Michelle Rathman: [00:00:00] Welcome to The Rural Impact, and as you heard in the opening, I'm Michelle Rathman, and it is really incredible, and I mean that, to be back here with you today. Just about a year after ending my three years as host of another rural-focused podcast, we are back. And we're doing it with our own show and one that we hope to help connect you to the dots between policy and rural everything.
Michelle Rathman: Now, for those of you who are not familiar with my background, I have been working in the rural health space for nearly three decades, hard to believe, but I have. And as every year passes, I am more aware and informed about just how policy impacts every aspect of rural life, whether it's education, healthcare, economic growth, climate, equity, housing, transportation, you name it, there's a policy behind it that's working. And for far too many people, in my opinion, what's not working. So we want to talk about all that, what's happening in rural America. And today, I am beyond elated to kick off our first series that we're calling, "Rural [00:01:00] Health on Life Support," and we know that it is.
Michelle Rathman: And you should know that each series, we will be having three episodes to make sure we cover as much territory as possible because there are a lot of issues out there that we need to cover. And joining me today for this inaugural episode is, without a doubt, the most informed person on the subject of rural health you'll ever have the pleasure of meeting, Mr. Alan Morgan. Now you should know that Alan is recognized among the 100 most influential people in healthcare by Modern Healthcare Magazine. He is the CEO of the National Rural Health Association, an organization I'm so proud to be a member of for I think about 13 years.
Michelle Rathman: Welcome, Alan. We are thrilled to have you here on The Rural Impact. Thanks for joining us.
Alan Morgan: Michelle, I'm so glad to be here. Thank you so much for the opportunity and wow, I'm just so excited that you're up and running with your new programming and I can't thank you enough for your leadership that you provide within the National Rural Health Association.
Michelle Rathman: Thanks Alan. As I said, we have a lot to [00:02:00] talk about and I cannot escape the fact that we've just come off of the house passing. Hopefully we'll move on to the senate, the debt ceiling issue, that little thing that we know that's been on all of our radar screens. But before we dive into that, Alan, I think it's so important for our listeners to really understand the state of rural healthcare today, and that's a mouthful, but if you could just kind of go down your tick sheet of all the things that we need to be really aware and informed about where the whole landscape of rural health is concerned.
Alan Morgan: Yeah, that's a good place to start. It's really a tale of two towns when you talk about rural. We're currently seeing decline, life expectancies. You've got workforce shortages. You've got hospital, rural hospital closures.
Alan Morgan: So there's a lot of challenging challenges facing rural America, but these challenges are driving innovation. And so actually we're seeing some of the more innovative approaches to delivering healthcare services happening in these small towns all across the us. [00:03:00] So it's challenging when you're talking about it in the face of such adversity.
Alan Morgan: The success that we're seeing in rural healthcare today. So that's a great starting point to all of our discussions to follow.
Michelle Rathman: Thank you because, we've been watching and I appreciate what you said about just all the things that we're watching. We have been watching hospital closures, and I think we would be remiss if we didn't talk about the fact that pandemic support has ended. And as a result, we know many rural hospitals were already on the brink of disaster, if you will, for so many communities. But share with us how the pandemic has affected rural hospitals and health systems. Because when I tell people how dire it is and they're not dialed in, they just don't understand the depths of the challenges that they're facing. So talk a little bit about how the pandemic has negatively impacted, and if you think there's something positive about it, I wanna hear that too.
Alan Morgan: Wow. Yeah, no [00:04:00] the Pandemic for Rural Health was an a national event wave, and I talk about that, and you mentioned it as rural healthcare is a small boat on the front end of this wave, more than half were operating in the red. So, it was a really difficult situation. As the pandemic hit us, and we were terrified about what that meant to these rural facilities, two things happened.
Alan Morgan: The federal government stepped in with significant support for these rural facilities, number one and number two, as the pandemic began to subside patient volumes just soared across the US in these small hospitals, which gave a false sense of security. So, as we topped that wave rural hospitals in 2022, were looking fairly okay at the beginning. We're on the other side of that wave right now, Michelle, without a doubt, we've already had 10 rural hospitals close this year alone, and we're only at the halfway point. So clearly we're going to have more rural [00:05:00] hospitals close this year by the end of the calendar year than we've seen in the past three years alone.
