We need a rural health refocus
Despite improvements in the quality and delivery of health care in America, few in Washington comprehend the barriers to care rural Americans still suffer. Across the board, rural Americans face distinct health challenges compared to folks living in urban areas and are often sicker, spend more money on health care costs, and have access to fewer doctors and hospitals. We know this firsthand because we have seen it ourselves. We both grew up in Midwest towns, raised in blue collar families, where access to medicine, a hospital, or even a doctor could hinge on the digits in your zip code.
But these challenges are not a thing of the past. If you have a health crisis in Shannon County, Mo., for instance, you lack 9-1-1 services in your county. Pregnant mothers in Pike County, Ind., must travel significant distances for prenatal care, because there are no obstetric wards, birthing centers, OB/GYN services, or certified midwives in the county. These are today’s painful realities of access to and availability of care in rural towns across our country.
America already spends well over $1 trillion each year on health care and yet rural communities are still facing major health disparities. Addressing these problems requires us to look beyond the financing of health care and explore ways to modernize our health system further so it meets the unique needs of rural America.
A major challenge facing rural communities is access to care. In most cases, people in rural areas must travel long distances to visit a health care provider and many times even farther for specialized care. A 2018 Pew Research study showed that nearly a quarter of rural Americans say access to good doctors and a hospital is a major problem, and that rural Americans on average live nearly twice as far away from a hospital as those in urban and suburban areas.
When the pandemic hit, the Trump administration provided expanded telehealth flexibilities, which enabled nearly 40 percent of adults to utilize telemedicine last year. In fact, the highest rates of telehealth utilization came from those on Medicaid, Medicare, and those earning less than $25,000. In Washington, advancements in telehealth services have been hailed as one of the silver linings of the pandemic, but even with remote access to telehealth services we see rural disparities. Because so many communities lack broadband or smartphone access, many seniors would have been left without access without the Trump administration also allowing reimbursement for audio-only telemedicine. Congress should ensure that such access, when appropriate, remains in place once the public health emergency officially ends.
While telemedicine has greatly benefited remote patients, it is no substitute for access to high-quality providers seeing patients in person. As of this past September, nearly 70 percent of Primary Care Health Professional Shortage Areas were located in rural areas. We know that workers who train in rural areas often return, but we need the right incentives to encourage that investment. Congress should examine the Medicare Graduate Medical Education Assistance programs to make sure medical schools are helping prioritize “rural tracks” that improve representation in rural areas. Congress should also consider how we can streamline and simplify many of the 72 health workforce programs at the U.S. Department of Health and Human Services in order to more efficiently address these shortages.
But just as we believe many in Washington fail to understand the severity of the crisis facing rural health access, we also believe that the answers to these challenges do not lie inside the Beltway. That is why the new incoming House Republican majority will prioritize field hearings around the country to hear firsthand from the folks on the front lines of the problems. We need to hear from providers in West Plains, Mo. and Sullivan, Ind. about why they chose to practice and live where they did. We need to hear from hospitals in Rolla, Mo. and Greene County, Ind. about how they can stay afloat so that rural America does not lose another 180 hospitals, as we have over the last 17 years. We do not need academics and bureaucrats dictating the solutions for our communities — we have experts readily available who have firsthand experience with what works.
Rural America in many ways is the backbone of our nation. These communities harvest the crops we eat and grow the timber that shelters our homes. It is where tens of millions of our fellow Americans call home. As members of the Ways and Means and Energy and Commerce Health subcommittees we can refocus Congress’s attention on the challenges and possible solutions to spur important improvements in the quality and delivery of health care in rural communities across America so patients have an equal shot at better, healthier lives.
Jason Smith represents the 8th District of Missouri and ranking member of the House Budget Committee. Larry Bucshon represents the 8th District of Indiana and is a physician and member of the House GOP Doctors Caucus.
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