Hillsdale Hospital News

Episode 77: Rural Health Policy & Advocacy

Rural hospitals and healthcare providers are constantly facing new challenges as the healthcare industry changes and as regulations shift. At the same time, legislators and federal agencies need to hear from rural hospitals if any new action needs to be taken for their benefit or if coming changes will impact them.


Our guest today is Carrie Cochran-McClain, Chief Policy Officer for the National Rural Health Association.


Make your voice heard to promote NRHA’s rural health FY 2023 Appropriations requests and priorities including extension of LVH/MDH hospitals, rural ambulance payments, 340B protections, telehealth provisions, and sequestration relief. NRHA has developed pre-prepared materials and talking points as guides for these conversations. https://www.ruralhealth.us/advocacy/advocacy-campaigns


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Audio Engineering & Original Music by Kenji Ulmer




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Rachel: JJ we talk about health policy constantly on Rural Health Rising and how important it is for rural hospitals and health care providers to have a seat at the table.

JJ: That’s right, Rachel. There are many ways to have an impact on health policy, but for our listeners who really want to gain experience in policymaking at the federal level, we have a great opportunity. Opportunity to share.

Rachel: The Robert Wood Johnson Foundation Health Policy Fellows program seeks out midcareer professionals who are interested in federal health policy to learn how to improve the health of our nation and ensure everyone has a fair and just opportunity for health and wellbeing. The program starts in September and runs for one year. Applications are open now and close on November 7, but you’ll need at least a few weeks to get your materials together, so don’t wait. If you’re interested in learning more or applying to this prestigious program, visit healthpolicyfellows.org. That’s healthpolicyfellows.org. Rural hospitals and health care providers are constantly facing new challenges as the healthcare industry changes and as regulations shift. At the same time, legislators and federal agencies need to hear from rural hospitals if any new action needs to be taken for their benefit or if coming changes will impact them. So how do rural hospitals and healthcare providers keep their interest top of mind for decision makers in Washington, with direct.

JJ: Communication, personal engagement, and the support of advocacy experts bringing forward a collective rule voice.

Rachel: I’m Rachel Lott.

JJ: And I’m JJ Hodshire.

Rachel: And this is Rural Health rising.

JJ: Welcome to episode 77 of Rural Health Rising. I’m JJ Hodshire, president and chief executive officer of Hillsdale Hospital.

Rachel: And I’m Rachel Latte, director of Marketing and Development.

JJ: Well, Rachel, we’ve been pretty busy here, and advocacy has been heavy on our minds, not only looking at some of the changes that are happening in Lansing, Michigan, which is our capital, conversations with our state representatives, with our senator at that local level, but that doesn’t stop there. In fact, we are represented federally, and that takes a lot of time as well, doesn’t it?

Rachel: It does. We have been doing a lot on our own here in Michigan lately, along with our state hospital association, but for our federal interests and challenges as well. We fortunately have the tremendous support of our national association, whose policy experts keep us informed. They’re advocating on our behalf, and they’re also helping us find ways to advocate directly. So today we have a great return guest who happens to lead those efforts.

JJ: That’s right. And we concentrate on when we’re faced with Michigan issues. Michigan Hospital Association we’ve had Brian Peters, MHA President, on this program before, and in fact, I’m on the MHA board and have spent a lot of time advocating for rural hospitals. But really what warms my heart is when we can bring to the studio experts who are working at the federal level, which takes on a whole new understanding, right when you start talking about federal legislation and how that impacts rural health care nationally. State level, state impact nationally. So, our guest today is Carrie Conquered McLean, chief policy Officer for the National Rule Health Association. We want to welcome you again to Rural Health Rising. Carrie?

Carrie Cochran: Well, thank you so much, JJ and Rachel. It’s my pleasure to be back with you today and talking a little bit about rural health care policy at the federal level.