Alan Morgan: That's 151 rural hospitals closing since 2010. And almost 200 that have closed over the last 15 years. So it is a scary and dire situation where we find rural health and rural health access at this point.
Michelle Rathman: So, let's talk about some of the domino effect, because certainly there is one. We know, and I work with rural hospitals across the country, and I'm hearing. All over the place. Obviously workforce shortages, that's one significant really adverse effect. In some rural communities where the hospital is struggling, to just staff, for example.
Michelle Rathman: It could take 8, 10, 12 weeks just to see a primary care provider because we've got these workforce shortages now for hospitals that have closed. I was talking to one of your colleagues at the National Health Association. I said, I wonder if we can come [00:06:00] up with a number.
Michelle Rathman: Of how many people, hundreds of thousands of people we are talking about collectively who have to travel.
Michelle Rathman: What, 35, 50, 80, a hundred miles just for essential care. So, if you could kind of go down, as I said earlier, that tick sheet of when a rural hospital closes, what does that mean in terms of, I just mentioned two workforce shortages and patients, but what are some of the other implications for a community that loses its hospital?
Alan Morgan: Yeah, that's a lot to unpack right there. Look on the workforce. You and I talked a lot about the workforce. I want to tee off of that from when we were together just a couple weeks ago, and I almost want to put the workforce shortages into three buckets. One being the physicians, the MDs, and the DOs
Alan Morgan: Two, the nursing staff, nurse practitioners, physician assistants, RNs. And then three the hospital support, the operations staffing of that. All three experiencing shortages right now. The real odd and challenging workforce issue I think now is just being able to attract the operations and the administrative staff that’s challenging, in addition to the nursing
Alan Morgan: component of it. They nationwide, they're able to get the bodies, but the salary levels have really exploded, which is great, except that it's not budgeted in, and both federal and state programs have not caught up into account for the increasing salary costs on that, which is just. To your direct question, further hampering healthcare operations.
Alan Morgan: When it comes to a hospital, with the exception of maybe 12, 15 rural counties, healthcare is the largest employer in these communities. And so, you lose when a hospital closes, you lose the direct jobs and revenue from the staff there. You also lose that those. [00:08:00] Other businesses in the community, whether it be food service or even floral or the other issues that rely on that hospital, and that's before you get to the economic consequences of lo losing in migration.
Alan Morgan: People not coming to a town because they know they don't have access to 24/7 emergency room services. And so, you really can't understate the adverse impact from an economic standpoint that rural hospitals closures have.
Michelle Rathman: Yeah, and I think, part of this podcast, what I really had hoped to do is to help connect the dots to policy because the things that you're talking about didn't just happen because of a pandemic. I mean, rural hospitals, let's be honest, were quite vulnerable, many of them prior to the pandemic.
Michelle Rathman: And we have been sounding the alarms about the workforce challenges that we face. And I know that's something that your organization has really focused on is the payer piece. So maybe we break that a little bit out into [00:09:00] its own little bucket here is because, it's not just because people are saying I'm fed up with of practicing medicine, just in terms of an affordability standpoint.
Michelle Rathman: You said it, paying the rates that we have to pay for traveling nurses, for example, locums, for example, to fill in all those gaps that we have. But we take a look at small, independent or rural physicians and we've got some challenges with respect to just how they're reimbursed.
Michelle Rathman: And that's a payment policy issue, correct?
Alan Morgan: It absolutely is. Gosh, Michelle. Rural health, it's unfortunate that rural healthcare really is almost the study of unintended consequences and misperceptions about what rural America is, and between the unintended consequences and the misperceptions that's a lot for us to overcome when it comes to advocacy and policy development. As we're going ahead on this, and to your point, it's just, it's really difficult. There's this [00:10:00] concept that rural America is depopulating, but it's not. The census shows it's growing. But at the same time, these communities just are structured for primary care and general surgery. That's what the rural hospitals do, and you've got to make sure that the. That the, both the federal government and the state government are good partners in ensuring access.
Alan Morgan: And currently we're just not seeing that. Where we're seeing these rural hospital closures happen are in communities with high patient needs, a lot of chronic health issues and an inability to pay. And we've clustered a community most in need of healthcare services in these small towns. And put the financial burden on these healthcare facilities so that bad debt is soaring, and that is leading to hospital closures and clinic closures.
