August 16,2019

Grassley op-ed: Improving rural health care

Improving rural health care

By Senate Finance Committee Chairman Chuck Grassley


Rural communities are struggling to keep health care services available to their residents.

Like most Americans, Iowans share growing concerns about the rising cost of prescription drugs, out-of-pocket health expenses and surprise medical bills. In states such as Iowa and Nebraska, we also face additional challenges that are unique to less populated areas of the country.

During my annual 99 county meetings, health care employers and hospital administrators routinely tell me about their uphill climb to keep hometown hospitals open for business. In addition to providing lifesaving and primary care treatments and services, rural hospitals anchor local economies. They often serve as the primary employer and an important recruitment tool for employers trying to grow their workforce in a highly competitive labor market.

In Iowa and in other rural states, residents are challenged by geographic isolation, severe weather and transportation obstacles to see a doctor or nurse practitioner for basic primary care services, let alone receive specialized medical treatments. Some rural health care providers struggle to meet local demands to furnish a full range of inpatient, outpatient and rehabilitation services.

A different set of barriers confronts hospital administrators who must meet the bottom line to make payroll and pay the bills to keep the lights on and the doors open. Low patient volumes and difficulties recruiting and retaining health care professionals present big challenges in the rural health care space.

There’s also a shortage of mental health professionals in rural communities. People struggling with mental illness have trouble finding care and treatment.

With so many challenges facing rural communities, the last thing they need is to worry about is if they’ll be able to pay for the medications they’re prescribed. That’s why I’ve been working with my Senate colleagues to reduce the price of health care, particularly prescription drugs.

The bipartisan Prescription Drug Pricing Reduction Act passed out of the Finance Committee last month 19 to 9. This bill would modernize and improve the successful Medicare Part D benefit by simplifying the program’s design and putting a cap on out-of-pocket costs for seniors and other Part D beneficiaries.

It would increase transparency into middleman practices, including pharmacy benefit managers (PBMs), as well as manufacturer drug pricing decisions. It would also eliminate excess Medicare Part B drug payments that drive up beneficiary and program costs.

The Prescription Drug Pricing Reduction Act would also allow the Medicaid program to pay for gene therapies for rare diseases through new risk-sharing, value-based agreements. That would help increase access to life-saving, miracle treatments that many lower-income and vulnerable citizens didn’t have before.

Added to other rural health initiatives, such as my legislation that created the Critical Access Hospital program and the Medicare Modernization Act, the Prescription Drug Pricing Reduction Act would provide real solutions to many rural Americans who desperately need relief.

No rural community should ever have to go without health care services, yet for too many, that is a real possibility. I’ve been working to make sure that doesn’t happen. And I will continue to do so.

Progress has been made, but there is much more to be done. Thankfully, as technology advances, so do health care delivery methods. Telemedicine has tremendous potential to help solve many of the challenges confronting rural communities to maintain access to high-quality care. Cutting red tape and prioritizing telehealth services will grow patient volume, expand access, improve care and increase flexibility.

No one should have to settle for limited health care services because of where they choose to live. I’ll continue to work with my colleagues on both sides of the aisle to address the health care challenges facing our rural communities and deliver substantive solutions.