Supporting the goals and ideals of National Rural Health Day.

Mr. Speaker, I ask unanimous consent that all Members may have 5 legislative days in which to revise and extend their remarks and include extraneous material for the Record.

Mr. Speaker, it is my honor to rise today as co-chair of the Bipartisan Rural Health Caucus to commence hosting the Special Order hour in celebration of National Rural Health Month.

Every year, National Rural Health Month is a time for us all to bring attention to the unique healthcare needs in rural America and honor the incredible efforts of rural healthcare providers, organizations, and other stakeholders.

It has been more than a decade since Congress last had a bipartisan coalition focused on promoting and advancing healthcare solutions for our Nation's rural and remote communities.

Sadly, during that time, the prognosis and progress has only gotten worse for those who live in rural America. The health and wellness of our people has not improved.

Especially given the divisions in our country and in Congress today, we need to find more ways that we can come together around common issues and common ground and develop solutions that ensure rural Americans do not get left behind.

That is one of the reasons why earlier this year, I re-launched the Bipartisan Rural Health Caucus with my distinguished colleague from the great State of Tennessee, Diana Harshbarger.

Earlier this year, we came together with a shared desire for Congress to play a more active role in improving and promoting life and access to healthcare in rural America.

Today, nearly 50 Members of Congress, Republicans and Democrats, have joined the Bipartisan Rural Health Caucus, representing rural areas across the country from Guam to West Virginia to the Upper Peninsula of Michigan down to central Texas.

Whether political, demographic, or geographic, the diversity of our caucus is our strength because rural America is America.

I yield to the gentlewoman from Tennessee (Mrs. Harshbarger), my distinguished co-chair.

Mr. Speaker, mahalo to my co-chair, Representative Harshbarger, for providing leadership and insight for many, many years in this particular area and serving on the front line as a pharmacist in her own community.

Mr. Speaker, I yield to the gentleman from Washington (Mr. Kilmer).

Mr. Speaker, I yield to the gentleman from California (Mr. LaMalfa).

Mr. Speaker, I say mahalo to Representative LaMalfa, and I will extend a great deal of gratitude for helping to guide us through a crisis that is hitting rural America far too often, natural disasters, as we are seeing it.

I look forward to also now working with you to make sure that when a disaster strikes, our healthcare system will be able to support them every step of the way.

Mr. Speaker, I yield to the gentleman from Pennsylvania (Mr. Thompson), who often says ``food is medicine.'' I appreciate his guidance and wisdom on this particular issue.

Mr. Speaker, as you can see, we have strong leadership across this great country that is making sure that the health and wellness of rural America is taken care of. I am so appreciative of all the members of our caucus that have stepped forward and stepped up, not just now but in so many years past and will definitely be part of that leadership going forward.

Mr. Speaker, it looks like it is a great day for the great State of Pennsylvania.

Mr. Speaker, I yield to the gentlewoman from Pennsylvania (Ms. Wild).

Mr. Speaker, unfortunately, the sad reality is that if you are living in rural America, you are more likely to experience lower health expectations, lower health quality, and lower life expectancy simply because of your ability to access healthcare that you need.

I have sat with constituents in my community of Wainiha who have asked me if it was fair that people that live right down the road in urban Honolulu live 10 years longer than they do. While at times it may seem that they may require more medical attention and care, rural Americans often have more access to healthcare because of such things as you have heard of today: physician shortages, lack of reliable and affordable transportation options, insufficient health insurance coverage, and an increased exposure to environmental and occupational hazards.

As a Representative in Congress for one of the most rural and remote districts in the country, I know that many of my constituents are often just one diagnosis away from a serious illness and the difficult financial and family decisions that often come with this.

Across the country, more than 60 million Americans, about one in five Americans live in rural areas. While they make up just 18 percent of the total U.S. population, they are scattered, as we have heard, across 97 percent of our country's land area.

Rural Americans face numerous health disparities as compared with their urban counterparts. Rural Americans are more likely to die from heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke, as compared to their urban counterparts.

Unintentional injury or death. You heard Representative Thompson talk a little about this and the ``golden hour.'' They are more likely, by 50 percent higher rates, to die in rural areas as compared to urban areas often because of their ability to access emergency care when involved in a motor vehicle crash or opioid overdose.

There are so many steps that we can continue to address, but I would have us hear from another part of our great country and a rural caucus, that of the great State of North Carolina.

Mr. Speaker, I yield to the gentleman from North Carolina (Mr. Davis), another distinguished member of our Rural Health Caucus.

Mr. Speaker, as you heard, across our country, we have strong leadership on rural health, much action to be taken, and many opportunities that we need to make sure that we seize.

