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Lankford Advocates for Continued Rural Health Access

CLICK HERE to watch Lankford’s floor speech.

WASHINGTON, DC – Senator James Lankford (R-OK) today spoke on the Senate floor to advocate for rural access to healthcare by calling on his Senate colleagues to include his Rural Hospital Relief Act in any legislation addressing the COVID-19 pandemic. The bill would be a permeant solution to update Medicare’s Critical Access Hospital (CAH) designation so more rural hospitals can qualify for this financial lifeline and continue to serve their communities with quality, affordable health care services.

In April Lankford and Durbin wrote a letter to Health and Human Services Secretary Alex Azar to ensure rural hospitals have the needed support to respond to the COVID-19 pandemic and maintain financial stability to continue severing their communities. The two members also called on Senate Leadership to clarify eligibility for publicly owned hospitals and similar care providers within the Paycheck Protection Program (PPP).


Senator Durbin and I have worked for months on an issue on rural health care, whether it is in rural Illinois or in rural Oklahoma, there is a challenge dealing with rural hospitals and sustaining their viability. So he and I partnered together to be able to determine what is the best way to be able to get a solution that is a long-term solution to what they’re currently facing with COVID-19. While COVID-19 has impacted all types of businesses, rural hospitals have uniquely dealt with some very difficult challenges both with getting PPE early on in the process, much more challenging for rural hospitals than it was for urban. Keeping doctors, managing separation, getting airflow areas in hospitals to be able to manage the flow of the virus through areas, and also managing just patient count. Where for many rural hospitals they just shut down because all elective surgeries stopped and such and so they lost all of that income, though they still had all the employees, an exceptionally challenging thing. 

But it’s challenging on top of the challenges they already faced for decades in just surviving in rural America. So what Senator Durbin and I have brought is a reasonable, nonpartisan solution to how we can deal with not only COVID-19 but the health of rural hospitals long-term. Decades ago Congress established something called the Critical Access Hospital to make sure those hospitals that were designated as Critical Access Hospitals would receive proper reimbursement from the federal government for health care services. Many individuals in rural areas, in fact, the dominant proportion in many rural areas receiving health care receiving it through Medicaid or Medicare. We want to make sure that those providers providing those high-need areas are reimbursed appropriately. But in 2006, Congress shifted the designation for Critical Access Hospitals and took away something called the necessary provider, giving the flexibility to the states.

As a result of that action in 2006, we’ve seen the closure of 118 rural hospitals nationwide since that time period. The Critical Access Hospital designation was created because of a string of hospital closures in the 1980’s and early 1990’s. But yet we’ve not responded in the way that we should from the change in statute in 2006. Simply what we’re trying to do is to able to give that flexibility back to states again—that if they have a hospital in a rural area that is the only provider in that community that is Medicare-dependent hospital, is a very small hospital with fewer than 50 beds, that area has to be an area designated as a rural area. It can’t just be any suburban area or any other type of hospital. It has to be a rural hospital in particular. It has to have a high percentage relative to the national average of individuals with income below the poverty line. 

Those hospitals in those locations could be designated by their states as a necessary provider and be treated as if they are a Critical Access Hospital. What would that do? That would be a lifeline for reimbursement, because now we have some rural hospitals designated as Critical Access and some hospitals that meet all the other criteria, but they may be 34 miles away from another hospital. That hospital and that county dies, the other hospital survives. Or in my state, where we have a Critical Access Hospital 34 miles away from a hospital across the border in Texas. So, the hospital in Oklahoma can’t get the Critical Access designation and can’t survive because 34 miles away there’s a hospital in another state that has the Critical Access. 

We need the flexibility in our states to be able to renew this kind of designation. For Senator Durbin and I we’ve run this through a lot of places and a lot of people and gotten a lot of technical input in it to be able to make sure ensure this actually works for our rural hospitals and make provides not just a short-term survival through COVID-19 but also provides a long-term stability for them. This is the type of work we should do together to make sure we stabilize those rural hospitals. They are a lifeline to people in rural America. They are a lifeline of employment and they are a stable feature in every community. And without it, those communities dry up because people need access to health care and this is the way that they can get it. So I’m glad to be able to partner with Senator Durbin on this issue, and it is our hope to be able to get this into the next bill dealing with COVID-19 in the days ahead. Quite frankly, it was our hope to get it into the last one and we didn’t get it, and into the one before that. And surprisingly enough everyone seems to be nodding their head on both sides of the aisle that’s a good idea, it seems to be effective. We want to move it from that’s a good idea to done for rural hospitals across the nation. With that, I would yield the floor.