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Chairman Smith Opening Statement – Markup of Health Care Legislation

May 08, 2024

“One of our top priorities on this Committee is helping every American access health care in the community where they live, work, and raise a family. 

As prepared for delivery.

“One of our top priorities on this Committee is helping every American access health care in the community where they live, work, and raise a family. 

“In rural America and small towns, families often struggle to get health care.

“600 rural hospitals are on the brink of closing forever. People in remote areas sometimes have to wait up to 30 minutes after dialing 9-1-1 before an ambulance arrives. Small towns are facing a severe shortage of doctors and nurses, and patients have to disrupt their lives to drive hours to routine appointments.

“The lack of access to emergency and outpatient services and preventative care is one of the reasons why rural Americans have a 43 percent higher mortality rate than urban Americans. Congress has a responsibility to the millions of patients living in rural America to make sure they have access to reliable, quality, lifesaving care. 

“That is why, today, the Committee is marking up legislation that protects, expands, and secures our health care system in rural and underserved areas.

“The first bill we will consider was introduced by Congressmen Schweikert and Thompson and protects access to at-home health care options, like telehealth. This bill was the product of legislation from nine Committee members, including Vice Chairman Buchanan’s provision to allow access to telehealth regardless of where the patient is located and Congressman Hern’s policy that expands telehealth options for behavioral health patients. 

“In addition to expanding telehealth, a policy championed by Dr. Wenstrup and Mr. Blumenauer will allow Medicare patients to receive inpatient, hospital-level care at their homes. Only a few short years ago, these possibilities seemed unthinkable but are now revolutionizing care for seniors on Medicare and those living in rural areas. Without this bill, beneficiaries will no longer be able to talk to their doctors or receive acute hospital care from the comfort of their home starting at the end of this year.

“Dr. Wenstrup and Ms. Sewell have included legislation that provides critical funding to preserve emergency ambulance services for families living in all types of communities. 

“The next bill we will consider permanently expands emergency ambulance access in mountainous communities, like the ones that the bill’s sponsor, Congresswoman Miller, represents in West Virginia. This bill gives ambulance services in rural areas the same treatment as the Critical Access Hospitals serving those communities. With this bill, patients who live on winding back roads in mountainous areas will have greater access to life-saving ambulance services.

“Our third bill addresses the crisis of hospital closures in small towns. Between 2005 and 2022, 186 rural hospitals shuttered. Today, many more are on the brink of closing forever. Without these hospitals, small towns face a future with no inpatient care and no emergency rooms. This legislation, introduced by Congressman Feenstra, authorizes annual grants for struggling rural hospitals on the brink of closure. With this additional funding and technical assistance, rural hospitals can stabilize their finances and continue serving patients in their community.

“The next bill addresses the shortage of Certified Nursing Aides. Ninety-nine percent of nursing homes have job openings, and the Biden Administration’s new nursing home mandate will require these homes to hire an additional 100,000 nurses and nurse aides. America needs to train more nurses to fill the need. The bill offered by Congressman Estes allows nursing homes that received fines for minor reasons, unrelated to direct resident care, to continue training Certified Nursing Aides to grow this critical workforce.

“The fifth bill from Dr. Murphy tackles the severe shortage of doctors in rural communities. Rural communities have 60 percent fewer doctors compared to urban areas. When medical students complete residency in rural areas, they are more likely to practice in that same community. Congress has recognized this disparity and allocated 120 of new residency slots to rural hospitals. Unfortunately, we’re not seeing this distribution play out in reality. So far, of the 93 distributed slots classified as rural, only 12 went to truly rural hospitals and the other almost 90 percent went to urban hospitals that are exploiting a loophole. This bill closes that loophole, so these residency slots are filled at truly rural hospitals. 

“Our last bill helps more rural hospitals take advantage of a promising new designation that can preserve or bring back services to patients in rural America. In 2020, Congress created the Rural Emergency Hospital structure to allow struggling facilities to maintain emergency and outpatient services in their communities. However, the eligibility rules are restrictive and hospitals could only qualify starting in 2023. The legislation today from Chairman Arrington expands the designation to hospitals that have closed since 2014. Because of this bill, more Americans will have the opportunity to get life-saving care in their hometown.

“Together, these policies will achieve a giant leap forward in addressing the lack of access to health care in America’s rural and underserved communities.”