I thank the witnesses for coming in this morning, and I look forward to hearing their testimony.
I believe that there is room for us to work together to address how we deliver health care to people in rural areas. But I also believe that, if we are going to have a serious conversation about this topic, we need to get our facts straight.
Time and again, I hear from my Republican colleagues about rural hospitals closing down, threatening access to health care for many communities. As they do with virtually every perceived problem in the health care system, my colleagues place the blame for this squarely on the Affordable Care Act.
But there’s another side to this story.
One of the major financial strains placed on hospitals is uncompensated care. When patients, many of whom are poor and quite sick, are not covered by insurance and cannot afford to pay out of pocket, hospitals have to pick up the costs.
We recognized this problem when we passed the Affordable Care Act. And we worked to reduce uncompensated care dramatically through an expansion of coverage under Medicaid. This would provide some of the most economically vulnerable people, many living in rural and underserved areas, with access to coverage.
However, under Republican leadership, more than 20 states simply refused to accept Medicaid expansion, simply because it was part of President Obama’s Affordable Care Act. Their decision has left 4.3 million of their residents uninsured, forcing hospitals - many of which serve rural areas - to pick up the costs.
And, not coincidentally, 80 percent of recent hospital closures are in states that chose not to expand Medicaid.
This is not a problem with Medicare regulations governing rural hospitals, nor is it a problem with the Affordable Care Act. It is a problem with a Republican Party that would prefer to sabotage the President’s health care law for political purposes rather than try to make it to work.
So, if we want to improve access to care and address the issue of rural hospital closures, we need to start by convincing our Republican friends to do what they should have done in the first place and expand Medicaid.
To address the needs of rural communities, we also need to make long-term investments in our health professional workforce.
The United States faces a growing shortage of physicians nationally, projected to reach between 46,000 and 91,000 by 2025.
Rural areas are going to have a particular scarcity of physicians, particularly in primary care.
But we should be skeptical that the solution to this problem lies in gutting Medicare support for graduate medical education in urban areas.
There is minimal evidence that this will result in more doctors practicing in rural areas. It will simply exacerbate the nationwide doctor shortage and lower the quality of training they receive.
There are better ways to train physicians to serve in rural areas, and I encourage my colleagues to look to creative alternatives. The University of Washington, for example, runs an innovative regional partnership called WWAMI that trains physicians throughout the Northwest.
The program is the finest in primary care and rural medicine in the country, and it has ably served the needs of communities in Washington, Wyoming, Alaska, Montana and Idaho for more than four decades.
And there are other investments we can make. We can treat the medical profession like we treat the armed services and provide ROTC-style medical school scholarships to physicians who agree to a tour of service in underserved areas. I call this idea RDOCS, and I believe that it is a smart investment that will get young physicians to practice and - most importantly - stay in rural areas.
Moving forward, rather than attacking our existing programs and pitting urban areas against rural areas, I invite my colleagues to consider alternatives that will make a meaningful difference for rural communities.
Thank you and I yield back.
