August 13,2019

Securing Quality Care: Rural Health in Iowa

Securing Quality Care: Rural Health in Iowa

Prepared Remarks by U.S. Senator Chuck Grassley of Iowa

Chairman, Senate Finance Committee

Hosted by the Bipartisan Policy Center and UnityPoint in Des Moines, Iowa

Delivered on Tuesday, August 13, 2019



I’d like to start by thanking our hosts here at UnityPoint for rolling out the welcome mat. We’re here today to listen to ideas near and dear to our hearts in rural America. More specifically, we’re here to discuss policies to help keep high-quality health care accessible in rural communities.


As we all know, rural communities are struggling to keep health care services available to their residents. According to a national analysis released earlier this year, nearly 18 percent of Iowa’s rural hospitals are at high risk of closing their doors.


Today we’ll have candid dialogue on the unique challenges confronting our rural health care delivery system and the people living in underserved communities. We’re here to learn about obstacles to care and ways to improve our systems of care so rural residents aren’t left behind. We’re not here to just talk the talk. I hope to leave here today with a bipartisan blueprint that will serve as a vehicle to get more lawmakers on board in Washington.


This is a good time to thank the Bipartisan Policy Center for organizing this event here in my home state. As a solutions-oriented organization, you have a deep leadership bench to help shape the debate and steer us forward. For many years, I worked on rural health care issues with Senators Tom Daschle and Bill Frist, during their service as Majority Leaders in the United States Senate. We considered it a special mission to develop commonsense Medicare payment policies that help isolated and underserved communities provide reasonable access to needed medical care as close to home as is possible. Recently however, I haven’t had as much success building bipartisan support to advance targeted rural health policies in the Senate Finance Committee. I welcome and encourage your advocacy to bring solutions to the table and work with me to build a coalition of the willing.


With us today to help set that policy table is a group of well-informed practitioners and health care providers who report to work every day to serve and save lives right here in Iowa. I want to thank Sue Thompson, a VP and chief executive here at UnityPoint in West Des Moines; James Roteman, CEO, Pocahontas Community Hospital; Dawn Bach, Director of Nursing at Buena Vista Medical Center, as well as a heart patient herself, and, Dr. Jennifer McKay, a telehealth medical provider with Avera Medical Group in South Dakota.


Later this month, I will wrap up my 39th consecutive year meeting with Iowans in each of Iowa’s 99 counties. Like most Americans, Iowans share growing concerns about the rising cost of prescription drugs, out-of-pocket health expenses and surprise medical bills. Here in Iowa, we also face additional challenges that are unique to less populated areas of the country.


Employers, civic leaders and hospital administrators routinely convey concerns about the uphill climb to keep hometown hospitals open for business. In addition to providing lifesaving and primary care treatments and services, rural hospitals anchor the local economy for many counties here in Iowa. 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 such as dialysis, radiation and chemotherapy. I know that some of you are struggling 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 our rural communities. People struggling with mental illness have trouble finding care and treatment. The downturn in the farm economy and catastrophic flooding affecting Iowans across the state have further exposed the critical shortage of mental health services for Iowans who need them.


Beyond the lack of access to specialty care, some rural communities are facing the stark possibility of having no health care services available in their county whatsoever. In the most plainspoken terms, I’d like to share a message to these rural communities: Not. On. My. Watch. I’ll continue to leverage my leadership assignments, champion innovative solutions and raise my voice to educate policymakers and lawmakers in Washington: Rural health care matters.


It matters to a farmer in Audubon County whose pant cuff gets caught in the grain auger and requires emergency treatment to save life and limb. It matters to an expectant mother in Ringgold County who must drive hours for routine pre-natal appointments and has concerns about getting to the hospital in time for labor and delivery. It matters to Iowans who are struggling to cope with the financial burden and emotional toll of flood-ravaged homes, farms and business and who have limited options to access mental health services.


The good news is, we’re here today having an important dialogue to discuss meaningful solutions and to find a path forward.