Michelle Rathman: Yeah. And I know you feel the same way when I say we wish it was a much higher priority for so many of those who have the [00:11:00] power to change the direction of this. And we're going to have a lot of conversations on this podcast in the future about something that we talk about a lot, social drivers of health or social determinants of health.
Michelle Rathman: And when we were at the NRHA conference in San Diego, I had several conversations about the fact that when people have these inequities, so lack of housing, food deserts, transportation challenges and so forth unmet dental needs as another big aspect of our deficits where rural health is concerned.
Michelle Rathman: They go long periods of time without healthcare and then they show up in a rural hospital emergency room. And I think what you're saying here is that you know there are so many circumstances that rural hospitals and administrators can't control, and yet they're coming to their doors and if you will, the weight of that world is on their shoulders.
Alan Morgan: It's a huge issue, right Michelle? And gosh, this has been something you've really been focused in on and [00:12:00] I appreciate that as well too. When you look at health measures, when you look at obesity, diabetes, hypertension, C O P D, The rural population has faces these at a much higher level. The only health measure that is tracked, that actually rural is better in is prevalence of cancer, which is great.
Alan Morgan: Cancer rates are higher in urban areas than they are in rural. Yes, but the problem, in particular with cancer, even though the prevalence is lower, mortality rates are much higher. And that gets right to your point. When patients and community members that have cancer in small towns, have a lack of transportation, the lack of access to care, the delaying of care, the delaying of screening procedures, these all come together to make it a much more dangerous place for rural communities [00:13:00] so
Michelle Rathman: a, it's a really tough recipe, isn't it?
Alan Morgan: Yeah, it really is. And you're seeing this all come to play, and it points to the fact that rural is a unique healthcare delivery environment.
Michelle Rathman: All right, so we're going to stay on the subject of rural hospitals because it's co so interesting, Alan, when I started this work with rural hospitals, I think, you know, and usually my gigs have been like once a month for six or seven years and one particular location going back and I did a lot of work in the state of Georgia.
Michelle Rathman: A place where they have seen an a pretty significant amount of hospital closures. And one of the things that we kind of battled with in terms of, getting community to see the value of the rural hospital, to not view it as a band aid station, well full circle here we are, we have what is called a rural emergency hospital.
Michelle Rathman: And I would like for you to explain to our listeners, What it is and how it came to be. And then we can get into a little bit [00:14:00] of the weeds about maybe throwing out our projections about what that might look like, down the road for long-term sustainability. So first of all, the rural emergency hospital.
Michelle Rathman: It's an actual designation. Go through how that came to be for us.
Alan Morgan: Yeah. I love this part of the discussion. So, the Rural Emergency Hospital program, the first new provider designation in over 20 years, not since the critical access hospital program. And I love it and I love it because it gets to the heart of per preserving access to care, most notably. 24 7 emergency room service, and you've got to have that.
Alan Morgan: You're not going to be safe in a rural town community without timely access to 24 7 emergency room service. A rural emergency hospital is a hospital without inpatient beds, but that means you're still going to have access to specialists through tele telehealth, and you still have the [00:15:00] ability for specialists to come in as needed to these facilities.
Alan Morgan: You're going to have emergency or you're going to have 24 7 emergency room services. You're going to be integrated with the ability to transfer patients when needed. And it really provides that access to care and that assurance for that small community that maybe now has a hospital of an average daily census of, gosh, two to 10 low volumes, but it makes sure that the access maintains.
Alan Morgan: What I like about this. Is the federal government is going to provide a monthly payment to these rural facilities, which is going to total a little over 3 million a year just to ensure that the facilities stay open. And so, it's the recognition that rural hospitals provide a utility to that community, that the community, it is a community asset.
Alan Morgan: So I'm really excited about that. I'm excited about the future for that, but let me make one [00:16:00] pause here. That being said, I can say that and I can still say, Michelle, the last time we talked, we were talking during a pandemic, and for the last three years I've had countless discussions with federal officials on why is there not more bed capacity in rural America?