Rachel: So, Carrie, to start, for those who may have heard episode, I think it was 53 that you were on before, but might need a little refresher, or for those who have not met you before here on our podcast, why don’t you give a quick reintroduction of yourself and a little bit about your background and your work at NRHA.

Carrie Cochran: Sure. So, as JJ said with the National Rural Health Association, I helped to kind of develop and implement our federal policy efforts for all of rural health care. So, we spend a lot of time talking about provider and facility issues, but really also represent the patient perspective, the public health perspective, a broad range of efforts here at NRHA. My background, I had the pleasure when I first came to Washington, DC. Many moons ago now, to work in the Federal Office of Royal Health Policy with the fearless Tom Morris and team, and then stayed in the Health Resources and Services Administration, or HRSA, within the US. Department of Health and Human Services, really focusing on access to care for underserved populations. And I worked a lot with NRH in that capacity and had the pleasure of coming over here to focus my efforts a little bit more, I think, from the direct kind of provider patient voice here at NRHA.

JJ: So, you know, now that we’ve established who you are and what you do, let’s start with the why. Now, we did this last time, but we want to do it again to remind our listeners what motivates you and what gets you up out of bed in the morning. So, Carrie, what is your why?

Carrie Cochran: My why? So, an apology if I said this last time, I can’t remember what my Y is. So, this is an interesting comparison.

Rachel: Well, just some changes over time, right. You see it from a slightly different perspective depending on how your days going, right?

Carrie Cochran: Yeah. So, my why? So, I am originally from Montana. My family has spent I am the fifth generation of my family to be living in Montana at some point in our lives. And I just have a real passion for thinking about what life is like in those rural communities and making sure that people have equal access to rural healthcare. I love my job because we cover kind of the whole gamut of everything from the minutiae in Medicare reimbursement to the really big kind of public health infrastructure kind of questions. And I get to work with really fantastic people out in our rural communities and feel kind of their support as we go forward in our day-to-day efforts.

JJ: You know, Carrie, let’s get into some meat here. Obviously, there are some hot topics facing rural hospitals right now across America. We do know that since 2010, the number is well over 140 hospitals rule have closed in America. And the projection by Scott Becker on this very podcast just a few months ago was that hundreds are at risk of closing across the United States in the next one to three years. Very sobering thought when you give consideration to lack of access for health care. And we just attended your monthly grassroots advocacy call a few weeks ago, but we did learn a lot about what’s happening at the federal level, and I was just hopeful that you could share a few issues you and your team are focused on these last few months of the year and maybe talk a little bit about how that changes. And what does it feel like in Washington as we get ready to end the year and obviously put in an election year? Yeah, election year. We do know some were defeated already, and so what’s it feel like and what are you working on? Could you share that with us?

Carrie Cochran: Yeah, so this time of year in Washington is so I was saying earlier to JJ. It’s kind of like you’re eerily quiet and busy all at the same time. So, we know that Congress just took a break for about six weeks of recess, which will take us up into and really through the midterm elections. So, while it’s pretty quiet around here on the sidewalks and on the streets, but there’s also an awful lot of communication and work that’s being done as we anticipate the big kind of end of year legislative vehicle being discussed when Congress returns from the midterms. So, lots of interest in kind of what’s happening with elections. As you may have heard, there are all sorts of pundits who anticipate elections going one way or another. Right now, the rumor is that it’s anticipated that the Senate will be held by the Democrats and that the House is likely to turn over to a Republican majority. But that’s all up in the air. And how our end of year activities, both the FY 23 appropriations or federal budget package, as well as a number of non-budgetary provisions that are anticipated, the question of how those move forward and what our strategy is really depends a little bit on those midterm elections.

JJ: And so obviously you’re nonpartisan. So, can you frame for us what that looks like? That’s a tough balancing act at times, isn’t it? And now you have some folks who are angry that they weren’t elected. Maybe they were working on a specific piece of legislation for us, for rural health. Does that change whenever there’s an election like that, or is it pretty they’re just going to carry it forward could you give us? What does that dynamic look like?

