Durbin Delivers Remarks At NRHA’s 34th Rural Health Policy Institute Conference

Durbin highlights his SIREN Act, work to help address the rural health care workforce shortage, and more

WASHINGTON – U.S. Senate Majority Whip Dick Durbin (D-IL) today delivered remarks at the National Rural Health Association’s (NRHA) 34th Rural Health Policy Institute conference.  Durbin highlighted the importance of rural health care; the effects of the COVID-19 pandemic on rural hospitals; and bipartisan legislation Durbin is working on in Congress, such as the Rural Hospital Closure Relief Act—legislation to update Medicare’s “Critical Access Hospital” designation.  Durbin also spoke about his Supporting and Improving Rural EMS Needs (SIREN) Reauthorization Act with Senator Susan Collins (R-ME), bipartisan legislation that would extend funding to hire staff and purchase equipment for rural fire and EMS agencies nationwide.  He also spoke about his bipartisan Rural America Health Corps Act, which would address critical rural health workforce shortages by creating a new program that improves the existing National Health Service Corps (NHSC) program by providing new dedicated student loan forgiveness funding for health care providers that serve in rural communities.  In President Biden’s American Rescue Plan, Durbin secured $1 billion in scholarships and student loan repayment for clinicians and nurses.

Durbin also addressed the rural health workforce crisis, and reiterated he will continue to work to address this shortage.  In Illinois, 94 percent of our rural communities don’t have enough mental health care providers, more than half of the nearly 195,000 registered nurses are over the age of 55, and one-in-four say they plan to retire in the next five years.  Fewer than 8,000 nurses graduate from Illinois nursing schools each year.

Photos of the event can be found here and Durbin’s remarks as prepared for delivery are below

U.S. Senator Dick Durbin Remarks for the National Rural Health Association Rural Health Policy Institute Conference

February 7, 2023

As prepared for delivery 

I want to thank Pat Schou for those kind words.  More importantly, Pat, thank you for all you do to keep the people of our state healthy.  I want to recognize the President of NRHA, Leslie Marsh and your CEO, Alan Morgan.  Thank you for inviting me to be part of NRHA’s 34th Annual Policy Institute. 

Welcome back to Washington, D.C., NRHA members!  The last time I spoke at an NRHA Policy Institute was February 2020.  What have you been up to?  Keeping busy?  Just kidding.  I know what you’ve been doing.  You’ve been keeping rural hospitals and health centers open, and keep your communities safe during the worst public health crisis in a century.  

Trying to hire and retain good doctors, nurses, EMTs, and other health professionals and keep morale up— even when your entire staff was exhausted from working long hours and double shifts.  Well, I’m here to thank you for your dedication and sacrifices these last three years.  The way I see it, you all deserve medals. 

I know how important rural health care is.  In my state, 60 percent of our counties are rural.  You all know this, but folks in rural areas across America are more likely to die prematurely from chronic diseases, suicide, and drug overdoses.  Despite that, the ratio of providers to patients is lower in rural communities than in cities and suburbs. 

In Illinois, our rural areas have only 45 physicians per 100,000 residents, compared to 90 physicians per 100,000 in urban parts of our state.  That means rural Illinois has half the rate of doctors.   And of course, people in rural areas have to travel longer distances to get health care. 

Not only are hospitals the economic backbone of many small towns, they also are the main source of care in many rural communities – not only for emergency and in-patient care, but also for primary care.  Even before the pandemic, they were fighting an uphill battle.  Nearly half were operating in the red.

The American Hospital Association warns that more than 600 additional rural hospitals – nearly 30 percent of all the rural hospitals in America – are at risk of closing in the near future.  And more than 200 are at immediate risk of closing. 

When a rural hospital closes, jobs disappear.  Doctors leave.  It becomes harder for existing businesses to stay afloat, and harder to attract new businesses. Schools and churches struggle, and families pull up roots.  This isn’t only a rural problem.  With rural communities producing nearly all of America’s food and fuel, this is a national crisis.

Before anyone had even heard of COVID-19, I teamed up with Senator James Lankford, of Oklahoma, a conservative Republican, to update Medicare’s “Critical Access Hospital” designation. 

This update would make more rural hospitals eligible for this financial lifeline so they can continue to serve their communities with quality, affordable health care services.  Our bill is called the Rural Hospital Closure Relief Act.  We plan to re-introduce it soon.  NRHA has endorsed it – thank you for that.  And with your help, I hope we can persuade Congress to finally pass it – this year.

I also came up with a plan to provide federal grants to rural EMS agencies, to help them recruit and train personnel and purchase equipment—everything from naloxone to power stretchers.   

Back in 2018, I found a good Republican partner in Senator Pat Roberts of Kansas, who was chairman of the Senate Agriculture Committee at the time.  We called our bill the SIREN Actand we were able to include it in the last Farm Bill. 