Alan Morgan: Why were you not more prepared for a pandemic? So, the first thing we announce when we come out of this pandemic is, We've got a great new program that's going to eliminate all inpatient beds. You have to pause and realize at a larger common-sense standpoint. So I can say both of these are true. I'm excited about this program, but just recognize this flies in the face of all the discussions we've had about the last three years about bed capacity in rural communities.
Michelle Rathman: I echo that and I think one of the things that concerns me the most, Is that it doesn't serve as the model that I would hope [00:17:00] where is there a model within this that would address those social drivers of health? The wellness factor. I mean, we've talked for years about the fact that wellness doesn't pay.
Michelle Rathman: When we focus on the things that influence whether or not a person is more susceptible to diabetes, hypertension, cancers, and all these things, where does it leave room for staff, funding for programs and so forth. So I think that we still need to do our, do the work that needs to be done to also help rural emergency hospital however possible, be leaders in those subject matters and not just again, treating sickness and people who are in need of emergent health services, but how do they work to build programs that address some of these social drivers of health. And I don't know what the future holds, but I think that's something that we have to really watch the space for.
Alan Morgan: Oh gosh, yes. Yes. And that recognition that you just articulated about the future and what that holds, that is of [00:18:00] such paramount importance here. And I've, I'm having, I don't know about you, but I'm having such a sense of deja vu because all these discussions we're having right now on the rural Emergency hospital, Were exactly the same discussions I had when I started my time with the National Rural Health Association over 20 years ago.
Alan Morgan: I mean the exact same. And so I can see based on history where we're going and I think when people, when communities look and they'll say, nah, I don't think this rural emergency hospital is for me. That may be true, but I really believe. I believe that what we saw at the Critical access hospital program will come to fruition with this rural emergency hospital program too.
Alan Morgan: And you talked earlier about policy. We're already talking with congressional leaders on Capitol Hill about enhancements and expansions to this rural emergency hospital program. What I want to see, and I know you do too, is I love this concept where the government recognizes we need to [00:19:00] maintain this access.
Alan Morgan: And providing payments to ensure access and ensure the doors open. Now, I'd like to see as we move forward, This rural emergency hospital program be expanded the inclusion of swing beds into it, the inclusion of the three 40 B pharmacy program. And so we're going to take the best of what we currently have, and we're going to work for policy makers to try to expand this so it's a better fit for more rural communities.
Michelle Rathman: Yes, we are going to talk about advocacy in just a moment because one of the things that I am so frustrated, about, and at the same time, really grateful to the organization for is that, you guys are leading the way to write policy, to push policy, to advocate for policy. And the thing that I see year after year is that we just have to keep going back and going back and going back and putting our hands out and, begging to not be left out, which we're going to talk about in a few moments.
Michelle Rathman: But let's stay on something [00:20:00] a little bit closer to the emergency hospital and that's the struggling rural EMS. It scares me, Alan. I know that there are some really innovative models like the community paramedicine program that's, kind of in a test pilot mode, if you will, in some states, but we don't have the same model.
Michelle Rathman: We don't have volunteers that jump out of bed in the middle of the night to go to their rigs and, we, now are working to have an EMS paid model where guess what? Those emergency first responders deserve to be making a living from, and so that whole image of rural volunteer EMS we've got some rural communities with no hospitals and maybe with one or two rigs.
Michelle Rathman: So let's talk about policy that's associated with the cluster of EMS reimbursements that we have, because it varies from state to state. We have no continuity. The billing practices have been, subject to many investigative [00:21:00] reports. So, what is the state of rural EMS Alan? What do we need to be focusing our attention on where policy is concerned?
Alan Morgan: Yeah, Michelle, you need to dedicate a whole show just to rule E ems. You really do. It is such a complicated really test story on policy development, policy challenges. It is, and I, when I talk with media, I mentioned that e EMS is, in my mind, one of the most complicated policy. Challenges we have in rural America, and I say that because of the.
Alan Morgan: Different. It is a patchwork quilt of how we do EMS in a rural context. And you mentioned that you've got the volunteer EMS, you've got the county EMS, you've got the EMS as part of the hospital, you've got the for-profit EMS companies and these different [00:22:00] types of EMS and different. Payment mechanisms makes it insanely difficult to get a national picture on the size, the scope, and also the levers to pull from a policy mechanism to make it better.