Carrie Cochran: Yeah, you’re right, we are nonpartisan or bipartisan, depending on kind of how you think about it. We work with both sides of the aisle because in all but just a very few of our states, there are rural areas. And so, our goal in working with Congress is to find out what the broader issue our member of Congress is interested in and figure out how we move the needle within that kind of rural portfolio. So, we do work with both sides of the aisle and both kind of extremes within both sides of the aisle and we have champions in both of those buckets. And so there always is kind of a turnover in terms of our leadership on some issues when we have an election. But we are lucky that because most states have rural communities that we have lots of strong voices for healthcare and rural healthcare in Washington. And we are in the process of not only trying to get some of our priorities passed before this Congress ends at the end of the calendar year, but thinking about how we gear up for the next Congress, the 118, to do kind of that education introduction of important rural bills.

JJ: Can I talk real quick about that process? So, do you have a program, an introduction for new Congressmen and women in terms of what they can expect from your association or what you can shed with any light that you can shed with them? So, can you talk about what’s January going to look like for you?

Carrie Cochran: Yeah, that’s a great question. So, we have a number of ways that we kind of work directly with members of Congress and their staff as we anticipate kind of changes in Congress and I should say both new members coming in but also members changing committees so they may all of a sudden be on a health-related committee and it may be kind of need to refresh on certain kinds of issues that they haven’t thought about in a while. So, we are anticipating hosting briefings for members and staff on rural issues honestly throughout the 2023 year. Obviously, we’ll do some early education for those brand-new members, but really working to strengthen and reestablish and kind of recommit on rural with a lot of our partners. We also are really looking to stand back up our rural health caucus and coalition in the House and Senate, which is the gathering of kind of members who have come together to talk about or share an interest in rural health care and thinking about how we can get those kind of reinvigorated in the 118th Congress. And I would be remiss if I didn’t also mention that early in 2023, we host our annual Policy Institute, which is an opportunity for folks to come to Washington DC. This year. It’s February 7 through the 9th and we at that event will host members of congress, members of the administration, as well as work with you to set up one on one kind of direct meetings with your state companions and Cohorts to talk about the issues that are pressing for you. So, we’re getting geared up for that Policy Institute in February, which is also a huge way that we communicate and connect with our members of Congress early on in the term.

JJ: That’s exciting.

Rachel: Yes, I know. Last year. It was last year, right, that it was virtual because I participated in some of the calls with our that’s right. Congressional delegation but didn’t get to participate as much as I would have liked because we had so much gone on here with COVID at the time.

Rachel: But I am looking forward to that, or at least I will be this year. I don’t know about you, JJ, but I’m going.

JJ: You’re going? Absolutely.

Carrie Cochran: For sure.

Rachel: I love it. So, let’s talk real quick. This, I know, has already passed, but can we talk about the Inflation Reduction Act and what its impact is and will be on rural hospitals in particular?

Carrie Cochran: Yeah, great question. So, you probably, or your listeners probably are very familiar with the Inflation Reduction Act and some of the kind of being known for some of its climate related provisions, but there were some important pieces in there for healthcare that we want to make sure people have on their radar. So, thank you for this ask. One of the biggest pieces that we heard about was around kind of prescription drug coverage and the changes that occurred there. So, there was an overhaul of Medicare Part D, which is the prescription drug component of the Medicare program. There were a number of changes in this space, but they basically allow Medicare to start negotiation of drug prices for kind of high-cost drugs, meaning that both the cost of the drug will be lower for Medicare as well as the beneficiary and their copayment. Those negotiations can start, I think, as early as next year, but they won’t actually kick in until 2026. There’s also a number of other kinds of incremental changes that will be happening. Things like caps on the amount of out-of-pocket payments or costs beneficiaries will be paying under Medicare, expanded subsidies for Medicare Part D or prescription drugs under Part D. And then some cost sharing, especially around vaccines for adults. So, some really significant changes to how Medicare pays for drug costs, drug pricing for our rural seniors. There also was an extension of the Affordable Care Act subsidies under the marketplace. So, this is for folks who are buying their health insurance coverage under either a state or federal marketplace kind of plan and support for them to pay for those copays and deductibles. There was a three-year extension of those subsidies. So that’s going to help a lot of rural folks who are getting their coverage that way. And then last, but definitely not least, we were very encouraged to see recognition of the US. Department of Agriculture’s Rural Development Program and some support for them to strengthen and stand up the work they do. Those programs are so cool because if you talk to them, they basically can go into a rural area and build an entire community based on the range of services that they provide. And they’re a huge resource for rural communities, both in terms of some kind of broadband telehealth, but most importantly, capital resources for hospitals and others. So, we were happy to see some support for them in this bill as well.

