Rural Health and Economics
Senate Testimony: The National Rural Development Partnership
Prepared Testimony of Claude Earl Fox, M.D., M.P.H.
Administrator, Health Resources and Services Administration
Before the Agriculture, Nutrition and Forestry Subcommittee on Forestry,
Conservation and Rural Revitalization
United States Senate
Washington, D.C.
March 8, 2000
Good afternoon, Senator Craig.
I want to thank you and the Committee for the opportunity to provide testimony
on our experience with the National Rural Development Partnership. I currently
serve as the Administrator for the Health Services and Resources Administration
at the Department of Health and Human Services but I come by my interest and
concern for rural America honestly. I was born in a rural hospital, grew up in a
small rural town, and have worked in and with rural communities most of my life.
During my time as the State Health Officer in Alabama, I chaired the Alabama
Task Force on Rural Hospitals and was part of an important effort there to help
champion the critical role these facilities play in their communities.
Now, as Administrator of HRSA, I oversee an agency that puts a great deal of
resources into rural communities through a variety of programs such as the
Community and Migrant Health Center Program, the Maternal and Child Health Block
Grant, the Rural Health Outreach Program, and the Area Health Education Center
program, just to name a few.
As you know from your own home state, the challenges faced by rural communities
are many. Resources are limited, poverty rates are high and rural communities
are notoriously susceptible to economic downturns when crop prices drop or
natural disasters strike. Higher rates of rural poverty increase the importance
of temporary financial assistance, child care subsidies,
Head Start and other social services programs.
The rural health care system is also quite fragile. Hospitals in rural areas are
disproportionately dependent on Medicare and Medicaid reimbursements.
Communities have a hard time attracting and retaining doctors and other health
care providers. Rural hospitals and rural health care systems play a much larger
role in their local communities than simply providing health care
services.
They are often among the largest local employers and a bellwether of the
economic health of a small town. Research shows that the health sector provides
10 to 15 percent of the jobs in many rural counties, and that if the secondary
benefits of those jobs are included, the health care sector accounts for 15 to
20 percent of all jobs. On an individual employer basis, hospitals are
often second only to school systems as the largest employer in rural counties.
Studies on industrial and business location also conclude that schools and
health services are the most important quality-of-life variables in these
decisions. A strong rural hospital can be a solid foundation for a strong small
town with a diversified local economy and can serve as a magnet for other
economic development. Conversely, a struggling rural hospital or the closure of
a small rural hospital can often have the opposite impact on a small town
through lost jobs and disincentives for businesses to locate and grow.
The Department has an ongoing commitment to rural America. The Office of Rural
Health Policy, within my agency, was given the responsibility by Congress to
advise the Secretary on rural health issues and policy. And I must say, that
office has done a good job of highlighting the unique health needs and
situations of rural communities and families. They’re actively engaged in the
regulatory process and work with HCFA to make sure Medicare and Medicaid
policies are fair to rural communities. The Office also runs a variety of grant
programs that help build, support and sustain the rural health care
infrastructure.
That is just one part of the equation, though. The challenge comes in making
sure we have a coordinated rural perspective, both within HHS and across the
Government. Enter the National Rural Development Partnership (NRDP), providing
HHS with information and encouragement to broaden our perspective. Early in the
process, the Department of Agriculture invited HHS
to participate in this effort to bring together rural stakeholders. We began our
work with USDA on the development of the Presidential Initiative in 1990 and
began contributing financially to the effort in 1991. HHS currently contributes
approximately $422,000 annually and considers this sum a sound investment in a
resource that continues to pay dividends. HHS also provides active staff
representation to the National Rural Development Council. In fact, the HHS
representative to the Council, Dianne McSwain, has served as the chair of the
National Council for the last two years.
Since 1991, our work with the Partnership has helped HHS build an increasingly
effective internal “rural voice.” By that I mean we try to understand and
account for the impacts our decisions have on rural communities. This has been a
detailed process of raising awareness among our programs and staff offices. An
important milestone was the establishment of a Department-wide workgroup and
getting that workgroup recognized as a resource for rural input. I wish that I
could say that the work is done, but we recognize that raising awareness and
educating our colleagues is a continuous process.
Let me share with you several examples of our successes, using the NRDP
resource:
· During the development of the review criteria for the state health care reform
waivers, the Health Care Financing Administration worked with the HHS rural
workgroup to identify appropriate questions on the impacts of these waiver
proposals on rural populations. The HHS rural workgroup worked through the NRDP
Healthcare Taskforce to identify issues and concerns and to translate that
information into the question format that would be most helpful to HCFA. There
is no question that this input resulted in a more effective review process,
better service to the states applying for waivers and, eventually, a more
responsive program response.
· When the Administration for Children and Families developed the Temporary
Assistance for Needy Families regulations, the NRDP again worked with the HHS
rural workgroup to provide ACF with comments on the potential impact of the
proposed TANF rules on rural families. As the TANF rules have been implemented,
several State Rural Development Councils have been very involved in welfare
reform efforts in the rural communities in their states. ACF and the Assistant
Secretary for Planning and Evaluation have worked to be responsive to the unique
challenges of welfare reform in rural communities by funding research which
includes rural-specific components and be providing technical assistance
targeting those serving rural recipients.
· The NRDP Healthcare Taskforce assisted HRSA and HCFA in the development of a
rural perspective in the State Children’s Health Insurance Program outreach
strategies. This work included putting together a rural subcommittee for the
White House SCHIP Taskforce and developing a rural chapter for the White House
SCHIP Outreach report. The NRDP
also worked with the 36 State Rural Development Councils to provide rural
comment during the recent SCHIP regulation development process.
· Recently, the HHS rural workgroup sponsored a meeting on rural child care in
conjunction with the NRDP Welfare Reform Taskforce. Subsequently the NRDP and
the HHS Child Care Bureau have forged an ongoing working relationship. For
example, the Child Care Bureau devoted their most recent bi-annual Leadership
Forum to issues of rural child care with
Partnership members serving on the steering committee and as presenters. The
Associate Commissioner of the Child Care Bureau has just participated in the
NRDP National Policy Conference.
I could go on to list many more instances where the NRDP and the State Rural
Development Councils have assisted HHS to do a better job. The Partnership is
just that – a partnership of all levels of government and the private sector
working together to ensure that our programs reach the people they are supposed
to serve and do it as efficiently and effectively as possible. As
a Federal administrator and a rural person, I am glad that the “rural voice” of
the Partnership is available to my staff and myself.
By the numbers: Rural Doctors and Rural Economies
www.ruralmedicaleducation.org