We have talked a lot about rural America, from California to Pennsylvania to North Carolina. I would like to bring us back to Hawaii now. It is the most isolated archipelago in the world, with the nearest landmass over 2,300 miles away. I can tell you, it is a long distance, given that I travel it pretty much every weekend, crossing that great, beautiful, blue Pacific Ocean.

My district represents all the islands in Hawaii. On our neighboring islands, patients often have to fly to Oahu, our main island with Honolulu, to get emergency or even routine medical, dental, or mental health care. Many Oahu-based providers often spend their weekends, if they can even reach the availability of air transportation, traveling back and forth between our islands just to try to make sure our patients get the medication and services they need to survive.

I know a lot of people are thinking we have telehealth now, so that should be no problem. Again, consider the remoteness of our islands and the remoteness of so many of our rural communities. Broadband speed and access are not equal everywhere across this great country and our territories. Oftentimes, people are just asking folks

to pick up a phone to be able to triage and immediately start to provide care and scrips, which, in many cases, people need because they are living in isolated and remote parts of rural America.

As in many other parts of this country, in Hawaii, we are seeing providers, hospitals, and clinics struggle to keep their doors open because of high operating costs and insufficient reimbursement rates. As was alluded to earlier in this discussion, since 2010, 155 rural hospitals have closed their doors, making the difficult decision to leave their patients behind.

Often these patients aren't just patients. These are family members, neighbors, and friends. With limited healthcare options and access, we know that for many of these individuals, those hospitals, those providers closing their doors, it is a life sentence.

You would think, after these last 15 or so years, that we are out of the woods. Well, think again. Over 40 percent of all rural hospitals are operating with negative margins and are vulnerable to closure. This is on top of the fact that rural communities often have fewer healthcare providers. Over 50 percent of rural communities and counties have no access to hospital-based maternal care. That means just being able to go somewhere to be able to have your child safely. Seventy percent are lacking even a single psychiatrist in their county.

Looking at the stats, when we think about it, just basic physicians, general internists, and doctors in rural communities, you have 13.1 physicians per 10,000 people as compared to 31.2 in urban areas, less than half the amount that urban America is able to enjoy.

When we are talking about specialist care, think of our own situations and how often you would need that specialist or a loved one has needed a specialist to provide lifesaving care for them. Rural America has 30 specialists per 100,000 individuals as compared to 263 specialists per 100,000 people. We can see the disparity, and sadly, we can see the great need that exists in rural America right now.

High costs have also proven to be a significant barrier. Whether it is providing housing for recruiting and retaining healthcare workers in our State, covering medical transport via medevac airplane or helicopter, considering even the wages of professionals, these are all things, as you have heard today, that we have legislative bills we are trying to focus on, making sure that these barriers no longer exist and reducing the challenges to accessing healthcare in rural America.

Mr. Speaker, we will soon hear from another great State in this country, so let me at this particular time take this back to my home State of Hawaii.

As I mentioned earlier when Mr. LaMalfa came up, we have seen such devastation in my district with the Maui fires. The response in the wake of this disaster has really highlighted to us the importance of making sure we have a strong and robust healthcare system. From critical access care personnel and medical countermeasures and supplies, you have to have them ready and onsite because in so many cases in our rural communities, whether you live on islands or there are hundreds of thousands of miles that separate you from the nearest access point, help can often be days away.

At the onset of our fires, I remember our chief of police telling us that we have often been told--sadly, now we see it--that if we are in a crisis, we are 72 hours away from help. We have to make sure, especially when it comes to critical access care and healthcare, that we have the supplies and personnel in all of our communities to be able to help respond to disaster once she strikes.

My district also has one of the most racially and ethnically unique populations in the country, and these communities often experience, sadly, some of the highest healthcare costs and suffer from some of the highest health disparities that we see across the country.

Mr. Speaker, again, one of the wonderful aspects of this caucus is that it is both bipartisan and represents all of America.

Mr. Speaker, I yield to the gentleman from Michigan (Mr. Bergman).

Mr. Speaker, you have heard today so many tales of tragedy and disparity across our country in rural America, but also through the legislation, bills, and advocacy that we have seen from our Bipartisan Rural Health Caucus members, so many opportunities for us to do good by rural America.

As I close today, I appreciate all of our Members who have come forward to share their stories from across this great country. Let me highlight an article that was recently run in The Washington Post that focused on the fact that more people in Puerto Rico are dying at higher rates because of these healthcare disparities and lack of access to a health system.