Alan Morgan: Michelle, over the last two years, usually when I'm talking, you know this, when you're talking to a hospital execs, the top three issues are always the same. They're always, it's reimbursement number one workforce. Number two, and then the community health number three, and I don't mean that in that order, but that's what they're really focusing on.
Alan Morgan: I’ve got to tell you, in the last two years when I'm talking to rural hospital CEOs, EMS has now elevated to one of the top three issues across the board, every state. And the challenge is how do you fund properly these healthcare professionals that are on episodic? Care delivery points, and to your point, the most [00:23:00] the mechanism that's gaining the most policy esteem out there is this community paramedicine and the concept of, okay, we're going to move, we're going to train community paramedics and we're going to be able to reimburse them for doing.
Alan Morgan: work within a healthcare facility, and that's going to compensate for their downtime, for the incredible cost associated with education and professional continuing education as well too. And just that on-call aspect of it, making sure that all states view emergency response as an essential service.
Alan Morgan: That's important as well. So many times again and again, I've seen rural communities recognize step to the plate, recognize, and then financially support the EMS within their county. And that's another good one. The easy answer is always going to be the federal.
Michelle Rathman: Oh, I'm seeing it too. And when we talk about the next subject I want to touch on with you is the fact that, again, now, not only do [00:24:00] we have challenges with closing hospitals, let's connect the dots. Okay. Closing hospitals, vulnerable hospitals vulnerable EMS. And now we've got OB deserts, littering this country.
Michelle Rathman: I read a report and actually just talked to the gentleman at your conference in San Diego. There is a swath of Texas that you know, like a total of three or four counties the size of Connecticut without a single OB provider. In our very next episode, we are really focusing on maternal outcomes and OB desert, but I think
Michelle Rathman: In the context of community paramedicine, there's been some chatter about, Hey, let's train them to deliver babies, in transit. Ridiculous. Is this where we are? So, let's talk about the growing rural maternal mortality in OB desert crisis. Alan, I think any of us would be, we would be kidding ourselves if we didn't put to the context of what's happening today where we've got.
Michelle Rathman: Restrictive women's reproductive care all over the country. I don't want to get [00:25:00] into that per se, but I do think, again, we're grownups here we would be remiss if we did not connect the dots between rural OB deserts and the demands that we currently have that we can't meet.
Michelle Rathman: And, the fact that we are this developed country with some of the worst numbers in terms of infant and maternal mortality. The death rate is astonishingly high. What, what can be done from a policy standpoint to not just address this one small community at time? We have got to look at this as a country and I think wake up and say something's got to be done.
Michelle Rathman: Policy. Is an answer.
Alan Morgan: Yep. Totally agreed. I mentioned to it when people oftentimes feel like, what are the top pressing issues for rural health? And it's fairly easy. The top four are going to be reimbursement, workforce, behavioral health, and EMS. Tho, those are the top. What is the most important? Policy [00:26:00] topic for the future of rural America that is maternal health, because that is all about the recruitment of young families, indoor communities.
Alan Morgan: If you don't have access, To maternity health, you're not going to get in the families that are the future for the community. So, I think that has to be top line issue that we are all rule advocates are focused in on at this point. And we had multiple sessions at our annual conference covering the data on this and the policy options.
Alan Morgan: It all gets to the point Michelle is, and you alluded a little bit to that in your conversation is Having low volume procedures doesn't lead towards great outcomes. The result, the re the, what needs to be done is this, again, state and federal partnership in increasing trainings and staffing.
Alan Morgan: We have to have a focus in on that from a policy angle. We have [00:27:00] to understand the maternity care is, and I tie it to it. The viability and success of these rural communities as they move forward. And you have to have that. What I am concerned about is we get the data in, and I mention it and you talked about it.
Alan Morgan: Do we have train EMS on deliveries and OB care. It, you've got to make sure that you've got the proper trainings, the proper professionals, and I'm really concerned that we'll con if we don't do that, the focus is going to be, oh, we need to remove more of these access points out there.
Alan Morgan: There are no easy so solutions, but it has to start with better funding for this particular service.
Michelle Rathman: And better funding for prenatal care and access to prenatal care, which obviously drives outcomes. My gosh. All right. We've got a few more subjects before we go. This is, I just, it's a fascinating conversation. I love talking with you and we, obviously NRHA is, just an incredible advocacy organization.
