Rural-health lobbyist sees friends leaving Congress as critical spending decisions loom

The National Rural Health Association this week urged a wholesale re-education of Congress on the issues facing rural America's hospitals and providers and the patients they serve. David Lee, government affairs and policy manager for the association, writes in the Daily Yonder that now is the time for a Congress that has not shown much interest or understanding of rural health issues to understand the long-term significance of its action or its inaction.

Already, Lee notes, three payments for rural hospitals have been allowed to expire: the Medicare Dependent Hospital program, the Low-Volume Hospital Adjustment and the Section 508 or hospital wage index programs. Together, he writes, these programs "provide millions of dollars in reimbursements to rural hospitals treating specific Medicare populations. Unless these payments are restored, many hospitals will likely have to reduce services and staff to stay afloat."

Red dots show Area Health Education Centers; gray stars
show administrators of AHEC programs. (AHEC graphic)

There is more to come, he fears, if legislators use rural-health program dollars to make up for other spending or budget cuts. Lee sees a likely target in the appropriations for Area Health Education Centers (map), which he says have consistently been below authorized spending allowances. AHECs are necessary, he argues, to counteract doctor shortages in rural America.

Lee looks at the composition of the newly elected Congress and the many champions of rural health who are soon leaving it. "Key rural health problems that now hang in the balance include increased dependence on reimbursements from Medicare, Medicaid, and self-payers; longer distances patients must travel for primary and specialty care; fewer providers per capita, which may lead to long waits for visits in the rural health care delivery system; lack of funding in rural health education; and the need for continued rural health research," Lee writes. "The next two years, indeed the future of rural health care, depends on active engagement now." (Read more)