IV 
115TH CONGRESS 
1ST SESSION 
H. RES. 627 
Recognizing that access to hospitals and other health care providers for 
patients in rural areas of the United States is essential to the survival 
and success of communities in the United States. 
IN THE HOUSE OF REPRESENTATIVES 
NOVEMBER 16, 2017 
Ms. JENKINS of Kansas (for herself, Mr. KIND, Mrs. MCMORRIS RODGERS, 
and Mr. WELCH) submitted the following resolution; which was referred 
to the Committee on Energy and Commerce 
RESOLUTION 
Recognizing that access to hospitals and other health care 
providers for patients in rural areas of the United States 
is essential to the survival and success of communities 
in the United States. 
Whereas access to quality health care services determines 
whether individuals in the United States can remain in 
the communities they call home and whether their chil-
dren will return to those communities to raise families of 
their own; 
Whereas more than 60,000,000 individuals in rural areas of 
the United States rely on rural hospitals and other pro-
viders as critical access points to health care; 
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•HRES 627 IH 
Whereas rural areas of the United States need quality health 
care services to attract and retain business and industry; 
Whereas to ensure that communities in the United States 
survive and flourish, Congress must address the unique 
health care needs of individuals in rural areas of the 
United States; 
Whereas individuals in rural areas of the United States are, 
per capita, older, poorer, and sicker than individuals in 
urban areas of the United States; 
Whereas the population in rural areas is composed of 10.4 
percent of veterans in need of care, compared to only 7.8 
percent in urban areas; 
Whereas the rate of disability for individuals increases from 
11.8 percent in urban areas to 17.7 percent in rural 
counties; 
Whereas pregnant women are being left without care as 54 
percent of rural counties do not have hospital-based ob-
stetrics due to high costs and staffing shortages; 
Whereas according to the Department of Health and Human 
Services, ‘‘rural areas have higher rates of poverty, 
chronic disease, and uninsurance, and millions of rural 
Americans have limited access to a primary care pro-
vider’’; 
Whereas according to the Department of Agriculture, individ-
uals in rural areas of the United States have higher rates 
of age-adjusted mortality, disability, and chronic disease 
than individuals in urban areas of the United States; 
Whereas the 20 percent of the population of the United 
States that lives in rural areas is scattered over 97 per-
cent of the landmass of the United States; 
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•HRES 627 IH 
Whereas the geography and weather of rural areas of the 
United States can make accessing health care difficult, 
and cultural, social, and language barriers compound 
rural health challenges; 
Whereas individuals in rural areas of the United States are 
more likely to be uninsured and more likely to receive 
coverage through public sources than individuals in urban 
areas of the United States; 
Whereas the proportion of uninsured and underinsured indi-
viduals is rising faster in rural areas of the United States 
than in urban areas of the United States; 
Whereas the growing opioid epidemic has placed an even 
greater burden on the limited care resources in rural 
communities as— 
(1) it is estimated that as many as 2.5 million peo-
ple in the United States are suffering from opioid addic-
tion related to prescriptions, and an additional 467,000 
are addicted to heroin; 
(2) eighty percent of people addicted to opioids do 
not receive treatment, and those who do are severely lim-
ited by the types of treatment available especially in rural 
areas; 
(3) according to the Centers for Disease Control and 
Prevention (CDC), the counties that prescribe the most 
opioids are likely to be in rural areas, where the unem-
ployment rate stands nearly two percentage points higher 
than the national average; and 
(4) according to the CDC, the rate of death from 
opioid-related overdoses is 45-percent higher in non-
metropolitan counties; 
Whereas access to health care continues to be a major chal-
lenge in rural areas of the United States, as— 
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•HRES 627 IH 
(1) less than 11 percent of physicians in the United 
States practice in rural areas; 
(2) nearly 60 percent of areas designated as primary 
care Health Professional Shortage Areas (commonly re-
ferred to as ‘‘HPSAs’’) are rural and more than 3,000 
physicians would be needed to remove these designations; 
(3) rural areas of the United States have fewer than 
half as many primary care physicians per 100,000 people 
as urban areas of the United States; and 
(4) more than 50 percent of patients in rural areas 