Michelle Rathman: You all know your stuff; your staff knows their stuff. You are out [00:28:00] there, you know, and I just before we talk about the debt ceiling I just went, to the website and I'm just going to read for folks all the policy places that are normally left behind that the NRHA, and the how many, every members you have advocate for.
Michelle Rathman: We talk about the fact that you're advocating for the protections of the 340B Drug Pricing Pro program. Many people do not know what that is. Alan, in a real quick nutshell, 340B deciphered, what's it mean for a rural hospital, rural community, for rural people and populations.
Alan Morgan: Yeah, absolutely. The 340B program is a safety net program where the federal government negotiates discounted prices for pharmaceuticals to decrease the cost, to allow, to help these small providers that are dealing with a high load of un uncompensated care to be able to keep their doors open, serve their communities.
Alan Morgan: And also pass on some of these savings onto the communities [00:29:00] themselves to make sure they improve access. And for every rural hospital that had a, had managed to have a positive financial line in last year, they were all com participating in the 340B program. You can't understate how important this is just to keep the doors open on these facilities.
Michelle Rathman: And we can't understate how imperative it is that the big pharmaceutical companies play along, do their part, follow the rules, the law as it were. You also advocate for Medicaid coverage, food and nutrition programs, border health. Another big subject that so many or organizations don't even touch. Community health workers.
Michelle Rathman: Alan, when we talk about better health outcomes and we wait for rural hospitals and rural clinics, if you will, to step in where there's no one else to fill those gaps, Community Health Workers are. Fortunately for us, they're an answer, but they're not funded the way that we need them to.
Michelle Rathman: You also work on maternity care, [00:30:00] mental health. We talk a good game in this country about how important it's, we have to increase mental health. Ellen, you said it earlier, behavioral health in the context of vulnerability. Where do you rate rural communities in general in terms of their ability to deliver behavioral and mental health services in this country today?
Alan Morgan: It's a huge concern and it goes across the gambit when you're talking about substance abuse. Dealing with that, dealing with overdoses. Rural urban suicides. The rates are much higher in rural areas. One thing that's nagging in a lot of traction on when, and Michelle is. The impact of behavioral health issues and concerns in the operations of these small hospitals, in small clinics.
Alan Morgan: So when I talk with them and they're like, yeah, you're right, we actually have seen increased staffing costs, increased operational costs because a much larger percentage of our professionals are dealing with personal issues as well too. So [00:31:00] it's a much larger impact, and I think many people realize.
Michelle Rathman: Oh my gosh. And you go down that path just a little bit. When you think about. We need a healthy workforce in healthcare. Makes sense, right? We're also talking about childcare deserts, housing deserts, for those who want to work in rural health professions. Again, these are things that are totally different conversations.
Michelle Rathman: Okay. Before we go, I am an avid member of the Grassroots Advocacy Forum and yesterday we got the big email with the subject line, debt ceiling deal reached. So in your wisdom, can you share with us if passed, if it moves forward as it is, what does that mean? Good, bad, or indifferent for rural health?
Michelle Rathman: Anything, any provisions we should be keeping our sights on.
Alan Morgan: Yeah, I'm really concerned, our team is getting into the weeds right now as we speak. As you mentioned, this is timely. Looking at what this actually means. For rural communities. I can tell you we do know right off the bat there, there is a trimming of some of the [00:32:00] programs that are currently in the works and across the board in HHS and the USDA as well too.
Alan Morgan: Where they the Congress had appropriated funds for our programs in the past. And now those dollar amounts have been reduced as a result of that. And again, I want to get to the point, especially about rural Americans, when we get together with rural Americans that really focus as they should be because they're from small communities on working within their means.
Alan Morgan: And we all agree with that. I think what we all don't agree with is the fact that when we do these reductions, We always end up facing the brunt of them in our rural communities. Where they end up cutting is too oftentimes impacting our small towns, which gets to your point. That is why we have such a huge focus of making your voice louder, what we say is our tagline on that, and making sure that in these discussions, at the end of the day, our policy makers do not forget about our small communities, even though we're smaller in number.[00:33:00]
Alan Morgan: Wow. I'll tell you what, our rural communities and our rural healthcare leaders, they're active, they vote, they take an interest in that, and they recognize the impact that any sort of reductions in federal support have on their rural communities.
