Senate Finance Committee Holds Hearing to Discuss Rural Health Policy

The National Rural Health Association (NRHA) applauds the Senate Finance Committee for holding a powerful hearing today discussing the state of health care in rural America. The hearing, entitled “Rural Health Care in America: Challenges and Opportunities,” focused on the difficulties providers face in rural communities, as well as the innovative ways in which they are working to ensure continued local care. As Senate Rural Health Caucus Co-Chair Pat Roberts said, this hearing is “long overdue.”
Throughout our country, income and health outcomes are inextricably intertwined, and in rural America poverty rates rise as health disparities grow. A January 2017 Centers for Disease Control (CDC) study found that “the death rate gap between urban and rural America is getting wider.”  The rates of the five leading causes of death — heart disease, cancer, unintentional injuries, chronic respiratory disease, and stroke — are higher among rural Americans, and these trends do not appear to change anytime soon. Nineteen percent of rural Americans are living in poverty, and communities are struggling to return from the Great Recession. The rate of the rural uninsured continues to rise.
Senator Wyden began his opening statement by discussing the 83 rural hospitals that have closed, and the more than 673 that are in “dire straits.”  Forty-four percent of all rural hospitals operate at a loss and one in three rural hospitals is financially vulnerable. Closures of this magnitude will create a national crisis in access to emergency services as well as significantly harm rural economies. Rural hospitals are key pieces of the rural economy: When a rural hospital can keep its doors open, it is often the largest or second largest employer in its community and comprises as much as 20% of the local rural economy. Quality rural health care not only saves lives, it provides jobs, attracts businesses, and reinvests millions back into rural communities.
Often a precursor to a rural hospital closure is the shuttering of the hospital’s obstetrics department. Between 2004 and 2014, more than 200 rural hospitals stopped providing labor and delivery services, placing 18 million reproductive age women at risk. According to a 2017 study from the University of Minnesota Rural Health Research Center, obstetric shortages and closures disproportionately occurred in rural communities with high percentages of low-income and minority mothers. In fact, rural hospitals in communities with higher percentages of African American women were more than 10 times as likely as rural counties with higher percentages of white women to have never had hospital-based obstetric services and more than 4 times as likely to have lost obstetric services between 2004-2014.
To resolve these troubling issues, innovative new health care delivery models are needed in rural America.  Flexible and sustainable models that focus on improving access and population health are a significant part of the solution. As Finance Committee Chairman Senator Orrin Hatch explained at the beginning of the hearing, “One consistent theme we will hear from our witnesses today is flexibility – they want the flexibility to design innovative ideas that are tailored to fit the specific needs of the communities they serve.” We believe that flexibility is key for rural communities, and a “one-size fits all” approach to rural policy is destined for failure.
Three of NRHA’s members testified at the hearing: Dr. George H. Pink, Deputy Director, NC Rural Health Research Program Sheps Center for Health Services Research; NRHA Past President Dr. Keith J. Mueller, University of Iowa College of Public Health, Gerhard Hartman Professor In Health Management and Policy, Director, RUPRI Center For Rural Health Policy Analysis; and Ms. Konnie Martin, Chief Executive Officer of San Luis Valley Health in Alamosa, Colorado. We appreciate the Committee’s work to ensure that the witnesses come from diverse rural health backgrounds, and we were incredibly grateful for their perspectives on the various challenges facing rural communities.
Dr. Pink outlined the long-term unprofitability of rural hospitals and focused on the effects of the closure crisis on communities: “Some convert to another type of health care facility, but more than one half no longer provide any health care services – they are now parking lots or empty buildings. Patients travel an 3 average of 12.5 miles to the next closest hospital, but many travel 25 miles or more. For the old, poor, and disabled who cannot afford or do not have access to reliable transportation, these distances can be very real barriers to obtaining needed care.”
NRHA applauds the Senate Finance Committee for holding this important hearing. We are grateful to the Members of the Committee for their constant commitment to rural America, and we look forward to continuing this dialogue with them about policies to improve rural health care during and after the hearing.

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