As we take a look at the numbers, as we know, Puerto Rico has been devastated by natural disasters, compounded by COVID-19 already stressing a very strained healthcare system. They are lacking professionals in the community to be able to serve their residents. The fact is that they only have one working ambulance for 25,000 people in a town. Too often, by the time the call is made and the ambulance shows up at the home, those people have already passed away.

The fact is that they had 35,400 deaths last year in 2022 for a population of 3.3 million, thousands more than researchers could ever have expected, historical highs that they are seeing compounded as a result of a strained healthcare system that is unable to take care of its people.

There are stories and examples of veterans who have served and fought under our flag that you stand before right there not being able to access the critical care or even the basic care that they need, deserve, and fought for.

Too many people are dying as a result of a lack of access to healthcare. When we take a look at the numbers, there are disparities in terms of increases in Alzheimer's, substance abuse, mental health conditions, and chronic health conditions like blood pressure, diabetes, kidney failure, respiratory failure--all of these things.

To me, when I read this article and all the problems they cite--lack of facilities, lack of professionals, too many of the young ones leaving their community to go to work in the United States or take on other professions--this was a cautionary tale to all of rural and remote America that if we don't get our act together soon in our States and our territories to make sure that no matter where you live in this great country, especially in rural and remote America that makes up over 97 percent of this great country's land mass, we will continue to see people die.

The stakes could not be higher when it comes to making sure that the Bipartisan Rural Health Caucus continues to stay together and fight for those most basic things for every single one of our constituents. No matter where you live, no matter what district, each one has a touch of rural. We need to make sure that the healthcare access and mental health services they need will be there for them when they need it.

Mr. Speaker, I thank you for allowing us this critically important Special Order hour to highlight rural health in our country. I look forward to working very closely with all of my colleagues to make sure that rural America has the healthcare that they need and deserve.

Mr. Speaker, I yield back the balance of my time.

Mr. Speaker, I thank my colleague for yielding.

Mr. Speaker, 49 years ago in Port Angeles, Washington, I was born in what was then called Olympic Memorial Hospital. Over the years, members of my family and I received good, quality care from what is now known as Olympic Medical Center and its well-trained physicians and nurses, and from a staff that genuinely cares about the community.

The future of healthcare in rural communities faces extraordinary challenges that threaten the ability of folks to access the care that they need and that they deserve.

Unfortunately, the reality for many Americans in rural areas when it comes to healthcare is a story of gaps and barriers.

This isn't just a problem for the Olympic Peninsula. Rural populations often bear the brunt of healthcare disparities. They are usually older, have less income, and often have complex health issues.

These factors burden rural hospitals, many of which are already buckling under pressure. In fact, today the rural hospital closure crisis threatens more than 400 rural hospitals nationwide with imminent closure.

For folks on the Olympic Peninsula, quality care should be readily accessible, not a service only available in the shadow of the Space Needle.

No matter who you are or where you are from, you ought to be able to find quality, affordable medical care close to home.

This rural-urban healthcare divide is a crisis that demands attention from Congress. An important piece of the puzzle is addressing the site neutral payment policy, which has significantly impacted rural hospitals like Olympic Medical Center.

This policy, originally intended to equalize payment rates between hospitals and outpatient clinics, often disadvantages rural hospitals, which rely on higher reimbursement rates to maintain operations and provide essential services.

By advocating for an exemption for rural Sole Community Hospitals from this policy, we can ensure these vital institutions receive adequate funding.

In addition, in July I introduced a bipartisan bill known as the Rural Hospital Technical Assistance Program. This bipartisan effort would provide targeted, in-depth technical assistance to vulnerable hospitals and communities struggling to maintain healthcare services.

That means helping to prevent closures, strengthening essential healthcare services in rural communities, and improving financial and operational performance.

Our bill seeks to alleviate the strain felt by many rural providers by authorizing new Federal funding to support improvements to these crucial facilities, aiming to ensure that everyone, regardless of where they live, can stay just as healthy as someone living in a big city.

Consider the hypothetical, but very real situation, of an older patient in Port Townsend who receives chemotherapy multiple times a week at Jefferson Healthcare or the pregnant mother in Elma receiving prenatal and obstetric care at Summit Pacific Medical Center.

Without strong rural hospitals, these patients and others may face a long and burdensome commute to an urban hospital or go without care entirely.

The Rural Hospital Technical Assistance Program aims to mitigate these very real scenarios and keep facilities open and thriving, ensuring that everyone can access medical care near home.

Our bill is important in bridging the gap of healthcare disparities that we see every day. It aims to prevent the unfortunate and unnecessary closure of rural hospitals and to ensure that folks in rural communities receive the care that they need and that they deserve without the necessity of long-distance travel or facing financial ruin.