JJ: Excellent. So, one of the items I have kept a very close eye on is the low volume adjustment for Medicare dependent hospitals. And that’s us, obviously, in a very rural poor community where 70% of my payer mix is Medicaid Medicare. This has significant implications to me if we do not receive it financially. So, could you give us an update? I know that it had been extended, we heard on the call with you through December, but is this going to be codified into the law? What are your thoughts on this for hospitals like ours who are listening to this podcast?

Carrie Cochran: Yep, great question. So, the Medicare dependent hospital and the low volume hospital designations, as you mentioned, JJ, are designations under Medicare that for hospitals that typically they’re not made permanent. So that means Congress, on a somewhat regular basis, has to extend the authority for CMS to offer these payment adjustments to facilities. And to your point, there’s 140 Medicare dependent hospitals and almost 550 low volume hospitals in our rural areas across the country. So very important designations. We were very happy to see that this was a program that was set to expire on September 30. And so, we were very happy to see that Congress included an extension of this program in its short-term continuing resolution it did for the budget. So, we know with certainty that those designations will continue until Congress picks up the mantle again on December 16 to talk about what the end of year kind of full package looks like. So, in the past, that hasn’t always happened and it’s been kind of a mess because you have to, like, retroactively figure it out with the Centers for Medicare and Medicaid Services. And so that in itself was very exciting, I think just from a logistics standpoint or process headache standpoint, but we do feel very hopeful, very good about kind of the continuation of those designations. You know, I would hope for a five-year period of time. I mean, we always advocate for that to be a permanent designation. If we can’t get that, we will go for as long as possible in order to provide as much continuity to you all and security to you all with that designation. So, I’m hoping a five-year continuation, it may be a three, depending on what our Congress mix ends up looking like. And what they have to negotiate down because all of it has a cost. Right. And that’s figuring out what those high-level numbers and how much they are willing to spend is always kind of the secret sauce in this process.

JJ: Yeah. Let me ask a question. Follow up to this, Carrie. So, what would be the objections that a party would raise to the low volume adjustment? So, we have a kind of a grasp, is it just because of the spending, the cost?

Carrie Cochran: I would say the vast majority of the time, it’s just because of the spending costs, the additional costs. And the hard part about that is when you look at the overall spending of healthcare in this country. Or even just the Medicare program. If you want to kind of narrow it a little bit. So, to speak. The amount that we spend on rural programs and rural designations is so small compared to the biggest bucket. And yet and your guess is as good as mine. But there tends to be where we can run into hesitation around creating kind of exceptions to the process that would that would change how you’re paid. So, in this situation, I feel like part of our job, a big part of our job, is just the education around why we need these designations and what’s happening out in our rural areas and why these hospitals need the additional support in order to keep their doors open. And that’s why folks like you are so important to help us tell this story to your members of Congress.

