IV 
113TH CONGRESS 
1ST SESSION 
H. RES. 356 
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 
SEPTEMBER 25, 2013 
Ms. JENKINS (for herself, Mr. YOUNG of Indiana, Mr. SMITH of Nebraska, 
Mr. KIND, and Mrs. MCMORRIS RODGERS) submitted the following reso-
lution; 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 356 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, 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, indi-
viduals 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 90 per-
cent of the landmass of the United States; 
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; 
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•HRES 356 IH 
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 access to health care continues to be a major chal-
lenge in rural areas of the United States, as— 
(1) 77 percent of the 2,050 rural counties in the 
United States are designated as primary care Health 
Professional Shortage Areas (commonly referred to as 
‘‘HPSAs’’); 
(2) 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 
(3) 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, because rural hospitals and other providers face 
unique challenges in administering care to patients, Con-
gress has traditionally supported those providers by im-
plementing— 
(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 
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•HRES 356 IH 
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 $4,800,000 in annual payroll, and the wages, sala-
ries, and benefits provided by a Critical Access Hospital 
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 
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