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.

On March 11, President Obama signed into law H.R. 1105, a $410 billion appropriations package that includes funding for critical rural health programs. The omnibus includes $53.9 million for rural outreach and network grants, $9.7 million for rural health research/policy, $9.2 million for state offices of rural health and $39.2 million for rural hospital flexibility grants. It also includes $2.2 billion for community health centers, $134.96 million for the National Health Service Corps and $32.5 million for area health education centers, as well as funding for other programs important to rural America. This adds up to a more than $10 million increase over the FY2008 funding levels for the rural health safety net programs alone. NRHA is thrilled to see such strong numbers in support of rural health and will begin now to look forward to the FY 2010 appropriations process. 

On Feb. 26 President Obama released his budget overview, outlining his priorities including a "historic commitment to comprehensive health care reform." According to Obama, "We must make it a priority to give every single American quality, affordable health care... It's a step that will not only make families healthier and companies more competitive, but over the long term it will also help us to bring down our deficit." 

The NRHA is very supportive of funding for critical rural health programs and awaits details on funding for those programs. The NRHA appreciates Obama's recognition of the unique challenges inherent in providing quality health care in rural America and support for the dedicated individuals and programs that ensure that rural Americans receive the care they need. We will continue to advocate on behalf of these programs as the president's final budget is developed. 

On March 4, NRHA CEO Alan Morgan joined U.S. Senators Jack Reed (D-RI) and Michael Bennet (D-CO) for a press conference on the importance of passing a federal spending bill that contains strong funding levels for critical rural health care safety net programs.

On Friday, February 13th, both the House of Representatives (246 to 183) and Senate (60 to 38) passed the final package of a massive stimulus package containing historic levels of spending for rural America.  Previously, both the House and Senate had passed stimulus packages (NRHA summary on the House package / NRHA summary on the Senate package) that were combined in the final conference agreement. The NRHA won a large victory for rural health with the inclusion of $500 million for health workforce training and $1 billion for prevention services, in addition to health information technology incentives for many rural providers.

Earlier today, the Senate voted to approve their version of the stimulus package by a vote of 61-37. The NRHA has worked to advance numerous provisions for the betterment of rural health care in both the Senate and House stimulus bills. Funding included in the House and Senate bills compute to the greatest dollars amounts invested in rural health care and infrastructure in the nation's history.  We are happy to report that the Senate version includes significant financial investment in rural health.

This week the Senate is debating the American Recovery and Reinvestment Act, worth over $850 billion. This bill includes significant investment for rural communities and rural health providers. In fact, the bill provides more money for rural America, dollar for dollar, than any previous federal investment. The NRHA is working with our congressional champions to ensure that the package is fully supportive of rural health, and we will need your help to gain final passage.

On Wednesday, February 4, President Obama signed the Children's Health Insurance Program Reauthorization Act of 2009, surrounded by families whose children rely on the program for their health coverage. President Obama referred to SCHIP as a "lifeline for millions of children" and said that it was a "down payment on [his] commitment to cover every single American." The NRHA has been strongly supportive of the SCHIP reauthorization, as rural children are proportionally more reliant on SCHIP and Medicaid.   

On January 15, the House Democratic leaders detailed a historic $825 billion economic stimulus package, featuring $550 billion in spending and $275 billion in tax breaks. The proposal would provide a total of $124.1 billion for health care programs, including $87 billion to help states with Medicaid costs.  The proposed bill also contains numerous investment projects for rural workforce, IT and infrastructure.  The NRHA anticipates a final stimulus bill in February.

Legislation to reauthorize and expand SCHIP is headed to the Senate floor, after the Senate Finance Committee approved a draft bill by a vote of 12 to 7 on January 15.  This comes one day after the House overwhelmingly voted to pass on the heals of H.R. 2, the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA).  The bill is very similar to two House bills during the 110th Congress, which will cover an additional four million children, that led to Presidential vetoes. 

Tuesday, January 20, 2009 was a historic day in our nation's history. Barack Obama was inaugurated in Washington, D.C. as the 44th President of the United States of America, the third president from Illinois and the first African American to assume our nation's highest office. The NRHA congratulates the President, the first lady Michelle Obama, their children, and Vice President Joe Biden and his family and looks forward to working closely with them and their staffs to improve the health of 62 million rural Americans.

Senator Hillary Rodham Clinton has introduced legislation that would increase investment in the training and education of health care professionals.  The Health Professional and Primary Care Reinvestment Act would expand health care training by improving recruitment and retention efforts and by increasing incentives for health professionals working in community settings, with a strong focus on rural needs.    

NRHA submitted questions on issues important to the rural health community to the candidates for President of the United States. This week, Sen. Obama sent NRHA his response. His responses are available by clicking on the full story link. Sen. Obama also sent a letter last week to attendees of the Rural Health Clinic and Critical Access Hospital conferences. If NRHA receives a response from Sen. McCain, his answers will be posted as well.

Both the House and Senate have passed legislation that will prevent group health plans from charging higher out-of-pocket costs and applying stricter treatment limits for mental health care than any other medical care. However, because the House and Senate used different legislative vehicles to pass the bill, final enactment of the bill is not assured. Congress must still take the final steps necessary to send the bill to the president for his signature. Fortunately, President Bush, business groups, insurance companies and mental health advocates all support the measure. The bill passed both houses overwhelmingly, and we expect that it will be enacted.