Rachel: Right, right. And so, what does this mean for because there are I know there’s a Senate bill and a House companion. One of them is a Save Rural Hospitals Act that would make those designations permanent. Right. And what does this mean now that we have the extension in the continuing resolution and then hopefully in either a continuing resolution at the end of the year or an omnibus bill? What does that mean for something like the Save Roll Hospitals Act? Is that one of those things where, well, it was in there and it’s been continued, so we’re not going to worry about it until it’s in jeopardy again? Because obviously, from where we’re sitting, we’re like, can we just not forget about that just because we got a temporary extension? Right. Do we have to keep going on this roller coaster all the time at the I don’t want to see the whims of Congress, but based on what’s going on in Congress every couple of.

Carrie Cochran: Years yeah, that’s a really good question. So just to your point. Rachel. When we think about how these ends of your bills happen and I’ll back up to say it really feels like with the rare exception. And obviously COVID was a little bit different because of the crisis that the nation was in. A lot of the bills that we’re seeing now are these very large end of year tied to appropriation what we call kind of Christmas tree bills. Partially because it seems to always happen around the holidays. But also, because it’s like everybody gets an opportunity to put their kind of specific priority onto a branch. Right?

Rachel: Right.

Carrie Cochran: So, we see a lot of times when we’re introducing legislation like HR 6407 or rural hospitals act, we’ll introduce what I almost call like, our wish list of rural hospital fixes and then work to educate folks on that full bill. And then when we have opportunities like this end of year kind of package, really lift up those things that are most at the peak crisis level. So obviously the extension of these designations is one of those. One of the other top priorities we have right now is relief from the Medicare sequestration, which is a 2% cut to Medicare, and then the PAYGO sequestration, which is a 4% cut, getting those waived and the sequestration was also part of that save our Rural hospitals act. So, part of it is introducing a bill and socializing it and educating folks about it and getting supporters. And then part of it is the strategy to get it in one of these big packages at the end of the year.

Rachel: And one of the other big issues that we have talked about a lot, we did just talk about it with our state legislators when we were in Lansing doing some advocacy. What was that? Last week before?

JJ: The week before, remember?

Rachel: Now, of course, I say that all the time. People probably think I just don’t even know, like, what a calendar or a clock is, which might be true. I did love the 90s when I go back. Oh, 22. Okay, anyway, but one that we talked about, there was a bill introduced recently at the state level in Michigan to help with some regulation for travel nursing agencies. This is something that we in particular have been very passionate about and also concerned about because it kind of looks like there’s been this price gouging happening during a historic crisis in our country, and it just doesn’t really seem like it’s been getting the attention it maybe should have. And I know there was I can’t remember if it was introduced in February or in August. Or maybe there was an update in August. But I know there was something put forward that would have required some sort of study related to what travel nursing agencies did during the pandemic and how they profited and how those profits were used compared to how much of that went to the nurses that they were employing. How much of that was back into the pockets of the agencies or their higher-level folks. But do we have any updates on any sort of either federal regulation or federal attention to this issue? Because even today in one of our meetings, one of our leadership meetings, we were talking about, you know, anytime there’s more turnover, we always have that risk of we might have to bring on more travelers again. And that cost is so significant for us. I think we’ve paid up to four times for a travel nurse per hour what we would pay for our committed nurses who are here and are invested in our hospital and our community. So, stepping off my soapbox, I think I stepped on a little bit there preaching what’s the latest at the federal level on this issue?