It isn't just about keeping open facilities like Olympic Medical Center in Port Angeles and Peninsula Community Health Services in rural Kitsap, Mason, and Pierce Counties.

It is about keeping people healthy, employed with good-paying jobs, and improving care in rural areas where the need is most critical.

The Rural Hospital Technical Assistance Program is a commitment to equity, a promise of access, and a crucial step toward ensuring that going forward, quality healthcare isn't a privilege confined to big cities.

We deserve a future where care is not constrained by geography but is easily affordable and accessible for all. Again, I thank my colleague for organizing this Special Order.

Madam Speaker, I thank the gentlewoman for her leadership with this bipartisan Rural Healthcare Caucus.

It is incredibly important and really defines my life. Prior to coming to Congress 15 years ago, I spent 28 years working in rural healthcare as a nonprofit community healthcare therapist, rehab service manager, a manager within rural hospitals, and a licensed nursing home administrator. I witnessed firsthand the challenges that individuals that live in rural America, rural communities face when it comes to healthcare.

I am acutely aware of the challenges many face when it comes to obtaining reasonably priced healthcare. It is especially critical for rural America, much like the 15th Congressional District of Pennsylvania that I have the privilege of serving today.

As a Member of Congress representing nearly one-third of the land mass of Pennsylvania, one of the most rural districts east of the Mississippi, I am keenly aware of the problems my constituents face when accessing medical services.

I always say that when I see rural hospitals in dire challenges, and we are struggling with some of that right now in our district, that the end results in a commute that can mean the difference between life and death to be able to get the services they need within the time frame that is required.

I saw that firsthand, quite frankly, as a volunteer firefighter and emergency medical technician for several decades. The importance of being able to get from that accident scene or from their home to a healthcare setting, a hospital setting in a timely manner, especially for those eventually requiring some type of surgery.

We talk about the golden hour. It is not an hour in many parts of rural America. We are facing a healthcare crisis in our Nation's rural areas. These often disadvantaged populations are still struggling to access affordable, quality care. Many remain uninsured. Most are underinsured. However, access to quality care remains the largest challenge.

Even if it is not the bricks and mortar, and we have seen so many of those closed over the past 15 years, it is the talent, the skill, the expertise within that bricks and mortar, the physicians, the nurses, the technicians. It is difficult.

As someone who used to participate in recruiting this talent into our rural hospitals, it is very challenging to get that, to be able to be successful with that. That is why I am a big fan of telemedicine.

I am really excited about the advances that we have made in telemedicine over the past decade or so. There is more that needs to be done.

Even when people gain access to health insurance, it does not equal access to healthcare. Rural hospitals across the country are closing, leaving patients without access to the emergency rooms and long-term care facilities. Quite frankly, where they are not closing, they are always struggling for staff. If you don't have access to qualified healthcare professionals, I don't care how we pay for healthcare, what kind of shiny package, what ribbon we put on it, there is no access to healthcare without those qualified, highly skilled providers.

Mr. Speaker, I am proud to work with the gentlewoman as a part of this caucus, and proud to be a founding member of the Rural Health Caucus. I am proud to work with the gentlewoman as a great member of the House Agriculture Committee, where under the Rural Development title, we support facilities like nursing homes and rehabilitation centers and hospitals and provide communities reasonable funding to be able to address that need.

This is a problem. It is a multidimensional problem that requires multidimensional solutions. I think that the formation of this caucus is one of the first best starts to address this.

This bipartisan group will bring awareness to these unique challenges, to other members, and actively work to find solutions to these problems.

Mr. Speaker, I rise today to recognize National Rural Health Month and to highlight the work of the congressional Bipartisan Rural Health Caucus, which I am proud to cosponsor with my colleague, Representative Tokuda from Hawaii.

Over 60 million hardworking, everyday Americans live in rural communities throughout the United States. As my co-chair, Representative Tokuda, is fond of citing, nearly 97 percent of our Nation is designated as rural.

Compared to their counterparts living in urban and suburban areas, rural Americans experience lower life expectancy, poorer health status, and more difficulty accessing quality and affordable healthcare.

Rural patients face these challenges due to a limited number of rural healthcare providers and professionals, higher rates of uninsurance and underinsurance, and long journeys to care providers, sometimes lacking transportation entirely.

Having served as a community pharmacist for over 30 years in east Tennessee, which is a rural area, I understand the unique healthcare challenges and obstacles faced by our patients and healthcare providers each and every day.

It is crucial that Congress takes action to address the issues that rural healthcare providers grapple with such as workforce shortages, supply scarcities, reimbursement challenges, limited access to telehealth, and difficulties ensuring their patients receive the care they need.

