National Rural Health Month
Floor Speech
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Ms. TOKUDA. Mr. Speaker, as co-chair of the bipartisan Rural Health Caucus, I am proud to lead my colleagues today in celebrating National Rural Health Month.
With 61 million people, roughly 20 percent of the United States population, living across 97 percent of the country's landmass, delivering healthcare to every corner of America has required unique and innovative approaches and remains an ongoing challenge.
As the primary growers and producers of the food, fuel, and fiber that keeps our country running, rural Americans are also quickly becoming older and more ethnically diverse, dealing with the challenges of keeping up with a world increasingly dependent on broadband activity to support all aspects of life, including healthcare delivery, can be a challenge.
Since 2011, National Rural Health Day has been recognized annually on the third Thursday of November--coming up soon, on November 21--to highlight the dedication of healthcare providers and communities in addressing the healthcare needs of rural Americans.
For those of us representing rural and remote parts of this country, every day is Rural Health Day, as we fight to provide access to even the most basic care services and to work to improve health outcomes and the life expectancy of our constituents.
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Ms. TOKUDA. Mr. Speaker, I will now make remarks about this very important month and some of my own experiences I have had in my district.
Coming out of the pandemic, the health workforce shortage crisis in the U.S. remains one of the greatest challenges to healthcare, and we must take immediate transformational action to address it.
Increasing the number of healthcare professionals is critical to expanding access to care in rural areas and keeping rural hospitals and clinics open, just as my colleague was talking about.
One way to address this issue is by ensuring providers are adequately compensated for their services. The Medicare Physician Fee Schedule is fundamentally broken. The Medicare payment rates have fallen by 29 percent over the last two decades, while the cost of running a practice is estimated to have increased by 3.6 percent.
We need longer-term solutions that provide greater stability and certainty to our clinicians. Congress must pass legislation to stabilize Medicare physician pay so that doctors receive adequate reimbursement to cover the actual costs of providing care, especially in areas of rural America where these costs are higher.
For doctors in my district, I am also advocating for increasing geographic adjustments to ensure provider pay more accurately reflects the uniquely higher cost of healthcare delivery in remote areas like Hawaii.
That is why I am introducing the Protecting Access to Care in Hawaii, or the PATCH Act, which would provide a roughly 24 percent increase in Medicare physician payments to Hawaii physicians so that they receive a similar boost to their counterparts in other remote States like Alaska.
For family physicians like Dr. Michelle Mitchell, higher reimbursements could have made the difference with helping her keep her practice in Hawaii and serving the community she cared for and loved.
From 2008 to 2021, Dr. Mitchell owned Hawaii Family Health in Hilo, Hawaii, where she provided primary care services and offered specialty services, like nutrition intervention and behavioral health to meet the needs of her patients.
However, at the end of the day, after covering her overhead, including paying staff, utilities, and rent, she would only bring home enough money to qualify for food stamps, but she persisted. In an effort to lift herself out of poverty, she started conducting telemedicine visits for patients on the continent where reimbursements were much higher, but this was not sustainable.
In the midst of the pandemic, she left Hawaii and moved to Kansas where she can have a more sustainable practice, leaving behind patients who have struggled to find a new doctor to care for them.
In rural places like Hawaii, we lose too many good doctors, and as a result, too many loved ones who can't get the care they need to survive. Nationally, the United States is facing a shortage of 40,000 to 60,000 physicians, and the shortage is expected to grow to 139,000 physicians by the year 2033.
In my home State alone, the shortage of physicians is 757 statewide, and this is only expected to get worse. Over the past year, we have had 42 physicians retire, 4 have passed away, 55 moved away, and 212 decreased their work. Over 22 percent, nearly a quarter, of our physicians are already over the age of 65, meaning they should be retiring soon, or will be retiring soon. The sad reality is that they can't retire because there are too many lives literally at stake to lose even just one more doctor in Hawaii.
Unfortunately, given the low physician reimbursement levels in Hawaii along with the high cost of living and limited affordable housing options, it remains a challenge just to recruit and retain new physicians to our State and encourage our own, quite frankly, our ``children,'' our ``keiki'', to join the profession too.
That is why it is so vital we fix physician payment models for rural places like Hawaii and to really make sure that we support our rural communities throughout this great country.
For my constituents from the island of Lanai, they say it is difficult to be born and to die in the place that they call home, in the place that they love. That is because of their inability to see the appropriate provider and get the care that they need for their health.
I look forward to working with my colleagues to finally fix our Nation's broken Medicare payment system. When we give our doctors a fighting chance to serve, we give their patients, our constituents, a better chance to live and to thrive.
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Ms. TOKUDA. Mr. Speaker, as you have seen here today, both Democrat and Republican, it doesn't matter which side of the aisle that we may sit and serve on, but at the end of the day, it is about taking care of all of our constituents and everyone that lives in rural and remote America.
Mr. Speaker, 80 percent of rural America is considered medically underserved and faces significant barriers to care, including geographic distances and lack of reliable transportation, fewer healthcare providers and medical facilities, lack of primary care and specialty services, and limited insurance options. As a result of these barriers, rural residents often experience worse health outcomes than their urban counterparts simply because of their inability to access healthcare.
Rural residents have a higher risk of dying early from cancer, chronic lower respiratory diseases, heart disease, stroke, and unintentional injuries. Many of these deaths are absolutely 100 percent preventable.
In my district, Native Hawaiian and Pacific Islanders experience greater rates of heart disease, hypertension, and diabetes, and Asian Americans often experience higher rates of late-stage cancer diagnoses.
