Save Rural Hospital Act needs your help: Urge your representative to sign on as a co-sponsor today

The National Rural Health Association encourages you, and all rural health leaders across the country, to contact their member of Congress and urge them to cosponsor HR 3225, the Save Rural Hospitals Act.

Members of Congress are home in their districts for the next two weeks, so now is the time to reach out to them.

HR 3225 will stop the flood of rural hospital closures by ending Medicare cuts to rural hospital and eliminating burdensome regulatory requirements. The bipartisan bill also offers a path forward for rural hospitals that may still continue to struggle by allowing them to transform into an innovative new payment model that fits the unique delivery needs of a rural community.

This is urgent. Fifty-six rural hospitals have closed, and 283 additional hospitals on the brink of closure.

NRHA asks you to visit the district office, attend town hall meetings and invite your member of Congress to tour your rural facilities. Explain to them how important your hospital is to the patients you serve and the rural economy. Don’t wait. HR 3225 will eliminate millions in Medicare dollars that have been cut from your hospital. America’s rural safety net hospitals needs this bill passed now.

Visit for more information on the HR 3225, the Save Rural Hospitals Act, and how you can help get this important bill passed.

Today marks 50th Anniversary of Medicare and Medicaid

As today marks the 50th Anniversary of President Lyndon B. Johnson signing Medicare and Medicaid into law, the National Rural Health Association recognizes the importance Medicare has on access to care in rural America.

Medicare serves a disproportionate number of rural Americans. Twenty-three percent of Medicare beneficiaries live in rural America, while only 20 percent of the population resides in rural America. Rural beneficiaries are more likely to be dually eligible for both Medicare and Medicaid than their urban counterparts.

Medicare – a major component of rural health care – pays rural providers less than their urban counterparts. Medicare spends 2.5 percent less on rural beneficiaries than it does on urban beneficiaries. Rural health care providers operate on very thin margins and many rural communities have severe medical workforce shortages. Yet, rural physicians, who put as much time, skill and intensity into their work as their urban counterparts, are reimbursed at lower rates.

Continued cuts in hospital reimbursements have taken their toll, forcing far too many rural hospital closures and leaving many of our nation’s most vulnerable populations without timely access to care. Fifty-five rural hospitals have closed since 2010; 283 more are on the brink of closure. Since the start of 2013, more rural hospitals have closed than in the previous 10 years—combined. If Congress allows these 283 rural hospitals on the brink to close, then 700,000 patients would lose direct access to care.

And this loss of access will result in increased Medicare expenditures. Rural hospitals provide cost-effective primary care. It is 2.5 percent less expensive to provide identical Medicare services in a rural setting than in an urban or suburban setting. This focus on primary care, as opposed to specialty care, saves Medicare $1.5 billion per year. Quality performance measurements in rural areas are on par if not superior to urban facilities. That is why NRHA fully supports the Save Rural Hospitals Act introduced earlier this week by Reps. Sam Graves (R-Mo.) and Dave Loebsack (D-Iowa). This important bill will not only stabilize rural hospitals but also presents a new rural model to keep access to health care in rural communities.

As we celebrate this milestone for Medicare, NRHA asks members of Congress to remember how Medicare provides access to care for the older, sicker and more vulnerable populations, and to consider the impact of access to care Medicare provides. Medicare serves an essential role in ensuring access to necessary health care that meets the unique needs of rural communities.

As we look toward the next 50 years of Medicare, more must be done to ensure rural Americans have access to the health care resources necessary to allow them to lead healthy lives.

Learn more about Medicare’s impact on rural America and the Save Rural Hospitals Act at 1 p.m. CDT today (Thursday) during a free NRHA grassroots advocacy call.

NRHA president speaks to U.S. senators on 50th anniversary of Medicaid

Today, the National Rural Health Association’s 2015 president Jodi Schmidt addressed the U.S. Senate Democratic Steering Committee to commemorate the 50th anniversary of the Medicaid program.

Sen. Amy Klobuchar (D-Minn.) and several of her colleagues listened as top health care experts detailed the importance Medicaid has played in improving health outcomes.

