Sen. Claire McCaskill, a Democrat, has called on two federal agencies for more details about support of hospitals and schools in sparsely populated areas.
The Missouri senator wrote to the Government Accountability Office seeking answers to several questions about the rate at which rural hospitals are closing, what’s driving those trends and what it means for the quality of health care in those areas. The GAO is the investigative arm of Congress.
She also called on the U.S. Department of Education for a report on how various federal policies affect rural schools.
In a letter to the GAO dated March 31 and shared with The Star on Monday, McCaskill warned that financial pressures on rural hospitals, driven partly by federal policy, pose a particular threat to health care in some parts of the country.
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“In recent years,” she wrote, “the number of rural hospital closures has increased significantly and if this trend continues, such closures could have a devastating impact on my constituents and countless other Americans.”
McCaskill also noted that the Centers for Disease Control and Prevention has said people in rural areas face a heightened risk of death from heart disease, cancer, accidents, some respiratory disease and stroke — suggesting that rural hospitals fill a special need.
The senator noted that health care plays a significant economic role in many small towns.
She also cited a Kaiser Family Foundation report issued in January that warned repeal of the Affordable Care Act would signal a “death knell” for some rural hospitals.
President Donald Trump and House Speaker Paul Ryan fell short in March in their effort to repeal the ACA, also known as Obamacare. But the president, in particular, has said the fight is not over. McCaskill voted most recently in January against a budget resolution calling for Congress to begin work on repealing Obamacare.
As the highest-ranking member of the Senate Homeland Security & Governmental Affairs Committee, her letters carry extra weight with a government watchdog agency such as the GAO. The agency has more policy experts and its reports are largely seen as non-partisan, while research done by congressional staffers tends to carry either a Republican or Democratic spin. Any GAO report prompted by McCaskill’s letter could take a year or longer.
Rural hospitals do face novel financial problems, said Missouri Hospital Association spokesman Dave Dillon. They serve older populations with more complicated medical conditions. A greater percentage of their patients either have no health insurance or rely on Medicare and Medicaid, which typically do not pay as much for the same treatment as private insurance, he said.
“In general,” Dillon said, “they face challenges that urban and suburban hospitals do not see.”