To ensure people living in rural and remote communities have access to quality healthcare, we must do more to keep more rural hospitals and clinics open, increase capacity and support for rural providers, and eliminate barriers to care for our rural patients, all things you have heard from my colleagues today.
Before the end of the year, Congress has a long to-do list for rural health. As we go home to celebrate the Thanksgiving weekend, let's keep a few of these important, critical actions in mind for our constituents.
Number one, extending critical rural health programs.
Congress must pass legislation reauthorizing a number of rural health programs that are set to expire at the end of 2024. This includes extending key programs like: The National Health Service Corps, which helps recruit and train aspiring health professionals to rural and underserved areas;
The Community Health Center Program, which supports 1,400 clinics to provide comprehensive health services to more than 31 million Americans, regardless of their ability to pay; and
The Medicare Flex Program, which provides technical assistance to help struggling, small rural hospitals increase quality of care and improve hospital operations. These programs play an important role in strengthening the rural health safety net.
Number two on Congress's to-do list: Safeguarding telehealth.
During the pandemic, telehealth flexibilities allowed providers to care for their patients remotely through the use of a computer or a telephone.
The utilization of telehealth and telephonic care in rural areas has been vital to reducing the challenges and burdens experienced by both rural patients and their providers. That is why we must support extending COVID-era flexibilities beyond 2024 and even making them permanent so that patients can receive timely access to care beyond brick-and-mortar settings.
We must also take action to prevent an impending 3.37 percent reduction in Medicare reimbursements to patients. If Congress does not act this year, Medicare payments will have been cut by almost 10 percent in the last 4 years alone, which is simply unsustainable and could force providers and medical groups to eliminate services, furlough staff, and implement hiring freezes.
Congress must act to ensure Medicare providers have the financial support they need to care for our Nation's seniors in rural America and across this country.
Mr. Speaker, I have a few more points to make, but at this time it is my pleasure to yield the floor to my colleague.
I yield to the gentleman from New York (Mr. Langworthy).
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Ms. TOKUDA. Kelly).
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Ms. TOKUDA. Mr. Speaker, to continue now my long to-do list for Congress that needs to get done by the end of the year for our rural and remote Americans to make sure that they have the healthcare that they need, number three, we need to fund the government for fiscal year 2025.
The House and Senate appropriation bills contain roughly $730 million for grant programs and initiatives that directly address the growing healthcare crisis in rural America.
Rural health discretionary spending is vitally important for preserving and improving access to care for individuals living in rural America. This funding includes resources to support rural hospitals, cybersecurity, including funding to help small, rural hospitals purchase health IT and equipment and address the growing threats on digital patient records. We read about this every single day in the newspaper. They need the support to be able to safely maintain both their health records and take care of their patients.
This funding also includes funding for community health interventions, including to address the various crises facing rural America in maternal health, as we have just heard from our colleague, opioid abuse, and mental health.
That is why I will keep fighting to ensure we pass a final spending bill that preserves increased funding for rural healthcare programs.
Lastly, number four, Congress needs to pass a disaster aid package. Earlier this week, President Biden submitted a request to Speaker Johnson on urgently needing funding to support the Federal response to Hurricanes Helene and Milton and other natural disasters, including the August 2023 wildfires on my island of Maui.
Over the past year, rural communities in the United States have been inundated by several natural disasters, including 17 storm events, 4 tropical cyclones, 1 wildfire event, and 2 winter storms.
In June, New Mexico faced two major wildfires, and Iowa experienced record flooding from the Big Sioux River, which caused mudslides, washed away roads, and required evacuations. In September, Hurricane Helene caused catastrophic flooding, power outages, and property destruction in North Carolina.
Rural communities are on the front lines of natural disasters, which can have far-reaching effects on health and well-being in the immediate aftermath. In the long-term, generationally, it has impacts and trauma that are felt.
Damage to infrastructure caused by storms can compromise emergency response efforts, limit access to basic needs, and disrupt access to necessary healthcare and prescription medication.
Storms can also have long-lasting mental health impacts. That is why it is critical Congress pass a disaster supplemental package this year.
The President's disaster aid request includes a total of $2.7 billion for the Department of Health and Human Services, of which $260 million would be used to support health center infrastructure and ensure continued access to high-quality healthcare services in impacted areas.
This funding request also includes $244 million to expand substance use and mental health prevention and treatment services and $159 million to restore services needed by people with disabilities and older adults.
Across the country, natural disasters have devastated communities, homes, farms, and businesses and disproportionately impacted rural America, which is why I am urging all of my colleagues to support a disaster aid package that addresses both the immediate and long-term needs of impacted rural Americans.
Mr. Speaker, today, you have heard from our colleagues on both sides of the aisle. The bipartisan Rural Health Caucus is now entering its second year and proudly going into its second Congress, having been restarted by myself and Representative Harshbarger, and proudly boasts 64 members on both sides of the aisle and quickly growing.
In closing, I want to reiterate our shared commitment to ensure rural health remains a priority as we wrap up this 118th Congress and head toward the 119th Congress in January.
We will continue working with our colleagues to ensure that we finish our to-do list for rural healthcare this year, continue our bipartisan work in the years ahead, and make sure that every Member of this Congress understands the plight, the need, the challenges, but, yes, the opportunity and the hopes of rural America.
Together, we can and must ensure everyone, regardless of where they live, how much money they have, or their life circumstances, has access to high-quality, affordable, lifesaving healthcare.
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