Poverty persists in rural America, and Medicaid continues to be crucially important for rural patients and rural providers. In fact, because rural Americans tend to be older, poorer and sicker than their urban counterparts, Medicaid is a larger source of health care in rural America than in the rest of the nation and has literally been a lifeline for millions who live in rural communities. Poverty in rural America is generational. Poverty rates are higher for rural children than for those living in urban areas, and the gap has increased in recent years. Rural children are more likely than urban children to live in extreme poverty. More than 42 percent of low-income rural children rely on Medicaid and the Children’s Health Insurance Program (CHIP).

As we know, 22 states have chosen to not expand Medicaid per provisions of the Affordable Care Act. It’s important to note that the majority of rural residents in the U.S. live in states that are not expanding Medicaid. Only three of the 11 states with the largest rural populations have expanded (Iowa, Kentucky and Michigan). In fact, rural, poor states are the least likely to expand Medicaid. Many rural hospitals are bearing the brunt, as sick and uninsured patients continue to show up in emergency rooms. Uncompensated care cuts such as DSH and bad debt reductions, on top of sequestration cuts, are forcing rural hospitals to close.

Have we made progress in the last half century? Over 50 years ago in Martin County, Ky., where the poverty rate was 65 percent, President Lyndon Johnson, declared an “unconditional war on poverty.” Today, Martin County remains one of the poorest counties in the nation with a 35 percent poverty rate, nearly double the national average. Progress? Yes, but it is undeniable that poverty continues to be a persistent reality for much of rural America.

NRHA members testify before Congress on rural health disparities

The House Ways and Means Subcommittee on Health held a hearing today on rural health disparities.   Several National Rural Health Association members testified on the importance of rural programs and how cuts and regulations are burdening their facilities.

Shannon Sorensen, CEO of Brown County Hospital in Ainsworth, Neb.; Carrie Saia, CEO of Holton Community Hospital in Holton, Kan.; and Daniel Derksen, director of the Arizona Center for Rural Health, each outlined the challenges of rural health care delivery, citing workforce shortages, older and poorer patient populations, geography, low patient volumes and high uninsured and under-insured populations as barriers.

The witnesses also highlighted how rural physicians and hospitals provide high quality, personalized care to their communities.

A common theme was the impact of burdensome regulations on their hospitals, such as the “96-hour-rule” and “physician supervision.” Also highlighted was the concern for rural hospital closures and the consequences to rural Americans access to local health care.

With 55 rural hospitals already closed, and 283 additional hospitals on the brink of closure, the witnesses shared how important local access to health care is in improving the health of the those in the communities they serve. As Sorensen stated, being 150 miles from the next tertiary care facility, it is important to be able to keep people in their community while they receive care.

Hospital administrators sharing stories of patients directly and negatively impacted by these regulations is a powerful message heard by Congress, and NRHA encourages its members to call their representatives and  senators and share their stories of how cuts and closures affect their communities.

NRHA’s Save Rural Hospitals Act is the comprehensive solution to the rural hospital closure crisis. Ask your representatives to co-sponsor NRHA’s Save Rural Hospitals Act today to ensure the future of rural America, and join NRHA’s continued campaign to #‎SaveRural hospitals, patients and communities.

Learn more about the legislation and how you can help at 1 p.m. CDT Thursday during a free NRHA grassroots advocacy call.

NRHA endorses Save Rural Hospitals Act

Fifty-five rural hospitals have closed since 2010, and 283 more are on the brink of closure, risking access to much-needed health care for more than 700,000 Americans.

That’s why the National Rural Health Association advanced the Save Rural Hospitals Act, introduced today by U.S Reps. Sam Graves (R-Mo.) and Dave Loebsack (D-Iowa).

The bipartisan bill will stabilize and strengthen rural hospitals by:

  • Stopping the many cuts in Medicare that rural hospitals have endured for years,
  • Providing rural hospitals with new funding so they can provide quality primary care to rural patients across the nation, and
  • Creating a path forward for struggling rural hospitals by allowing them to provide care that makes sense in their communities and receive fair reimbursement for emergency room and primary care.

“If Congress doesn’t act soon, almost 20 percent of Missouri’s rural hospitals could close, forcing tens of thousands of rural Missourians to lose access to their local emergency rooms,” Graves says. “My bill will save rural lives in rural communities in Missouri and across America.”