So far, $18 million in grants have been awarded, and the next round of grants—totaling $10 million—will be going out soon.  I know Robin Rose and Rob Schmitt from Gibson City Hospital are here today, they’ve received one of these grants, and I hope many more in this room do soon.  

Two years ago, Congress passed President Biden’s American Rescue Plan, which helped nearly 700,000 rural Americans gain health care coverage and directed $8.5 billion to rural providers to help cover soaring costs associated with COVID-19.

The Inflation Reduction Act, which President Biden signed last August, allows Medicare -- finally -- to negotiate prescription drug prices, which will lower prescription prices for all Americans and save Medicare $286 billion dollars. 

We also capped insulin costs for folks on Medicare at $35 a month.  Democrats want to go further and cap insulin prices at $35 a month for all Americans.  By the way, Congress passed both the American Rescue Plan and the Inflation Reduction Act without a single Republican vote.

Tonight, when President Biden delivers his State of the Union Address, I expect that strengthening America’s health care safety net will be one of his top priorities.  I share that priority.  Of course, the factors driving America’s rural health crisis didn’t start with COVID-19.  They’ve been building for years.  The pandemic just put a spotlight on them.

As pandemic relief from Washington starts to wind down, we need to find new ways to strengthen the rural health care safety net.  As you know, there are many pieces to that puzzle.  One promising example appears to be telehealth.  Millions of Americans participated in their first telehealth appointments over the past three years.

Yesterday, I met with a psychiatrist at a community health center who told me how their no-shows and cancellations went away by using telehealth.  It’s helped reduce barriers to accessing care and I believe we should continue to study the experience of the last few years—while making sure we have appropriate guardrails in place, especially when it comes to prescribing medications.  I want to tell you about another important piece that I’m working on with rural providers in my state.  That’s the nationwide rural health care workforce crisis.

Increasing the number of doctors, nurses, and other health professionals working in rural areas, I am convinced, will reduce some of our other health care challenges – including rural hospital closings -- and improve the vitality of rural communities.

Here are  some of the statistics that grabbed my attention: In Illinois, nearly 30 percent of our rural hospitals suffer from a shortage of primary care doctors.   Ninety-four percent of our rural communities don’t have enough mental health care providers.  More than half of the nearly 195,000 registered nurses in our state are over the age of 55—and one-in-four say they plan to retire in the next five years.  Yet fewer than 8,000 nurses graduate from Illinois nursing schools each year. 

I’ve been working with rural health providers, medical and nursing schools, community colleges, businesses, and civic leaders to come up with solutions to these health care shortages.  Our plan is to come up with a roadmap – a set of policy recommendations that we all agree on – to grow Illinois’ rural health workforce and then work together to achieve our goals.

We’re focusing on three key areas:  First, working with high schools and community colleges to expand the pipeline of students who want to pursue health care careers – everything from doctors and nurses, to respiratory therapists, lab technicians, imaging specialists, mental health counselors, EMTs and more.

Second, build the capacity of clinical education programs -- by expanding the number of nurse faculty and increasing the number of residency slots for doctors.  Third, enhance recruitment programs to increase the number of health professionals to live and work in rural communities.

My job in this partnership will be to try to convince Congress to support these efforts with funding … and new legislation, if necessary. 

Here’s an example of the kinds of solutions were looking at: As you know, a big reason for the rural health workforce shortage is student debt.  When medical professionals graduate with astronomical amounts of student loan debt, they can’t afford to work in rural communities, no matter how much they may want to. 

Remember President Biden’s American Rescue Plan that I mentioned?  I put a provision into that measure that invested $1 billion – with a B – into the National Health Service Corps.

This investment supports scholarships and student loan repayment for doctors, nurses, dentists, and behavioral health providers who commit to work in rural and urban areas in need.  This was the largest single-year appropriation to our health care workforce in history.  And it’s already paying dividends. 

At the same time, Senator Marsha Blackburn, a conservative Republican from Tennessee, and I asked ourselves:  What if we increased the incentives to reward health professionals who choose to live and work in rural communities? 

Right now, only 140 of the 788 health professionals working in Illinois through the National Health Service Corps are in rural areas.  That’s only 17 percent—not nearly enough to close the discrepancy in rural parts of our state.

So we’ve introduced a bill called the Rural America Health Corps Act.  It would increase to the total amount of loan forgiveness under the National Health Service Corps from $50,000 to $200,000—reflecting the real cost of medical education—in exchange for five years of service in a rural area.

We think it’ll convince more folks to choose rural, and ultimately plant roots down.  We’ve been building support for it. Our hope it to pass it this year.  The Rural America Health Corps Act and other solutions we plan to include in our “roadmap” would help reduce rural health care shortages not only in Illinois, but in every state.  We welcome your support. 

I could go on about solving America’s rural health care crisis, but you have a lot of other speakers to hear from, so I’ll stop here.  In closing, I want to thank you again for all your hard work. Together, we can repair America’s rural health care safety net.  I’m grateful to be your partner in that important work.