Carrie Cochran: Yeah, that’s another good question, Rachel. And you are not the only one on that soapbox. I feel like we have we actually just had a listening session today for a request for information that the center for Medicare and Medicaid Services is doing around equity and some of the public health emergency kind of flexibilities. And I feel like three quarters of the feedback we got was all around workforce. So, it is a challenge that I think across the board rural communities are struggling with and facing the traveling nursing piece. You’re right. In terms of the federal level. The bill that was introduced back in I think it was like June. Maybe. The Traveling Nurse Agency Transparency Study Act did request or require that the government accountability. Which is kind of like the program auditors for Congress that Congress is able to deploy to look at federal issue is really looks at the effect of travel nursing and what happened during COVID-19. I think the challenges beyond this bill I haven’t heard of a whole lot of conversation in Congress on a federal solution. So many of these issues are kind of state by state. But we are very much continuing to look at a couple of things. One, how the costs associated with the increase in salaries and the inflation pressures that facilities are facing, like how are we addressing that and paying for that through our Medicare program and putting forward comments to CMS and working with the administration on that and trying to get some relief there. And then the second piece of that is just continuing to think about what we do to support the nursing and more broadly healthcare workforce development, retention, placement in our rural areas and I think the end of year. I’ve talked about some of the quote unquote, like non budget related pieces of the end of your package. But a big part of this bill that’s coming up is funding for our discretionary programs in the federal government for fiscal year 2023. And within that we have a number of priorities around workforce. Both core programs like the National Health Service Corps and the Nurse Corps that help with the distribution of providers in rural communities. But then also support of kind of the Title VII nursing programs and HRSA as well as the Rural Residency Planning and Development Program that creates the infrastructure for us to be able to train people in our rural communities at our rural facilities. Knowing that if you train there, you’re more likely to stay there. So, it’s a multifaceted kind of approach. I wish there was one answer to all of this because it is something that’s causing a lot of pain, but we’re kind of trying to hit it from a lot of different levels here in Washington.

JJ: Yeah. So as my peers are listening to this podcast across the United States and for many of our rural hospitals, participation in 340 B is significant to me. Initially, a couple of hundred thousand. But the forecast for us, as we engage more and more rural health clinics and engage in other opportunities, it’s growing. And, you know, it’s upwards, potential upwards of half a million dollars just for my small rural hospital future state. So, there was a ruling at the end of September.

Rachel: Yes, I can’t remember. I got to go back and look at it. I wrote that and then I can’t remember what it was, but it was in favor of hospitals. I can’t remember exactly what it thinks it had to do with immediate repayment of any unlawful cuts to 340 B. Is that right?

JJ: Right. There was a suit in which we had a victory. But I guess from an advocacy standpoint, this is a big one, right?

Carrie Cochran: Yeah. So, a couple of things. There was a lawsuit that was settled in the fall. The big piece there, and Rachel, you were right. It’s a while back, 2017 maybe-ish Medicare changed outpatient hospital payment to reflect what they consider to be kind of a double discount for those entities that were filing under 340 B that was overturned. And so, there was some rural or some proposed policy in the outpatient PPS, Medicare hospital reg for next year to kind of make folks even for those cuts. So NRHA did comment on that, and those, like, impacted facilities will or should be seeing a change to reimbursement next year to reflect that. But to your bigger issue, JJ, I mean yeah. 340 B, what a mess, man. Not only is it a complicated program just across the board, as you know, I’m sure, and folks listening to this program know there have been significant abuses by drug manufacturers as well as PBMs or pharmacy benefit managers in terms of taking advantage of the limited federal oversight the program has. And that oversight, unfortunately, is limited by statute. So HRSA, even if they wanted to do more to regulate the program, they don’t have the authority to do it. And in that absence, manufacturers and PBMs are really employing some very discriminatory practices. So, we’ve had three-pronged strategy on this. One is to do what we can to work within the administration’s authority to get them more funding, to do some of this work to their ability, and then where they can ask them to kind of revisit their capacity, revisit some of what they can do.

Rachel: They ask us to do that all the time.