of the United States travel at least 20 miles to receive 
specialty medical care, compared to only 6 percent of pa-
tients in urban areas of the United States; 
Whereas rural hospitals and other providers are facing a 
growing closure crisis as— 
(1) 82 rural hospitals have closed since 2010 and 
673 rural hospitals are in severe financial crisis, rep-
resenting one-third of the rural hospitals in the United 
States; 
(2) because of the closure of these 82 rural hos-
pitals, 99,000 health care jobs have been lost and 
137,000 community jobs have been lost; 
(3) at this rate, 25 percent of rural hospitals will 
have shut down in the next ten years; and 
(4) medical deserts are being created across rural 
America, leaving many of our Nation’s most vulnerable 
populations without timely access to care; 
Whereas because rural hospitals and other providers face 
unique challenges in administering care to patients, Con-
gress has traditionally supported those providers by im-
plementing— 
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•HRES 627 IH 
(1) specific programs to address rural hospital clo-
sures that occurred in the 1980s by providing financial 
support to hospitals that are geographically isolated and 
in which Medicare patients make up a significant per-
centage of hospital inpatient days or discharges; and 
(2) a program established in 1997 to support lim-
ited-service hospitals that, being located in rural areas of 
the United States that cannot support a full-service hos-
pital, are critical access points to health care for rural 
patients; 
Whereas hospitals in rural areas of the United States achieve 
high levels of performance, according to standards for 
quality, patient satisfaction, and operational efficiency, 
for the types of care most relevant to rural communities; 
Whereas in addition to the vital care that rural health care 
providers provide to patients, rural health care providers 
are critical to the local economies of their communities 
and are one of the largest types of employers in rural 
areas of the United States where, on average, 14 percent 
of total employment is attributed to the health sector; 
Whereas a hospital in a rural area of the United States is 
typically one of the top 2 largest employers in that area; 
Whereas 1 primary care physician in a rural community an-
nually generates approximately $1,500,000 in total rev-
enue, and 1 general surgeon in a rural community annu-
ally generates approximately $2,700,000 in total revenue; 
Whereas the average Critical Access Hospital, a limited-serv-
ice rural health care facility, creates 107 jobs and gen-
erates $8,400,000 in annual payroll, and the wages, sala-
ries, and benefits provided by a Critical Access Hospital 
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•HRES 627 IH 
can amount to 20 percent of the output of a rural com-
munity’s economy; 
Whereas hospitals in rural communities play a vital role in 
caring for the residents of those communities and pre-
serving the special way of life that communities in the 
United States foster; and 
Whereas the closure of a hospital in a rural community often 
results in severe economic decline in the community and 
the departure of physicians, nurses, pharmacists, and 
other health providers from the community, and forces 
patients to travel long distances for care or to delay re-
ceiving care, leading to decreased health outcomes, higher 
costs, and added burden to patients: Now, therefore, be 
it 
Resolved, That the House of Representatives— 
(1) recognizes that access to hospitals and other 
health care providers for patients in rural areas of 
the United States is essential to the survival and 
success of communities in the United States; 
(2) recognizes that preserving and strength-
ening access to quality health care in rural areas of 
the United States is crucial to the success and pros-
perity of the United States; 
(3) recognizes that strengthening access to hos-
pitals and other health care providers for patients in 
rural areas of the United States makes Medicare 
more cost effective and improves health outcomes for 
patients; 
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•HRES 627 IH 
(4) recognizes that, in addition to the vital care 
that rural health care providers provide to patients, 
rural health care providers are integral to the local 
economies and are one of the largest types of em-
ployers in rural areas of the United States; and 
(5) celebrates the many dedicated medical pro-
fessionals across the United States who work hard 
each day to deliver quality care to the nearly 1 in 
5 people in the United States living in rural areas, 
because the dedication and professionalism of those 
medical professionals preserves the special way of 
life and sense of community enjoyed and cherished 
by individuals in rural areas of the United States. 
Æ 
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