Support for Hospitals Needed to Bolster Access to Rural Health Care

By Secretary Mike Espy

One Country Project
4 min readMay 29, 2024

In rural and urban areas alike, hospitals are both the first line and the last resort for individuals and families who need medical care. From treating common injuries to providing complex, life-saving care, hospitals are the first of many points of care for patients. In rural communities these sites fill an even greater role, often serving as the only option for preventive and basic primary care as well.

During my time serving in Congress and in President Clinton’s Cabinet, I worked hard to expand access to health care in rural communities. I continue to do so today, taking advantage of opportunities to collaborate with health care leaders and speak out on the future of rural health care.

This is an issue close to my heart. I was born with chronic asthma and experienced a life-threatening attack when I was young. My father rushed me to a “whites only” hospital and begged for oxygen, which saved my life. Decades later, many Mississippians are still in need of increased access to care. A few years ago, for example, a young Mississippi mother passed away after an asthma attack because she was not able to quickly receive care.

Where a person lives should not determine whether they can get life-saving care — or even preventive and routine care.

Sadly, many of the same disparities that existed when I was a child persist today. As the CDC reported only last fall, rural residents are more likely to die from heart disease, cancer, stroke, and other preventable diseases. Rural patients tend to be sicker, older, and less likely to have insurance than their urban counterparts.

Thankfully President Biden has made rural access to health care a priority. Recently, U.S. Secretary of Health and Human Services (HHS) Xavier Becerra visited my home state of Mississippi to highlight the Administration’s investments in rural health. Those achievements include $90 billion to improve behavioral health services and $65 million to address worker shortages in the Inflation Reduction Act.

Unfortunately, these hard-won gains could be undone by SITE Act and FAIR Act legislation now proposed cut patient care by slashing hospitals’ reimbursement rates. This would pile even greater financial strain on the shoulders of already struggling rural hospitals. The outcome, should these measures pass, is clear: many hospitals would have to reduce or discontinue important services, like maternity or mental health care. Other facilities could be forced to close their doors for good.

Hospitals are already being asked to do more and more with less and less. Nationally, more than 40 percent of rural hospitals operate with negative profit margins. Many simply cannot weather the shortfalls. Here in Mississippi, almost half are at risk of closing, including 28 that are on the brink of immediate closure. Between 2005 and 2015, 200 emergency departments across the country closed their doors permanently. And it’s not like Americans need less care. Emergency room visits increased nearly 30 percent during the same time — including a 75 percent jump in rural areas, even as populations declined.

Our rural communities cannot afford such losses. Hospitals provide care to patients in need around the clock, every day of the year. They are required to care for the sick, no matter if they can pay or not. For the majority of Mississippians who live in rural areas, hospitals are often the only place to receive acute and primary care. When these facilities are forced to shut down, residents must travel long distances to see a doctor and face longer wait times. As a result, many people try to “tough it out” and forego care or neglect follow-up appointments. Of course, this turns preventable issues into harder-to-treat problems.

It’s hard to ignore the economic consequences, too. Hospitals are important for more than their patients’ physical health. They are also vital to the economic health of our communities. Rural hospitals support over 300 jobs on average. They create demand for goods and services and generate significant public revenue, which are often the lifeblood of the town or county they serve. When they close, all of this is lost.

The cuts to care that some members of Congress are considering ignore the unique challenges our rural hospitals face. By slashing billions from hospital funding, these bills would cut away at a safety net that supports our entire health care system without addressing the underlying factors that are overtaxing it in the first place. Between 2019 and 2022, hospitals’ operating costs increased more than twice as fast as the rates at which Medicare reimburses them. As it stands, Medicare only pays about 84 cents on the dollar for the care hospitals provide. Out-of-control drug prices, caregiver shortages, burdensome insurance requirements, and overall inflation have pushed many rural health care systems to unsustainable limits. Slashing rates even further could shove many more over the edge.

I know firsthand what unequal access to health care looks like. We can do better. All Mississippians and all Americans deserve access to affordable, high-quality care, no matter where they live. Lawmakers in Congress won’t get there by cutting payments to hospitals. It’s time Washington rejected these misguided bills and focus on policies that will truly improve access to health care.