Congress Finally Acts on Rural Commitments, But What’s Next?

Congress Listens to Our Rural Voice

Since Congress irresponsibly let critical rural provisions expire at the end of September, the National Rural Health Association (NRHA) has continuously requested that Members renew their commitment to rural Americans and reauthorize funding for Medicare Extenders and Community Health Centers. Last Friday, after a brief government shutdown, Congress finally acted on their promises to support rural providers and facilities. The Bipartisan Budget Agreement, passed in the early hours of the morning, included a 2-year extension for Community Health Centers, Medicare Dependent Hospitals, Low-Volume Hospital adjustments, rural ambulance payments, Medicare Therapy Caps, and the geographic index floor under the Medicare physician fee schedule. Additionally, the legislation provides for a full ten-year extension of the Children’s Health Insurance Program (CHIP) and 6 billion dollars in additional funding to address the Opioid Crisis. The bill also finally repeals the Independent Payment Advisory Board (IPAB). Though this board was never formally created as a part of the Affordable Care Act (ACA), it could have been devastating for Medicare beneficiaries in rural America. 

For months, we have been told by Congress that they hear our voice, that they are listening to rural America. Finally, we saw action on this promise. It is no coincidence that this legislation passed the same week that more than 400 rural advocates joined us here in Washington, D.C. for the 29th Annual Rural Health Policy Institute to advocate for the needs of underserved rural communities across our country. This is what we can accomplish when we work together to make our rural voice even louder. Now that Congress has acted on its verbal commitment to our most vulnerable populations, rural facilities and providers can get back to work with the certainty they need that these essential programs will remain in place. Now we can finally turn to other priorities that will help improve access to and delivery of local care in rural America.

Rebuild Rural: The Importance of Health Care in Infrastructure

This week, we will receive a budget and further instruction on President Donald Trump’s infrastructure plan. It is essential that we build rural priorities into this massive investment in our nation’s future, and it is even more important that we recognize the special role that health care plays in our country’s infrastructure. This was one of our primary focuses at this year’s Policy Institute. We learned that 200,000 jobs are still lost annually in rural communities, and as a result 749 rural counties experience increasing unemployment. In most rural communities, the hospital is the first or second largest employer, but only if the community still has a hospital. 44% of rural hospitals operate at a loss and 30% operate below a -3% margin. 83 rural hospitals have closed since 2010, and 674 are vulnerable to closure. If all 674 vulnerable hospitals close, we will lose 99,000 direct health care jobs, 137,000 community jobs, and $277 billion in GDP. Per-Capita annual income in rural communities will decrease by $703, while rural employment would increase by 1.6 percentage points. Rural communities have not recovered from the Great Recession the way that metropolitan areas have. We need investments in rural infrastructure, and especially in health care, to ensure the future of our rural communities.

Health care infrastructure is more than just buildings and roads: it is the nurses, doctors, and other providers that care for patients; it’s telehealth services that localize specialty care; and it is community resources that provide jobs and opportunities. NRHA has developed a three-pronged approach to make rural Americans healthy and bring back jobs: include provisions to keep rural hospitals open and co-sponsor the Save Rural Hospitals Act, maintain jobs, and ensure access to care; cut red tape by reforming existing programs to bring grants and funding to the communities that need them most; and improve telehealth and transportation services to increase availability and delivery of care. The President’s Budget, sent to Congress today, will request $21 billion for FY 2019 as part of a 10-year $200 billion investment in infrastructure that is claimed to leverage $1.5 trillion in State, local, and private investment. We only need small investments in rural infrastructure to yield big rural health gains.

The Administration has demonstrated a commitment to eliminating waste and cutting red tape, and we believe that there is a key opportunity to do so here. Many of the programs offered by USDA Rural Development (RD) and other agencies are underutilized or grants are not awarded to those in the greatest need or for whom the grant would provide the greatest benefit. Changes are necessary to help these agencies more aggressively promote and market assistance programs offered to rural communities to ensure these resources are going where they are needed. Applicants for grant and loan applications often complain that the process is inefficient and not business friendly. Hiring expensive consultants should not be necessary to obtain these needed resources. We need to examine changes that can be made to ensure that applications are easy to complete and easy to access, and we must work improve the process to have applications considered more efficiently. We are looking forward to attending two sessions in the coming weeks with officials at USDA RD to discuss how to better serve our rural communities. We will also be meeting soon with other members of the Administration and Congress to discuss the best ways to invest in expansion in opioid-related funds, telehealth services, transportation for individuals in remote areas who are unable to drive themselves, and EMS services which can guarantee care delivery in underserved counties.

We have an incredible opportunity in the coming weeks and months to invest in the future of rural America. We hope that the action we saw from Congress this week will continue, and we will soon be able to work together to rebuild our rural communities.