Carrie Cochran: We’re partners on that. But also. We have a bill right now to protect 340 B Act of 2021, HR 43 90 that looks specifically at the prohibition of discrimination against providers who are part of kind of the contract pharmacy piece of the program that I think we’re hopeful, we’re pushing for that in our end of year. That and big end of your package. I don’t know. We’re really hopeful. We’re pushing it hard, but we’ll see what will happen with that. I think aside from this. We’re starting to have a really serious conversation with others at the national level about kind of what the long-term longevity of this program is and anticipating that we will probably be having lots of conversations in the 118th about legislative changes to the program and thinking about what that looks like and how do we write those in a way that really protects and engages our rural safety net providers. Hospitals. Our FUHC’s and others who are providing important services in our rural communities. Knowing that Pharma and others have a really strong lobbying presence in Washington. And so, I think it’s going to be an interesting kind of process as it rolls out over in the next year or two. But we do anticipate seeing some kind of new legislation built around this and really wanting to make sure that rural is protected as we move forward.

JJ: Excellent. We’re getting to what they call Lane duck session, right? This is where we kind of come to an end of the year and so I guess what would you expect to see before the end as it relates to appropriation bills? Anything that you’re keeping an eye on, anything that you see really is applicable to rural health and you’re like if we do, if we don’t. And I guess the question is what are you pushing for?

Carrie Cochran: Yeah, so a lot in terms of the broader end of your package, we mentioned a number of the things already. So, we’re talking about relief from the Medicare and pay Go sequestration so that rural providers are getting their full Medicare reimbursement, not necessarily more, just no deductions from their existing. We talked about a number of the Royal Medicare extenders, both the Medicare dependent and low volume hospital designations but also important Medicare payments to our ground ambulance services. There is an additional payment to recognize the challenge of EMS in rural areas and that also is expiring. So, asking for extension to that, we also are looking to make permanent a number of the flexibilities we saw in the public health emergency related to telehealth and specifically telehealth and federally qualified health centers and rural health clinics. I know my colleague Josh talk to you all about that earlier this year, but those were hoping while we have a little bit of a reprieve of those post pandemic or post public health emergency, we want to make those provisions permanent. 340 B talk about that. So, we really want to see the protect 340 b act included. And then last but not least, I think to your point, JJ, depending on how the midterms go, we will either see a bill before Christmas or before the end of the I should say the end of the calendar year, or we’re going to see people try to push that into January, February, March, so that they can have more influence on what the bill looks like. So, we’re talking about right now, we’re a full, like, Democrat controlled Congress. But if that changes in the elections, you’re going to see people kind of jockeying over timelines to see how much influence they have. The other piece to watch as we’re talking about the budget right now, the budget proposals for 2023. So, all of our, again, discretionary programs, that budget is looking really good, and it looks really good for rural, and we’re very happy. There’s been increases in a number of our key programs that support rural hospitals, support workforce, support kind of that public health, community-based infrastructure. But most of those numbers have come from there have been Democratic what they say, Markups. So, it’s come from a Democratic majority House, it’s come from the President, and it’s come from a Democratic majority Senate. So really, we don’t know where the Republicans stand on a lot of these numbers. And if one of them takes control of one of the houses or both of the houses, those numbers might change a lot. So that’s part of the reason we are still continuing our advocacy here in Washington, because even though it’s a quiet six weeks while everyone’s out campaigning, we still want to make sure that our priorities are front and center because we just don’t know what’s going to happen after the midterm elections.

Rachel: Well, and we are looking forward to doing some advocacy ourselves in Washington, DC. Next month, and I’m so excited that we get to see you guys while we are there. So, we’re looking forward to that. But with everything that we’ve talked about today, I know you mentioned the Policy Institute, which was in February, but in addition to that, what are some of the best ways for rural hospitals to engage with your efforts on all of these issues?