The congressional Bipartisan Rural Health Caucus is here to provide a forum for Members of Congress to advocate for legislative action that will help increase access to quality, affordable healthcare and mental health services for all rural Americans.

As co-chair, I will continue my work to advocate for legislation and policies that will ensure long-term sustainability of rural communities.

Earlier this year, I introduced the bipartisan Rural Physician Workforce Production Act, which improves Medicare reimbursement and enhances the current structure of the Medicare-funded graduate medical education program, bringing more medical residents and doctors to rural areas in need.

I also worked with my fellow colleagues from the Tennessee delegation to introduce the Rural America Health Corps Act, which would provide incentives for healthcare professionals to work in rural health facilities in exchange for forgiving medical student loans.

In addition to these bills, I am a proud cosponsor of the Save Rural Hospitals Act, bipartisan legislation that will aid in curbing hospital closures in rural communities by ensuring fairness in Medicare hospital payments.

This legislative work is absolutely critical and complements House Resolution 870, which I introduced with the majority of the Members of the Bipartisan Rural Health Caucus to support the goals and ideas of National Rural Health Day.

National Rural Health Day, the third Thursday of each November, was established to honor rural communities and the contributions and efforts of rural healthcare providers to address the unique challenges faced by the patients they serve.

Given the aforementioned healthcare disparities faced by rural Americans and the continued difficulty experienced by rural healthcare providers in keeping their doors open, it is vital that Congress prioritizes improved patient care and access in rural areas.

Our rural healthcare professionals and patients showcase a selfless and community-minded spirit. It is altogether fitting and proper that we celebrate rural healthcare providers and the millions of Americans that rural healthcare providers serve, and to express a commitment to advancing policy to improve healthcare accessibility and affordability in rural areas in our country.

Mr. Speaker, I thank Representative Tokuda and my colleagues for joining in this cause.

Mr. Speaker, I thank the gentlewoman and our co-chairs for leading this Special Order.

Mr. Speaker, I rise on behalf of eastern North Carolina to address my highest legislative priority: improving access to healthcare in rural America.

In honor of National Rural Health month, I join my colleagues here to speak about how we can fund commonsense bipartisan solutions to the most pressing challenges facing our healthcare system.

Since taking office in January, healthcare has been my number one legislative priority, having led, co-led, or cosponsored more than 60 bills in this space.

As we are here today, the people of eastern North Carolina are hurting, and at the root of this pain is the lack of access to healthcare.

To tackle these health disparities, I joined two colleagues in restarting the State Medicaid Expansion Caucus to demonstrate the overwhelming public support for basic access to healthcare.

After more than a decade of waiting, or in some cases dying, over 95,000 eastern North Carolinians will gain access to lifesaving healthcare starting this Friday, December 1.

As co-chair of the State Medicare Expansion Caucus, I will continue leading the charge in Congress to expand Medicaid across the country.

Beyond Medicaid expansion, I have championed the cause of rural hospitals. In the past decade, four rural hospitals in eastern North Carolina stopped operations, creating significant barriers to lifesaving medical care.

Martin General is the most recent example of suspending operations in the East.

While we have limited tools at our disposal, especially in communities where the payer mix skews toward Medicare and Medicaid, the Rural Emergency Hospital Designation Authority is a critical part of the solution.

As eastern North Carolinians grapple with limited access to care, the opioid epidemic continues to plague the region.

To combat this crisis, I introduced bipartisan legislation with Congressman John Rutherford to stem the flow of counterfeit substances, including fentanyl, that have flooded the drug market.

H.R. 4988, the Modern Authentication of Pharmaceuticals Act, will come down hard on counterfeit controlled substances by requiring on- dose identifiers to guarantee the legitimacy of pharmaceuticals. I urge my colleagues to support this legislation and put a dent in the fentanyl crisis.

While eastern North Carolinians and Americans across the country suffer from opioid addiction, patients recovering from injuries face their own barriers to treatment.

To ensure our most vulnerable patients get the care they require and deserve, I will soon introduce legislation to cut red tape for physical and occupational therapists, streamlining the delivery of care for patients recovering from debilitating injuries.

If passed, the legislation would ease the burdensome plan of care requirements that currently prevent payment for physical therapy services until the therapy provider receives a physician-signed plan of care within 30 days of a first evaluation. No patient should ever have to wait unnecessarily for vital healthcare services, including outpatient services.

As a member of the Bipartisan Rural Health Caucus, you can count on me to champion the causes of patients, healthcare workers, and providers alike.

We all have a responsibility in the greatest Nation on Earth to deliver a standard of healthcare befitting this greatness.