VA facilities, increasing mental health access, targeting care and strengthening the Office of Rural Veterans.

To read the NRHA press release, click here.

To read the full written testimony, click here.