Communications

(Feb. 14, 2025) – Earlier this week, Kansas Hospital Association staff, hospital executives, medical students and other Kansans involved in rural health care delivery attended the National Rural Health Association's Annual Policy Institute in snowy Washington, DC. Despite the challenging weather conditions that shuttered schools in the area and drove the federal workforce to work from home for a couple of days, they came together with others from around the country to hear presentations from rural health advocates on the changed national policy environment and to hit Capitol Hill to visit with members and staff of the Kansas Congressional Delegation.

Our group was able to talk with Senator Roger Marshall, Congressman Derek Schmidt and briefly with Congressman Tracey Mann. Due to schedule changes caused by the inclement weather, they met with staff from our other delegation offices except for Congresswoman Sharice Davids, whose office had been affected by illness. The talk of the town is both chambers' forthcoming consideration of budget reconciliation bills, the process that began this week in earnest.

On Wednesday, the Senate Budget Committee marked up its version of the budget resolution, which is the first part of this process. They prefer a two-step approach, focusing this first budget resolution on border security and defense spending and deferring action on tax cuts until later in the year. It passed the committee on an 11-10 party-line vote and is now available for floor action. If passed, the spending levels included within the bill would be sent as "instruction" to the authorizing committees (in this case, Armed Services, Homeland Security and Government Affairs) to draft legislation in line with the budget resolution's numbers. The Senate's process is seen as the easiest of the two.

The House, however, is choosing to do, as one of our Kansas Delegation staffers put it, "one big, beautiful bill." This would include tax cuts and the spending items in the Senate bill. The text of their budget resolution was released on Wednesday while our group was in town, and it was immediately controversial. It instructed the committees of jurisdiction (including, in this case, Ways and Means, the committee that oversees Medicare and Medicaid) to come up with at least $1.5 trillion in savings over 10 years. Still, it did not instruct them on how to do it. The House Budget Committee continued its markup of the bill late into Thursday. More details will be provided in the next KHA Federal Advocate newsletter.

In talking with members of our delegation, we impressed upon them the need to avoid further cuts to hospitals in Medicare by either treating hospital outpatient departments like primary care clinics in terms of payments–so-called "site-neutral" payment schemes–or extending Medicare sequestration beyond its 2032 expiration date. We thanked them for considering the permanent extension of pandemic-era telehealth flexibilities, the Medicare Dependent Hospital program, and the Low-Volume Hospital adjustment as part of the budget reconciliation process.

Additionally, we spoke at length regarding the need for more residency slots in rural areas. A special thanks goes to a group of KU School of Medicine students who eloquently described this need. Finally, we discussed the need for a follow-on bill to fix various problems with the current Rural Emergency Hospital program, generally referred to by advocates as REH 2.0. These include allowing retroversion to CAH status even if such hospital was a Critical Access Hospital due to a necessary provider designation, allowing recently closed hospitals to reopen as REHs, clarifying the ability of REHs to operate swing beds and allowing REHs to participate in the 340B Drug Pricing Program.

It was a successful visit, and despite the current chaos, our delegation left with a good understanding of the needs of Kansas' rural hospitals!
--Chad Austin