Everyone agrees changes are necessary. What will they be?
The Supreme Court confirmation hearing overshadowed another important meeting on Capitol Hill last week—one to discuss the future of rural healthcare in our country. Senators were joined by doctors and other healthcare practitioners with expansive knowledge in the field.
In the end, the exchange of ideas may have created more questions than answers. Each senator has their own idea for how the issue is best addressed:
One idea that came forth was proposed by a healthcare CEO from Tennessee, and seconded by a senator from the Volunteer State. Alan Levine, president and CEO of Ballad Health of Johnson City, Tennessee, urged the senators to pass S. 397, the Fair Medicare Hospital Payments Act. “It’s a bipartisan bill,” he urged, “and it’s the single biggest thing you could do near-term to help rural hospital.
Senator Lamar Alexander (R-TN) was in support of Levine’s second suggestion, the repurposing of rural hospitals to provide certain services. “Services like mental health, addiction, emergency services, maternity services for women and babies—we need these services rather than the high-end services we needed 30 years ago,” said Levine. “Repurposing these hospitals is a real opportunity.”
Wyoming insurance commissioner Tom Glause urged caution on the idea of repurposing. “I encourage us to be mindful of the unintended consequences as we look to repurpose rural hospitals,” he said. “The cost of air ambulance transport has skyrocketed; I encourage you to also look at that issue when the reauthorization of the [Federal Aviation Administration] comes up.”
Independent Senator Bernie Sanders of Vermont didn’t have much success convincing senators or other panelists that cutting Medicaid spending would hurt rural communities.
“We have not expanded Medicaid in Wyoming, so I don’t think we would see the substantial impact with a cut to Medicaid as we would with other programs,” Glause responded.
“It would have an impact on rural healthcare, but Tennessee has a very unique problem because our disproportionate share hospital [DSH] funding is capped in federal statute,” Levine agreed. (DSH funding is money granted by the federal government to hospitals who serve a disproportionate share of low-income patients).
Deborah Richter, MD, a family physician from Sanders’ home state of Vermont, offered her agreement with Senator Sanders’ position. “We’re already suffering under underpayment as it is,” she said. “A trillion-dollar cut would be devastating to us, and we’d see even more physicians and nurse practitioners exiting rural areas.”
The final point was a discussion of what defines a ‘rural’ community, with different speakers offering their own stories of the challenges of living in remote locations. If defining what rural means is a challenge, imagine the uphill battle senators face in getting everyone to agree on how to best serve such areas.