The Save Rural Hospitals Act will provide these hospitals with financial and regulatory relief to allow them to stay open and care for rural residents who are older, poorer and have higher rates of chronic disease than their urban counterparts. The average critical access hospital creates 195 jobs and generates $8.4 million in annual payroll.

“Rural hospitals are bedrocks of their communities, providing more than just high quality, local access to health care,” Loebsack explains. “Rural hospitals stimulate the local economy, creating jobs in the hospital and the community. Without local health care, lives and communities are lost. Our bill will save rural Iowans as well as the communities where they have built their lives.”

Since January 2013, more rural hospitals have closed than in the previous 10 years combined. If Congress doesn’t act now to prevent further closures, rural hospitals will be forced to lay off workers, cut wages, reduce services and close doors. Lives will be lost, and local economies will suffer.

“The National Rural Health Association has led the fight to stop rural hospital closures across the nation,” says Jodi Schmidt, 2015 NRHA president. “We’re calling on Congress to pass this comprehensive legislation to save rural hospitals and patients and to provide a pathway to the future for rural health.”

Ask your representatives to co-sponsor NRHA’s Save Rural Hospitals Act today to ensure the future of rural America.

And join NRHA’s continued campaign to #‎SaveRural‬ hospitals, patients and communities.

Learn more about the legislation and how you can help at 1 p.m. CDT Thursday during a free NRHA grassroots advocacy call.

Several Ways & Means Committee Members question MedPAC findings

At a U.S. House Committee on Ways & Means Subcommittee on Health hearing today on the Medicare Payment Advisory Commission (MedPAC), several members of Congress expressed bipartisan concern on rural health issues and beneficiary access to care, in light of the 55 rural hospitals that have closed and 283 other rural hospitals on the brink of closure.

During the hearing, Dr. Mark Miller, the executive director of MedPAC, was questioned by Reps. Lynn Jenkins  (R-KS), Ron Kind (D-WI), Adrian Smith (R-NE) Diane Black (R-TN) and Kristin Noem (R-SD) about MEDPAC’s findings on rural health.

Rep. Jenkins raised many critical questions about the rural hospital closures, and cited the National Rural Health Association’s report by iVantage that 283 hospitals are on the brink of closure and the effect more closures would have on rural Americans’ access to care.

NRHA applauds our rural champions for standing up for rural health care and asks all members of Congress to protect rural Americans access to health care.

The Ways & Means Subcommittee on Health will hold another hearing on Tuesday, July 28 to discuss rural health care disparities. Continue to monitor this blog for the latest news.

Supreme Court upholds ACA subsidies in states using federal insurance marketplace

Today, the Supreme Court decided the case of King v. Burwell, permitting subsidies for the purchase of insurance in states that rely on the federally run health insurance marketplace.

A little bit about the case: This case (or actually cases, the court put together a number of cases asking the same question) asked whether the Affordable Care Act (ACA) allows for subsidies for the purchase of insurance when a state relied on the federally run exchange. The language in the law allows subsidies in exchanges “established by the state;” however, IRS rules provided for subsidies in the federally operated exchange (

It will take some time before we fully know what today’s decision will mean for rural health.

But we do know rural Americans tend to be older, sicker and poorer than their urban counterparts. So they are more likely to be in need of health care and less likely to have employer-provided insurance to help pay for that care.

While the National Rural Health Association did not take a position on ACA, we have continued to fight to ensure access to health care in rural America. Because so many rural Americans live in states with state exchanges and are in the income bracket eligible for subsidies, NRHA is pleased these vulnerable rural Americans can continue to receive the subsidies necessary to allow them to afford health insurance.

Currently, 18 percent of rural Americans are uninsured. And about three in four rural uninsured are eligible for premium subsidies.

Only those living in states that rely on the federal insurance exchange are impacted by this decision. However, nearly 80 percent of rural Americans live in states using the exchange (vs. 60 percent for urban). Thus, the impact of this decision is felt particularly acutely in rural America.

According to a 2014 Kaiser Family Foundation report, 50 percent of rural residents (vs. 43 percent of urban residents) have family incomes between 100 percent and 400 percent of the federal poverty level (FPL). It is in this income range where people are potentially eligible for subsidies to purchase of health insurance.

