In Their Own Words: Virginia’s Congressional Candidates on Rural Health Care

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Hello Rural Angle readers. The funny thing about an election campaign is that, on the one hand, we hear about it constantly while, on the other, we rarely learn much about the candidates’ actual policy choices. Therefore, we recently put three questions about rural communities’ critical health care needs to our Congressional candidates in Virginia. So far, three have responded and we are publishing their answers here. We will publish other responses as we receive them.

The three candidates covered in this edition are: Gloria Tinsely Witt, D, CD5; Ken Mitchell, D, CD6; and Suhas Subramanyam, D, CD10. Each section below begins with our question, followed by the candidates’ responses. Enjoy!

New Rural Virginia: Rural hospitals and physicians’ practices are being bought up by big hospital chains. Not only do these mergers tend to curtail access to even-essential services, such as obstetrics, but they use their market dominance to raise prices as well. The result is a dangerous, and accelerating, decline in medical services accessibility. How will you work in Congress to reverse these trends?

Candidate responses

Witt: Increase funding for rural healthcare and offer grants to help rural hospitals and clinics stay self-sufficient. Provide tax incentives for practices to stay independent. Increase billing and price transparency to ensure rural hospitals and physicians' practices can compete.

Mitchell: When in Congress I will work to adjust future federal payments to rural health centers to keep up with current inflation, and to help pay for the lost revenue these rural health centers have endured. Over the past decade, health care costs have skyrocketed and federal funding and other payments for rural health centers have remained stagnant. Obstetrics and delivery services are viewed as money losers for rural hospitals because of low Medicaid reimbursement rates. These services are more expensive per unit of service in rural hospitals because they do not have the benefits of economies of scale and technology created efficiencies that big hospitals and urban hospitals have. In rural hospitals Medicaid pays only 57 cents on every dollar rural hospitals have to pay in costs and expenses for obstetrics and deliveries. I will support increasing Medicaid reimbursement rates for rural hospitals for these essential services.

Subramanyam: Throughout my career in the Virginia General Assembly, I have sought to take on anti-competitive corporate behavior that hurts our community. Whether it’s toll roads or electric utility companies, I am committed to looking out for consumers. Rural hospitals and physicians' practices are no exception, and as a volunteer EMT, I know how critical proximity to health care is. In Congress, I will keep the same mindset, particularly regarding rural hospitals and physicians' practices. Our rural communities shouldn’t have to commute to the doctors office, or to receive urgent care. Additionally, in the General Assembly, I introduced and passed HB 1265, legislation to bring federal dollars to the Commonwealth, through the Infrastructure Investment and Jobs Act, to expand broadband access in our rural communities.

New Rural Virginia: Rural communities are losing doctors at an alarming rate. A growing number of rural Virginian communities lack access even to general practitioners and have ever many specialists. And the problem is growing worse. Better telemedicine access could help but is no magic bullet. How can Congress help keep doctors accessible in rural communities?

Candidate responses

Witt: Create workforce development incentives (scholarships or loan forgiveness) to attract general practitioners, specialists, and other skilled healthcare workers to rural areas. Create grants to recruit and retain skilled staff. Finally, incorporate and fund programs to integrate telemedicine to bridge care gaps in rural areas.

Mitchell: Congress should support increased scholarship opportunities for medical students agreeing to practice in rural communities upon graduation for a predetermined time and fund loan forgiveness programs with the same stipulations. Congressional support for rural, home based health care would allow physicians to reach and treat more patients before requiring in hospital critical health care. They should be fairly compensated for their travel throughout the community. Congress must encourage state level licensing and use of nurse practitioners that can support and relieve physicians from some work tasks, thus reducing burnout from overwork. Development of a national program to recruit retired physicians and nurses to work or volunteer in a rural hospital or clinic can help alleviate some staffing shortages. Federal funding to expand broadband into rural areas must occur to consistently support telehealth and other technologies physicians need access to in order to effectively practice medicine in rural communities.

Subramanyam: While we must continue to expand the scope of telemedicine, we must do more to ensure that our rural communities have easy access to health care providers. I support tax credits, and other measures, to incentivize doctors to practice in rural areas across the country.

New Rural Virginia: The good news is that, largely due to expansion of the Affordable Care Act and Medicaid, the number of uninsured Virginians has been cut in half. The bad news? Nine percent of Virginians—and even more in rural communities—are still uninsured. And in low-density rural communities, a high uninsured population is another reason why medical providers close down. What can Congress do to continue to reduce the number of uninsured Virginians?

Candidate responses

Witt: Expand investment in funding for community health centers that provide care to underserved populations. Invest in programs that address social determinants of health, such as housing, education, and nutrition, which can impact insurance coverage and overall health outcomes. Support funding for navigators and enrollment assistance programs to help people understand their insurance options and apply for coverage. Increase subsidies for health insurance plans offered through the ACA marketplaces to make coverage more affordable – consider Medicare for All plan reinforcing healthcare as a human right..

Mitchell: Congress must continue to work to expand Medicare and Medicaid while recognizing the difficulty building political will to pass such legislation when the cost is hard to predict. Many uninsured people fail to go to the doctor until they are very sick and then incur significant expenses. Getting them to the doctor sooner requires a cultural shift and we need outreach and educational programs that can accomplish this. Congress should support development of educational programs and public service announcements in rural areas detailing how universal health insurance can improve their lives and that it must be undertaken in partnership with federal, state and local governments, and nonprofit organizations willing to invest in this message. Doctors, hospital administrators and the medical community should be enlisted to help educate the public in rural communities that real preventive health care is health care that is essential and cost effective and saves lives.

Subramanyam: As a former health care policy aide on Capitol Hill during the negotiations and passage of the Affordable Care Act, I’m proud of all that the bill accomplished, but there’s more work to be done, including expanding Medicaid coverage.

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