House Agriculture Committee Releases 2018 Farm Bill
Just this afternoon, the House Agriculture Committee Majority Staff released the 2018 Farm Bill, legislation that is required every four years to reauthorize critical programs in agricultural, health, trade, and food policy. There are many programs and opportunities for rural health included in this legislation, and in the months leading up to the release of the legislation, NRHA’s Government Affairs Team met with key staff and other advocacy organizations to ensure the future of these programs.
Rural America encompasses more than 90% of the nation’s land area, houses 46 million residents, and 20% of our nation’s population. Rural communities make up just 3% of job growth since the Great Recession, and many rural areas continue to see increasing unemployment. In 1980, 70% of rural Americans living in poverty were employed, but today less than 50% of the rural poor are working. Rural hospitals and providers are a critical part of the rural community, and often are the backbone of the rural economy. 83 rural hospitals have closed since 2010, and 673 are vulnerable to closure. If the 673 vulnerable hospitals closed, rural patients would need to seek alternatives for 11.7 million hospitals visits, 99,000 health care workers would need to find new jobs, and $277 billion in GPD would be lost.
According to the American Farm Bureau, 2.1 million farms, many of which are family owned, span across America’s rural landscape. Farms are also a crucial part of the rural economy, and rural farmers have unique and specific health care needs. The Farm Bill is so much more than just a vehicle for policies related to farm subsidies, commodities, and trade, and rural America has many communities without a single farmer. As we have discussed recently, the Office of Rural Development at the United States Department of Agriculture (USDA) has played a critical role in developing programs to address the opioid crisis and advance the use of telemedicine. USDA Rural Development operates more than 50 financial assistance programs for a variety of rural applications designed to enhance rural communities and economic growth. The Farm Bill is a critical piece of legislation to help all rural Americans, regardless of occupation or location, and an opportunity for us to advance innovative reforms.
Prioritizing Projects to Meet Rural Health Crises in Rural America
Title VI, Rural Infrastructure and Economic Development, is the section of the bill that includes USDA funding for important rural health programs. The first Subtitle is Improving Health Outcomes in Rural Communities, and under that Section 6001, Prioritizing Projects to Meet Rural Health Crises in Rural America includes four programs for rural health:
a) Temporary Prioritization of Rural Health Assistance
This piece amends the 1972 Farm Bill to allow the USDA Secretary to announce a temporary reprioritization of rural development loan and grant applications to assist rural communities in responding to a specific health emergency. The Secretary will have to submit the justification of this prioritization and the treatments for the crisis to the Agriculture Committee and the Secretary of the Department of Health and Human Services. The Secretary can extend the declaration if necessary.
b) Distance Learning and Telemedicine (DLT) Grants
These grants, available in a range of $50,000 to $500,000 may be used for the acquisition of eligible capital assets, such as audio, video and interactive video equipment; terminal and data terminal equipment; computer hardware, network components, and software; and distance learning and telemedicine infrastructure. In the 2018 Farm Bill, for DLT Grants, a reprioritization of funds not less than 10% of the grants to be used for telemedicine services to identify and treat individuals affected by the emergency. The 2018 Farm Bill authorizes funding for $82,000,000 from 2019-2023, an increase from the 2014 Farm Bill which authorized $74,000,000.
c) Community Facilities Direct Loans and Grants
These grants, low interest direct loans, and loan guarantees may be used to purchase, construct, and/or improve essential community facilities, purchase equipment and pay related project expenses. Examples include health care facilities such as hospitals, medical clinics, dental clinics, nursing homes or assisted living homes; public safety services; and utility services such as telemedicine. The 2018 Farm Bill text allows for the reprioritization of these funds in an emergency to ‘‘(i) to develop facilities to provide services related to reducing the effects of the health emergency, including— ‘‘(I) prevention services; ‘‘(II) treatment services; ‘‘(III) recovery services; or ‘‘(IV) any combination of those services; and that employ staff that have appropriate expertise and training in how to identify and treat individuals affected by the emergency.”
d) Rural Health and Safety Education Programs
Few changes are made for these programs, but we are pleased to see that they are reauthorized.
