The heartbeat of rural America

I have had the privilege of serving Kansans from the “Big First” congressional district, a largely rural area, for the last 14 years. My parents are 94 and 95 and still live in my hometown of Plainville, Kan., a town with a population of 1,900. My dad has morning coffee with Keith Unrein, our local pharmacist, and Dr. Sanchez paid a house call on my mom when she slipped and bumped her head a few months back.

This sense of community is what I love about my hometown and other small towns across America and this is why the current healthcare reform debate is so important to me. If we want a future of strong small-town neighborhoods across the country, Congress must address the unique healthcare needs of rural Americans when crafting healthcare reform legislation.

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Small-town communities are built around what I call the “The Basics” — churches, hospitals, pharmacies, long-term care facilities, schools, grocery stores and jobs.  Access to these basics determines whether small towns survive and flourish. If we empower healthcare and other services to become established and to develop, then folks remain in the communities they love and their kids return to the places where they grew up.

As co-chairman of the House Rural Health Care Coalition and co-founder of the Congressional Community Pharmacy Coalition, I have demanded and will continue to demand that Congress consider the unique healthcare needs of rural Americans.  Democratic congressional leaders and President Obama have vowed to pass a comprehensive overhaul of the healthcare system before the August congressional recess. I believe this debate is long overdue, but I am troubled by the rapid pace at which reform legislation is being crafted. Healthcare accounts for 17 percent of our national economy and we should not rush a bill through with so much at stake just to get something passed. Under this arbitrary deadline, I am concerned that rural healthcare priorities will not be sufficiently addressed.

 Rural Americans face a unique combination of factors and challenges that create certain healthcare disparities not found in urban areas. Currently, 50 million Americans live in areas with too few providers to meet their basic primary care needs. At the same time, rural Americans face inherent demographic challenges that place them at even greater odds than our urban counterparts — per capita, most rural populations are older, poorer and sicker. While health coverage is vitally important for these communities, the even greater crisis facing rural America is access to care because it does not do someone good to have an insurance card when there is no medical professional to administer care.

Several reforms are crucial to increase health coverage and access to care for rural Americans. First, we need to adjust Medicare reimbursement levels to ensure that rural healthcare providers are, at a minimum, receiving payments equal to urban provider levels. Demographics show that rural residents display greater inherent health risks and, without adequate reimbursement, these individuals will not have access to the healthcare providers they need. Federal policy should grant states authority to designate qualifying rural hospitals as Critical Access Hospitals, which would provide these facilities with enhanced Medicare reimbursements to improve their financial performance and reduce closures.  Currently, states do not have this designation authority and are unable to help their hospitals adapt to constantly changing circumstances. Additionally, advisory boards that set federal health policy, such as the Medicare Payment Advisory Commission, must include sufficient rural representation to ensure an equitable balance between rural and urban providers.

Second, the medical workforce shortage must be addressed. The National Health Service Corps, a program that incentivizes medical professionals to practice in medically underserved areas through scholarship and loan repayment programs, needs to be expanded. We must support workforce development initiatives to address the shortage of primary care physicians, nurses and other medical professionals, and encourage these professionals to provide critical services to our aging and increasingly medically complex rural population.

Third, we must eliminate health disparities and improve healthcare access for rural Americans. Rural Americans must have access to mental health care, disease prevention and wellness initiatives, and quality, cost-effective home health care and long-term care services. As a member of the House Committee on Veterans’ Affairs Subcommittee on Health, we must also continue to transform our healthcare system to provide these services to our rural veterans who have sacrificed so much for our country.

Fourth, we need to encourage the development of high-speed broadband networks to connect rural hospitals and clinics throughout the nation. A reliable broadband network is required to digitize health records and transmit medical data, which will streamline costs and reduce medical errors. Electronic health records and broadband infrastructure will improve patient care by connecting rural communities with medical specialists in urban areas.

We stand at an important juncture in our healthcare system. It is my hope that we will have a true exchange of ideas and a real debate on the different proposals that will bring some much-needed change to our current system. Rural Americans face a unique combination of healthcare factors and challenges, and rest assured that I will continue to fight to make sure that our children and grandchildren have the opportunity to raise their families in the neighborhoods and communities that many of us call home.



Moran, along with Rep. Earl Pomeroy (D-N.D.), is co-chairman of the Rural Health Coalition, comprised of 151 members from under-served states across the nation. They are committed to advancing rural priorities in healthcare policy.