OPINION:
Across America, rural healthcare is in crisis. Since 2010, 206 rural hospitals have ended inpatient care or shuttered altogether, while another 417 are at risk of doing the same. Among the hospitals that remain open, tight margins have forced many to slash services, especially for specialty care. Over the same time, more than 300 have ended general surgery programs, while more than 450 have terminated chemotherapy treatment.
In Tennessee where 78 of our 95 counties are considered rural these trends have hit our communities especially hard. Per capita, Tennessee leads the nation in rural hospital closures, and 21 of our counties have no hospitals at all. For residents of these communities, routine check-ups become hours-long commutes. Preventive care becomes a luxury. And otherwise treatable medical emergencies become life-threatening.
Medical data document the tragic consequences. Compared with urban counties, rural ones face far higher rates of early death from cancer, heart disease, stroke, chronic lower respiratory disease and unintentional injury. Instead of shrinking, these disparities are widening over time. Among Americans between the ages of 25 and 54, the gap in mortality rate between rural and urban areas grew from 6 percent in 1999 to 43 percent in 2019.
No American’s ZIP code should be the deciding factor in whether they lead long, healthy and rewarding lives. The tens of millions of Americans who reside in rural areas are no exception. Thankfully, Congress is taking major strides to ensure that every American has access to quality healthcare.
As part of the Working Families Tax Cuts, or One Big Beautiful Bill, I successfully fought for the creation of the Rural Health Transformation Program, which will provide $50 billion to strengthen rural healthcare across our country. In December, the program disbursed its first grants including $207 million to Tennessee to increase workforce capacity, eliminate maternity-care deserts, expand access to telehealth services and improve preventive care.
While this program is a huge win for the American people, there is much more Congress can do. As co-chair of the Senate Rural Health Caucus, I recently reintroduced my bipartisan Rural Health Agenda to address the core challenges facing rural healthcare: workforce shortages, underinvestment in facilities, and flawed Medicare reimbursement.
Start with workforce shortages. With higher patient volumes, urban hospitals often offer higher compensation than rural ones, which struggle to attract physicians. Even when accounting for population size, rural communities have approximately half the number of providers as urban areas, and close to 9-in-10 rural census tracts are considered Health Professional Shortage Areas. To encourage healthcare professionals to plant roots in rural communities, my Rural America Health Corps Act would offer them up to $200,000 in student loan repayments if they agree to work full-time for five years in rural areas facing workforce shortages.
Next, underinvestment in facilities. For years, constrained budgets have forced many rural hospitals to forgo routine upgrades, leaving them in desperate need for improvements. While national data on the age of rural health facilities are scarce, many were built with funds provided by the 1946 Hill-Burton Act and have gone decades without meaningful renovations. To ensure these facilities have the resources they need to provide quality care, my Rural Health Innovation Act would provide grants to Rural Health Clinics and Federally Qualified Health Centers to strengthen their ability to provide walk-in urgent care, triage, and emergency stabilization services.
Finally, Medicare reimbursement. For years, the flawed Medicare Area Wage Index has forced rural hospitals to accept lower payment rates than high-wage urban markets. Across the board, rural facilities receive reimbursements that are 20 percentage points lower than urban ones for the exact same services. For the most rural areas, that gap is over 30 percentage points. My Save Struggling Hospitals Act would correct this by ensuring that all hospitals receive fair Medicare reimbursement for the essential services they provide.
Americans living in rural areas deserve every opportunity to thrive. The Rural Health Agenda would help make that aspiration a reality, ensuring that every American has access to quality healthcare no matter where they call home.
• Sen. Marsha Blackburn is the senior senator for Tennessee and serves on the Finance Committee.
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