The Farm and Ranch Stress Assistance Network
Under Section 6003, the Farm and Ranch Stress Assistance Network, is reauthorized for such sums as are deemed necessary. NRHA recently supported the STRESS Act, introduced by Rep. Tom Emmer (MN-06), and we appreciate the work of the Agriculture Committee to continue this program.
For those in rural areas seeking mental health services, they face two giant obstacles: availability and accessibility. In 55% of all American counties, most of which are rural, there is not a single psychologist, psychiatrist or social worker. The Farm and Ranch Stress Assistance Network (FRSAN) could help support agricultural workers and their families in rural communities by providing easily obtainable resources for mental health services.
Agricultural Association Health Plans
Section 6004 of the subtitle allows the USDA Secretary to create a loan program and a grant program to assist in the establishment of agricultural association health plans. These plans are sponsored by a qualified agricultural association. This may bring additional health care plan options to rural communities through a variety of organizations. The Secretary is not allowed to make more than 10 loans under the rules of the section and may only provide grants to agricultural trade associations or industry associations which have been in existence for at least three years prior to applying for the grant.
More Is Needed For Rural America
While this legislation provides funding for key programs for rural communities, more is necessary in order to support our rural economy and improve rural health. Innovative programs and provisions in the case of an emergency will help our must vulnerable communities, but there are additions that we need to make to ensure the healthy future of rural America.
In February, Congresswoman Cheri Bustos (IL-17) and Congressman Doug LaMalfa (CA-01) introduced a bipartisan bill that would designate a Rural Health Liaison at the U.S. Department of Agriculture (USDA), who will act as a direct point of contact at the USDA for questions related to health care in rural communities and for the streamlining of rural health programs. We would like to see the creation of this position at USDA included in the 2018 Farm Bill to improve the coordination of rural health programs at the USDA and HHS. As Congresswoman Bustos explained at the 2018 Policy Institute, “The USDA has the ability to finance the construction of hospitals and the implementation of programs for telehealth and health education. The Rural Health Liaison would promote the awareness and availability of these resources, and provide guidance and technical assistance to USDA field offices and staff on how to best serve their communities.”
Additionally, Congresswoman Cheri Bustos (IL-17) introduced the Addiction Recovery for Rural Communities (ARRC) Act with Congressman Rick Crawford (AR-01), Roger Marshall (KS-01) and Dwight Evans (PA-02) – all members of the House Agriculture Committee. Senators Joe Donnelly (D-IN) and Pat Roberts (R-KS) also introduced companion legislation in the U.S. Senate. As we noted above, the 2018 Farm Bill includes provisions for at least 10% of Distance Learning and Telemedicine Grants to be set aside for an emergency – possibly for something like the opioid crisis.
The Addiction Recovery for Rural Communities Act would set aside at least 20% of Distance Learning and Telemedicine Program grant funding for substance abuse treatment. It would also prioritize USDA Community and Facilities Direct Loan and Grant applications concentrated on substance use disorder prevention, treatment and recovery services, and would prioritize USDA Rural Health and Safety Education grant funding for applicants seeking to improve education and outreach substance use disorder issues. We ask that the Agriculture Committee ensure that all of these key provisions are included in the final 2018 Farm Bill.
Finally, Finally, NRHA would like the Committee to consider the creation of an emergency hospital fund under Title VI, Section 6001 (A) Temporary Prioritization of Rural Health Assistance. When a rural community is faced with the closure of the hospital the community often looks for resources to keep that essential point of access to care. Members of Congress begin to examine potential resources to help keep the hospital open. This emergency funding would be available for hospitals facing eminent closure. USDA has experience with working with keeping struggling hospitals from closing through their rural development program, which is at times faced with borrows struggling to pay back their loans. This same expertise, coupled with available funding and loans, can be used to help struggling hospitals to keep their doors open to continue to serve their communities. We urge the committee to create a grant and loan program in order to prevent further closures of rural hospitals and ensure continued community based care for small rural and remote communities.