First, let’s review some of the policies that have already made a difference. More than two decades ago, I wrote the bill that created the Critical Access Hospital program. These hospitals are a lifeline to rural communities. I’ve worked tirelessly to expand, improve and protect this program from the chopping block in Washington.


In 2003, I also shepherded the landmark Medicare Modernization Act into law, which made dramatic improvements in rural health care. I championed several of its provisions to help rural hospitals achieve fiscal sustainability, including the low-volume adjustment payment formula; increased reimbursements for Critical Access Hospitals; and, creation of the Rural Community Hospital Demonstration Program for so-called “tweener” hospitals.


Most recently, in February of 2018, Congress passed a bipartisan budget caps deal which extended the Medicare-Dependent Hospital and low-volume hospital programs for 5 years, the longest extension of both programs. That same bill extended the GPCI floor, permanently repealed Medicare’s therapy cap, and extended rural ambulance add-on payments and paving the way for ambulance cost reporting.


By all accounts, these programs are pivotal policy instruments to help maintain access to health care in rural America. Thankfully, hospital closures that are happening in other parts of the country are not as common in Iowa. However, we must be pro-active and keep asking ourselves an important question: What needs to be done today so that you’re here to serve Iowans tomorrow?


The good news is there are viable solutions with new models of care on the horizon. The delivery of health care is changing and policy needs to keep pace with technology. Telemedicine has tremendous potential to help solve many of the challenges confronting rural communities to maintain access to high-quality care. Consider a diabetic patient who lives two counties away from the nearest eye doctor. Skipping regular eye-checks due to lack of access could lead to blindness. Vision screenings via telemedicine makes common sense. I’ve introduced a bipartisan bill that would allow rural diabetic patients to receive regular vision screenings using telemedicine. Cutting ridiculous red tape and prioritizing telehealth services will grow patient volume, expand access, improve care and increase flexibility. 


In the first seven months at the helm of the Senate Finance Committee, I’ve focused on reducing prescription drug prices, addressing the opioid crisis and the pervasive scourge of methamphetamine in our communities, and fixing lax enforcement and substandard care in nursing homes. I’m confident these priorities are shared by your health systems, your workforce and patients in the communities you serve.


With the new school year about to begin, I’ll close today by giving you each a homework assignment. As you know, the soaring costs for prescription drugs has struck a chord in America. I’m asking each of the stakeholders in this room to help spread the word with your communities. My bipartisan Prescription Drug Pricing Reduction Drug Act passed out of the Finance Committee last month 19 to 9. As chairman of the committee, I’m working to drum up grassroots support to keep up the momentum. As you might imagine, it’s facing blow-back from deep-pocketed special interests.


My bill would bring sorely needed transparency to the drug supply chain. I’ve held three committee hearings this year to examine the drug pricing issue. Ranking member Wyden and I exposed a cockamamie drug pricing system that virtually no one can make heads or tails of, let alone justify with a straight face. It’s time to throw some sunshine into the process and hold Big Pharma and pharmacy benefit managers accountable for the sticker shock hitting consumers. My bill is also good for seniors and taxpayer wallets. It would save taxpayers $100 billion and put a cap on out-of-pocket costs for seniors on Medicare Part D. With enough momentum, I’d like to see the president sign a comprehensive package of drug pricing reforms into law before the end of the year. That includes other bipartisan bills that have my support from the Senate HELP and Judiciary Committees.


Before I open up my time for questions, I encourage Iowans in the audience to take advantage of this opportunity to listen, ask questions and provide your feedback. As Iowans know, I take representative government very seriously. The team here from the Bipartisan Policy Committee chose to come to Iowa. And I’m glad they did. Let’s make the most of it. They have good ideas to share and with your input, they can incorporate your good ideas to inform the work they do:  building bipartisan coalitions to get targeted rural health solutions across the finish line.  And that’s really the bottom line here … keeping rural health care systems financially viable to strengthen economic vitality, access to care and our way of life in rural America.