Michelle Rathman: And then, my fear is we've got reductions and then that doesn't change the need. The demand is still there. The costs are increasing and bearing the brunt doesn't even, I think that's an understatement because now when you think about, it's like standing in quicksand and then having, lead bricks piled up on your shoulders and then, hoping that you're going to stay standing, I guess is the analogy that
Michelle Rathman: pops to my mind. So for our listeners, if you think about this for those of you who say, well, I don't get involved with politics, I don't I really think it's important for us to state that this is not about the politics. It is about the policy. And it is incumbent upon all of us to be informed about that, which impacts our lives directly and sometimes maybe indirectly, but the greater good for the community.
Michelle Rathman: So, [00:34:00] I'll just run off my tick sheet here. The things that NRHA is really hoping that people will be, become informed and advocate for, because you can't do it alone. Rural health infrastructure, that's a big one. Urging congress to invest in rural communities through the farm Bill Urging Congress to invest in rural health in general, the rural health workforce, and then reduce the burden in rural health clinics.
Michelle Rathman: I think those are the big policy and the advocacy campaigns that you're asking folks to pay attention to.
Alan Morgan: That is great. Thank you, Michelle. That is right on the mark and that is exactly why you're on our policy Congress. You're just such a great voice on the national level. Thank you again.
Michelle Rathman: Oh my gosh. I tell people I got my thirst for policies when I was chosen to lead the Jesse Jackson presential bid during a Mock Convention Delegation so many, so many years ago, and I've been involved, not from a political standpoint, because I do recognize that everything that happens in our lives, I say this and you'll hear me say it often, all roads to quality of life, [00:35:00] including yours, ours, are paved by policy, so today is a perfect day to connect the dots and do something about it. Alan, I am so thankful for your time and expertise today. And to our listeners, I strongly encourage you to follow the National Rural Health Association. You can find them all over social media. Go to their website.
Michelle Rathman: You can download the policy papers. You can actually read them, pop some corn. There are bills there. You can read 45, 80, a hundred-page bills. And I just think it makes us wiser and more productive citizens, if you will. And I'm really proud to be a part of an organization that's advocating on behalf of, the numbers keep fluctuating.
Michelle Rathman: It's somewhere around 62 million people. So, Alan, again, thank you so much and you are welcomed back anytime. Believe you, me, I'm going to be, I'm going to be reaching out to you anytime I need us to clear this up for people.
Alan Morgan: Michelle, thank you so much, and again, I'm really excited to be with you here again. But as I said, I was more excited to actually see you in person in San Diego a couple weeks ago and finally get to catch up. [00:36:00] Really appreciate your voice on behalf of rural America. Thank you so much.
Michelle Rathman: Thank you. I'm so glad. I mean, there's some backstory here. I was so glad to be able to be back with everyone and I'll just share with everyone, we took a year off. We were going to launch the Rural Impact a little bit earlier this year, and I have been going through my own journey. My husband has just recovered from kidney cancer surgery.
Michelle Rathman: So not only do I know healthcare on the outside, but I'm intimately aware of it, navigating on the inside. Very grateful to have access to the cancer care that we are fortunate to have. And I fully recognize, this, how fortunate we are to have those kinds of resources available to us. And I personally think that everybody should have those resources available to them as well, which is why I do what I do.
Michelle Rathman: And. Before we close out, I want to send a huge shout out to the Rural Impact production team. They are mighty, and that includes Brea Corsaro. She's our Associate Producer, Sarah Staub. She's an incredible creative force behind our graphics and the production. And a very special thank you to Jonah [00:37:00] Mancino for the amazing original music that he's produced for The Rural Impact.
Michelle Rathman: If you are interested in supporting our work and partnering with us, Head over to the rural impact.com and you can explore the many ways for you to do that. Thank you so much for listening. We'll talk to you on our next episode of The Rural Impact, where we're going to dive into America's rural OB desert and maternal mortality crisis.
Michelle Rathman: This is not light conversation and we hope that we've enlightened you as a result. Thank you so much. We'll talk to you next time on The Rural Impact.