Rural Health Information Hub Latest News

Rural Hospitals Built During Baby Boom Now Face Baby Bust

OSKALOOSA, Iowa — Rural regions like the one surrounding this southern Iowa town used to have a lot more babies, and many more places to give birth to them.

At least 41 Iowa hospitals have shuttered their labor and delivery units since 2000. Those facilities, representing about a third of all Iowa hospitals, are located mostly in rural areas where birth numbers have plummeted. In some Iowa counties, annual numbers of births have fallen by three-quarters since the height of the baby boom in the 1950s and ’60s, when many rural hospitals were built or expanded, state and federal records show.

Similar trends are playing out nationwide, as hospitals struggle to maintain staff and facilities to safely handle dwindling numbers of births. More than half of rural U.S. hospitals now lack the service.

“People just aren’t having as many kids,” said Addie Comegys, who lives in southern Iowa and has regularly traveled 45 minutes each way for prenatal checkups at Oskaloosa’s hospital this summer. Her mother had six children, starting in the 1980s, when big families didn’t seem so rare.

“Now, if you have three kids, people are like, ‘Oh my gosh, are you ever going to stop?’” said Comegys, 29, who is expecting her second child in late August.

These days, many Americans choose to have small families or no children at all. Modern birth control methods help make such decisions stick. The trend is amplified in small towns when young adults move away, taking any childbearing potential with them.

Hospital leaders who close obstetrics units often cite declining birth numbers, along with staffing challenges and financial losses. The closures can be a particular challenge for pregnant women who lack the reliable transportation and flexible schedules needed to travel long distances for prenatal care and birthing services.

Read more.

Treatment for Opioid Use Disorder Population Estimates Released

Most adults who needed opioid use disorder (OUD) treatment in 2022 either did not perceive that they needed it (43%) or received treatment that did not include medications for OUD (30%). Centers for Disease Control and Prevention (CDC) researchers analyzed Substance Abuse and Mental Health Services Administration (SAMHSA) data to come to these conclusions. Higher percentages of White than Black or African American or Hispanic or Latino adults received any treatment. Higher percentages of men than women and of adults aged 35-49 years than other adults received medications. Read the full CDC report.

Community-Based Maternal Behavioral Health Services Program Announced

The Substance Abuse and Mental Health Services Administration (SAMHSA) announced The Community-Based Maternal BHS program which will improve access to evidence-based, timely, and culturally relevant maternal mental health and substance use (behavioral health) intervention and treatment by strengthening community referral pathways. Grant recipients will be expected to collaborate with pregnancy and postpartum healthcare organizations, refer individuals in need of behavioral health care to the appropriate entities, and provide short-term mental health and substance use services to individuals who cannot access care. The deadline to apply is Aug. 26, with an anticipated project start date in Nov. 2024.

Bill Introduced to Help More Pennsylvanians Obtain Health Coverage

Rep. Mike Kelly R-PA from the House Ways and Means Health Subcommittee is sponsoring the Health Care Sharing Ministry Tax Parity Act (HCSM). The bill would allow members of faith-based organizations and ministries to deduct healthcare related expenses from their taxes to achieve tax fairness for ministries that share health care costs. The rules make it clear that these organizations would not be able to offer health insurance to ensure there would be no loopholes with the current tax rules. Millions of Americans participate in HCSM programs sharing the cost of more than $1 billion in medical expenses.

New ACA Rules to Protect More Consumers

The U.S. Department of Health and Human Services (HHS) Office for Civil Rights and the Centers for Medicare & Medicaid Services (CMS) recently issued a final rule under Section 1557 of the Affordable Care Act (ACA) to strengthen nondiscrimination protections and advance civil rights in health care. This rule reinstates non-discrimination standards for all Health and Human Services health programs and activities, protects LGBTQI+ patients from discrimination, requires that all entities including insurers and providers let people know language assistance and services are available, requires staff training on sections of the 1557 policies and respects federal guarantees regarding religious freedoms and conscience as set for by 45 CFR 92.3 and 92.302. See the Fact Sheet.

Congress Passes Maternal and Child Health Stillbirth Prevention Act

The Maternal and Child Health Stillbirth Prevention Act of 2024, HR 4581, passed through both the House and the Senate, and now awaits President Biden’s signature before it becomes law. The bipartisan bill amends the Maternal and Child Health Services Block Grant program to allow states to use those dollars for stillbirth prevention and research activities but does not include additional funding.

Pennsylvania House Bill 1140: Requires Health Insurers to Cover Contraceptives

On Tuesday, June 25, by a margin of 133-69, lawmakers in the Pennsylvania House passed House Bill 1140, which would require health insurance policies – as well as government health insurance programs like Medical Assistance and the Children’s Health Insurance Program (CHIP) – to cover FDA-approved contraceptive drugs, devices and products for covered individuals. The bill’s prime sponsor, Democratic state Rep. Leanne Krueger, said in a statement after the House vote that the bill would establish state-level protections for contraceptive access. “Pennsylvania currently has no protections in state law for contraceptive access, so attacks at the federal level jeopardize our access,” Krueger said. The bill currently awaits action from the state Senate.

Pharmacy Benefit Manager Reform Bill Inches Closer to Passage In Pennsylvania Senate

Health committees in the Pennsylvania House and Senate are working on a compromise agreement that will increase oversight of pharmacy benefit managers (PBMs). The Pennsylvania legislation would allow the state’s Insurance Department to regulate certain aspects of pharmacy benefit managers’ business that have been called anti-competitive. Read more. Included in this legislation is language that will prohibit PBMs from reimbursing qualified health centers participating in 340B less than they would reimburse similar entities that do not participate in the program. This is an evolving process so stay tuned for updates.

Legislation Will Put Pennsylvania in Interstate Licensing Compacts

Legislation addressing worker shortages in healthcare and facilitating Pennsylvania’s entry into interstate compacts has been sent to Gov. Josh Shapiro to be signed into law. Sponsored by Rep. Frank Burns, D-Cambria, HB 2200 enables interstate licensing compacts to become operational. The legislation requires applicants in healthcare professions to submit fingerprints as part of their criminal history records check and lays out the process that Pennsylvania State Police and state licensing boards must follow in considering them. The change in law allows licensees to practice in other participating states with just one license. Without the fingerprinting process in place, previous efforts to implement the compacts were unsuccessful.

ACO PC Released a Flex Model Office Hour

– Tuesday, July 16 at 2:00 pm Eastern. In this hour-long session, the Centers for Medicare and Medicaid Innovation will provide an overview of the new ACO Primary Care Flex Model (ACO PC Flex Model), which will focus on primary care delivery in the Medicare Shared Savings Program (SSP).  CMS has released a Request for Applications  and the application portal is open until August 1 for new or renewing ACOs who submitted an application to SSP by June 17, 2024.  CMS plans to announce applicants selected to participate in October 2024.  This model seeks to increase accountable care relationships for people with Medicare, especially those in rural and underserved communities.