Thanks to the support of Congressional champions and our longstanding partners, the NRHA was able to secure the inclusion of language correcting a technical issue impacting most rural health clinics (RHCs) that could pass the Senate as soon as today and the House by early next week. The bill is the overall Health Care Safety Net Act (H.R. 1343) that includes Community Health Centers, the National Health Services Corps and Rural Health Outreach Grants. We still need your help to assure passage of these vital programs and that Congress and the Administration support additional RHC issues.

The NRHA applauds the passage of S. 901, the Health Care Safety Net Act which provides $12.9 billion dollars for rural and medically underserved areas. On July 22, the U.S. Senate unanimously passed S. 901; the House of Representatives earlier passed a similar bill. The act reauthorizes and strengthens three programs which together provide a safety net will help millions of rural Americans each year access needed health care services.

On July 23, Wayne Myers of the Maine Health Access Foundation testified on behalf of NRHA before the House Agriculture Subcommittee on Specialty Crops, Rural Development and Foreign Agriculture. The hearing was held to explore rural health disparities and found that critical telecommunication and work force challenges contribute to greater disparities in access to health care in rural areas. Subcommittee Chair Mike McIntyre (D-N.C.) said, "With limited dollars available for rural health care programs, we must ensure they are used in ways that address the challenges and with sufficient federal coordination." Dr. Myers discussed the importance of quality health care in rural America to both the community's citizens and the community's economy.

On the same day President Bush vetoed H.R. 6331, Congress overwhelmingly overrode that veto. The House of Representatives voted 383-41 and the Senate voted 70-26. Both the House and Senate had more votes to override the veto than were originally cast to send the bill to the president. The NRHA strongly supported passage of the bill, which provides nearly $2 billion critical dollars to rural America and eliminates the pending 10.6 percent cut in Medicare payments to physicians through December 2009.

Today, President Bush vetoed H.R. 6331, the Medicare Improvements for Patients and Providers Act of 2008. The legislation had previously passed both the Senate and the House with overwhelming support. H.R. 6331 would provide $2 billion in needed rural health care dollars and temporarily eliminate the 10.6 percent cut to Medicare reimbursement rates for physicians. Overriding the veto will require a two-thirds majority in both the House and Senate. The NRHA needs your immediate help to ensure that this bill will become law.

On June 26, the Senate failed to act on H.R. 6331, the Medicare Improvements for Patients and Providers Act of 2008, which would have halted the scheduled 10.6 percent payment cut and extended a number of vital rural provisions that approximately totaled $2 billion over 18 months.The vote to close debate failed by a single vote. The NRHA was disappointed by the Senate's inability to pass Medicare legislation before the July 1 deadline.

On June 24, 2008, the House of Representatives passed H.R. 6331, The Medicare Improvements for Patients and Providers Act of 2008, by a vote of 355 to 59. The NRHA endorsed this bill as it provides a number of improvements for rural seniors and providers.  Now the Senate must act.  Read on to find out how you can help rural health.

Providers paid under the Medicare physician fee schedule will receive 10.6 percent payment cuts on July 1st if Congress does not act. Both the House and Senate are working frantically to provide a package that will protect providers from this payment cut. On June 20th, NRHA staff met with House Democratic leadership on a proposed Medicare package. This comes as Senate Democrats and Republicans work on their own compromise package.

On June 18, after a long journey, the Senate voted 80 to 14 to override the President's veto of the Food Conservation, and Energy Act of 2008, the "Farm Bill." Earlier in the day, the House also voted to override the President's veto by a vote of 317 to 109. The Farm Bill is now officially law. 

On June 11, Senate Finance Committee Ranking Member Charles Grassley (R-IA) introduced the "Preserving Access to Medicare Act of 2008". The bill contains provisions to prevent rural providers from receiving the cuts in Medicare reimbursements scheduled for July 1. Several other provisions critical to rural America are also contained, but Congress must do more. 

On June 6, Senate Finance Committee Chairman Max Baucus (D-MT) introduced S. 3101, the “Medicare Improvements for Patients and Providers Act of 2008.”  In addition, on June 11, Senator Charles Grassley (R-IA) is introduced a similar bill, “Preserving Access to Medicare Act of 2008.” Both bills contain provisions to prevent rural providers from receiving the cuts in Medicare reimbursements scheduled for July 1.

May 2, 2008 - Senate and House negotiators announced today that they have reached a comprise on a new Farm Bill. Staff for the Senate and House agriculture committees and for conferees will continue to work on finalizing a few remaining issues and obtaining official budget scoring from the Congressional Budget Office, but the main issues have been agreed to. The completed legislation will have to be approved by both the Senate and House before being sent to the White House.

On April 23rd, the House of Representatives passed, by a veto proof majority of 349 to 62, legislation that prevent states from losing billions in federal dollars by placing a one-year moratorium on seven new Medicaid regulations. Earlier this week, the Bush Administration issued a formal veto threat against the legislation. The legislation moves to the Senate where its fate is less certain as it is not clear whether the votes are there to overturn a Presidential veto.

On March 13, Paul Moore testified on behalf of the NRHA before the House Appropriations Committee, Subcommittee on Labor, Health and Human Services, Education and related agencies on the rural health safety net, a group of programs that strengthen and build upon our rural health delivery system.

NRHA Board Member Brock Slabach testified on May 22, 2007 before the powerful U.S. House Ways and Means Subcommittee on Health that the growth of Medicare Advantage Private Fee-for-Service plans (PFFS) in rural America may negatively effect rural providers and Medicare beneficiaries. Mr. Slabach outlined several of the NRHA's concerns that Medicare Advantage PFFS plans harm rural seniors' access to care, including concerns that such plans often reimburse providers at rates far lower than under traditional Medicare, that the plans are often confusing, can contain gaps in coverage, and are sold with questionable marketing tactics.