While some of these people receive insurance though their employer, Kaiser reported rural residents are less likely to have coverage though a job (51 percent of rural Americans vs. 57 percent of urban residents). Those without insurance though their employer face higher out of pocket costs for their premiums, which means many in this income bracket may simply not be able to afford coverage without subsidies, according to the report.

NRHA will continue to examine the potential rural impacts of this decision. Join us at 11 a.m. CDT June 30 for a call regarding the Supreme Court ruling, the latest Senate Appropriations news impacting rural health and our recent #SaveRural Hospitals Rally.

We will also update this blog with more details as we break down the decision and the accompanying dissent.

Sen. Grassley introduces additional rural hospital model bill

The Rural Emergency Acute Care Hospital Act of 2015 (S.1648) was introduced today by Sen. Chuck Grassley (R-IA), to establish a new Medicare payment designation, the Rural Emergency Hospital to sustain emergency services in rural communities.

Rural hospitals are critical to the 62 million rural Americans that rely on them to receive necessary local care. Rural hospitals provide care to vulnerable rural Americans as well as serve as an important economic and social anchor for their communities. However, far too many of these hospitals are in trouble.

Since 2010, 55 rural hospitals have closed, 283 more are on the brink of closure. And the pace of closures is increasing, since January 2013, more rural hospitals have closed than in the previous 10 years combined. Continued cuts in hospital payments have taken their toll, forcing closures and leaving many of our nation’s most vulnerable populations without timely access to care. If Congress doesn’t act to stop the bleeding and prevent further closures of rural hospitals, 700,000 patients would lose direct access to care; patients and local economies will suffer.

Our health care system is undergoing dramatic changes.

As stated in NRHA’s policy paper, providers have become increasingly aware that the current rural safety net programs are not structured for success in this new environment.

While it is critically important to sustain the rural safety net providers such as Rural Health Clinic, Federally Qualified Health Center, Critical Access Hospital, Medicare Dependent Hospital, Sole Community Hospital, physicians and other rural programs and providers during this time of change and uncertainty, it is equally important to outline a meaningful phased and non-destructive transition strategy that successfully links today’s payment and patient care delivery structures to the health care systems of the future.

NRHA applauds the forward thinking of Sen. Grassley by introducing a new model of rural health care to provide rural hospitals and communities a path forward to provide local care.  NRHA remains committed to advancing legislation that will also stabilize the rural health care safety net by stopping the numerous Medicare cuts that are significantly harming the financial viability of many rural hospitals.

Appropriations season in full swing

The Fiscal Year 2016 appropriations are underway.

The Senate Appropriations Subcommittee will markup FY 2016 Labor, Health and Human Services Funding Bill, which includes funding for multiple important rural health programs, at 3 p.m. ET today. To listen live, click here.

Tomorrow the full House Appropriations Committee will markup the bill. The House report is here.

NRHA continued to support robust funding for the rural health safety net in the FY 2016 funding measures.

Stay tuned to NRHA’s blog for the latest appropriation news.

NRHA asks Congress to support Border Health Security Act

The National Rural Health Association (NRHA) urges members of Congress to support the Border Health Security Act introduced by Senators Tom Udall (D-NM) and Martin Heinrich (D-NM). NRHA believes Congress must continue to make investments in emergency preparedness, health surveillance, and rural community infrastructure, particularly, at our nation’s borders.

The United States-Mexico Border Health Commission has worked over the past decade to address major bi-national health issues that strain the public health systems of both nation’s along the shared border. A major focus is on communicable diseases, such as H1N1, hepatitis, and measles, since these diseases do not recognize nor respect borders. As the Commission enters its second decade, the focus must be broadened and strengthened to improve defenses against bioterrorism, to warn of communicable disease outbreaks, and address the many health disparities in the border region.

The legislation would reauthorize the Early Warning Infectious Disease Surveillance (EWIDS) program. Created in 2003, it provide states along the U.S.-Mexico and U.S.-Canada borders with funding to detect, identify, and report outbreaks of infectious diseases. The bill also authorizes $7 million per year for border grants and operations.

The House companion bill will be introduced by Rep. Rubén Hinojosa (D-TX).