WASHINGTON, D.C. – U.S. Senator Deb Fischer (R-Neb.), a member of the Senate Agriculture Committee, today participated in the committee’s hearing on the rural care economy, including access to health care, child care, and mental health resources. During her line of questioning, Sen. Fischer raised the barriers rural America faces to utilizing telehealth services, as well as the impact high gas prices, food prices, and inflation are having on rural families. 

 

Click the image above to watch video of Sen. Fischer’s questions

A transcript of Sen. Fischer’s questions is below:

 

Senator Fischer: Thank you, Senator Boozman, for your kindness. Thank you, Madam Chair, for holding this hearing today, and thank you to our panel members. Joseph Carrica, you mentioned the number of cattle to people in your area. I would just say in Nebraska, we have four cattle for every person in the state, and I happen to come from a family ranch where we have, in my county, we have 30 cattle for every person. You mentioned mental health, you mentioned behavioral health. I fully understand that we are fortunate to even have our family doctors, our general practice doctors in rural areas and specialists are few and far between, very, very difficult to come by. Dr. Inwood, when you mentioned childcare, that's difficult at best for anybody in a rural area, especially those who live on their land. And it is impossible when you live 30, 40, 70 miles to your nearest community. In my case, that would be a community of 3,000 people. So, I would say that I am the member of this committee, if not the United States Senate, with the greatest understanding of what rural truly means in the U.S., and especially what rural means in very sparsely populated areas. I have a question for Dr. Henning-Smith. Great Plains Health in North Platte, Nebraska, began expanding its use of telehealth to remote clinic sites before COVID-19 hit us. And while this allowed Great Plains to be ahead of the curve when dealing with the pandemic, the true value of telehealth in Nebraska is the ability to provide quality health care to rural communities. It allows doctors to provide services to rural Americans who otherwise might have to drive over an hour in order to visit the doctor. So Dr. Henning-Smith, can you tell us about some of the barriers that telehealth still faces and the value that it has for rural communities, particularly in filling gaps in that specialty and primary care, and how we can leverage technology better to address these needs.

 

Dr. Henning-Smith: Yes, thank you for the question, and I have to say that my grandmother was from rural Nebraska. It's near and dear to my heart.

 

Senator Fischer: Oh, what area of rural Nebraska.

 

Dr. Henning-Smith: She was from outside of Blair, NE.

  

Dr. Henning-Smith: So I really appreciate the question on telehealth, and it has the potential and already is filling a lot of the gaps in access to care. Particularly access to specialty care, as you said, that's a particularly important and urgent need in rural places. We just don't have enough people to fund a specialist for each rural area, so we need to find ways to connect patients with the care that we need. And yet, there are gaps that remain, and those gaps are largely about infrastructure. The availability of broadband and a reliable connection is essential to be able to use telehealth either as a provider or a patient. And also, we need the right equipment. People need to have devices in their hands whether they are accessing telehealth with a smartphone or an iPad or a tablet or whatever else they are using to connect. They need to have access to that, and in both cases, the broadband infrastructure and the access to devices is more rare in rural communities.

 

Senator Fischer: Right, I totally agree with you on that. We have to get broadband deployed all across this country. For all of you, I have a question. When I am back in the state, which is just about every weekend, what I'm hearing from Nebraskans is they are concerned about inflation, about the prices of food, and the prices of gas. That is the number one concern. It has been for many, many months, long before the Ukraine situation we are facing. It is a deep concern for families across the state, so do you have concerns that inflationary pressure on essential products like food could have an impact on the health of rural families as their incomes are continually squeezed by these higher prices, and also how has the high cost of gas impacted people living rural communities? Do you have concerns that that is going to affect their decisions on if they can even afford to drive many miles to access that health care? We have family practice physicians in the community closest in my county, but for any kind of specialty, it is about 130 miles or more…or more to be able to reach a specialist. So, with food gas, I'm asking the indulgence of the committee chairwoman if we can quickly kind of hit on the stresses that families face.

 

Dr. Shoshanah Inwood: Okay, first of all, thank you so much for the question, and we have a lot of families from Nebraska and farmers from Michigan who have also been very helpful in helping us understand what these issues are. The issue of being able to get to work in order to have enough money to pay for all of those essential services like food and rent is critical. And child care is what enables families to get to work. When we hear about the distance of farmers driving up to 30 minutes for childcare providers, that definitely is a stress. So, we need to think about how we can do more child care training within communities, whether it's home-based care or more localized cooperatives that can alleviate some of those additional stressors of driving.

 

Dr. Joseph Carrica: Thank you for the question. As a community mental health center, it's our expectation to get the service to the person in need. So, we are actually taking the iPads to peoples’ residences so that they could access care from home. We are also experimenting with trying to get providers into more communities, and we've purchased three tiny homes in the last three years and what we do is we deploy those tiny homes into those communities to try to get access closer to those people and where they live. The abilities those tiny homes give us is the mobility to move through communities and try to embed those services closer to people who may not have the means to come to the city for care.

 

Dr. Douglas Holtz-Eakin. Well, I certainly don't think you should ask the economist about people's mental health. But, we do know from lots of survey detail that this is the number one issue across America. There is no question about that. We also know that people are not optimistic about dealing with it quickly. One of the striking things in the data is the rapid rise in inflation expectations, from under 3% in January of 2021 to over 6% now. So it's not that they feel stressed at that moment. It's they feel stressed for the foreseeable future.

 

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