Carrie Cochran: Yeah, so Pi Policy Institute is a great opportunity to get that face-to-face connection, if you don’t already have it with your members of Congress and come learn about kind of where national leaders are in terms of rural health. I would say the other thing that we’re asking for people’s help with is this big end of year push and helping us again, you probably have heard me say, myself and the team here in Washington, we can talk till we’re blue in the face. Hopefully we’re getting through to members of Congress. But you as constituents have so much more power and influence than I think folks realize. So, we need your help in getting that message across to Congress. So around kind of national Rural Health Day, which is November 17. I actually think we’re probably going to do that week after Thanksgiving. We are going to do a series of virtual flying virtual meetings so folks can really do a push on this end of your package, because depending on what happens post-election, we don’t know. Hopefully a budget is passed before we all get together in February. So, we want to make sure we’re not missing this magic window in a November December time frame. And we want people in Washington to hear the role voice. So, we’re going to be doing a big push on social media and on our website and through our regular communications about how you can help us send materials to Congress, talk to your members of Congress over zoom, email, kind of whatever your preferred communication is, but again, just helping us lift up our voices. And we have materials we’ve developed and talking points and all sorts of other things to hopefully make that easier for you and Rachel and JJ. I can get you those links if you can post maybe with podcast if it’s appropriate, please.

Rachel: Yeah, we’ll put those in the show notes for sure.

Carrie Cochran: Perfect. Okay, so that’s probably the biggest. But the other thing I would keep saying I’m going to end and then I just keep going. I do this all the time. The last thing I mentioned is the six-week window that we’re talking about right now. Between now and the midterm elections, I guess it’s not quite six weeks anymore is a perfect time to connect with your member of Congress because they are at home hitting the ground, shaking hands, chatting with folks, visiting places. So, invite them to come visit your facility, attend a town hall where they’re talking and bring up your issues. Again, our website, we have templates for how to do those invitations to members of Congress. You can find on their website kind of where they’re doing the town halls, but take advantage of them being local to put your issues in front of them. And because a lot of them are up for election or reelection or they’re out campaigning for their friends, they’re in that space to really be accessible to you as voters and constituents.

JJ: Well, carry, believe it or not, our time has expired.

Carrie Cochran: How is that possible?

JJ: Jason we could talk for hours. We could talk for hours. The passion that you have, Carrie, is second to none, maybe near Rachel in mind, but it is truly second to none. We’ve watched and we’ve heard you, and we’ve seen your work, and you and your team do a phenomenal job at advocacy for hospitals just like Hillsdale. And so, thank you. Thank you for your advocacy. Thank you for your hard work going to Congressmen and women and advocating for people that you really don’t even know. But, you know, the similar challenges that we face in rural America, the access issues and the transportation issues and all of these things that from community to community have a tie. But thank you on behalf of Hillsdale Hospital, on behalf of Hillsdale County, and for those who are listening nationally, for all rural health care, for the work that you and your team do every day to advocate and advance rural health in America. Again, it is second to none. And we thank you for your time and your commitment there and on this program. And we’re hopeful that we will have you back for a third time. Would that be your first guest ever? For three?

Rachel: You know, I think we have another guest maybe that has been three times either has or is about. But I will say my plan, as long as Carrie is okay with this, is that we have her and or Josh on every two or three times a year to kind of give us those updates on what’s going on at the federal level. And who knows, maybe we’ll try to teach them when we’re in DC.

JJ: Remote podcast. That would be awesome.

Carrie Cochran: That would be awesome.

JJ: So, thanks for joining us. Today on Role Healthy Rising. We’ve appreciated the time that you’ve spent with us, explaining the dynamics, and we would just encourage our listeners to contact your congressmen and let them know where you are today as it pertains to rural health and the advocacy help that you need. So, thank you for joining us.

Carrie Cochran: Thank you.

JJ: And before we close, we’d like to do a fun segment with each of our guests. We want to know what is your most unique rule experience or one of your favorite memories that is unique to.

Rachel: Rural life or maybe your second most? Because we did ask you this last.

JJ: Okay, all right.

Carrie Cochran: I can’t remember what I talked about last time.

Rachel: I think it was something about a.

Carrie Cochran: Bear that was going to be mine. Let’s see. I feel like all of mine are like, wildlife related.

Rachel: Montana. Right?

Carrie Cochran: I know, right? So, I will say one of the very earliest memories I have is I grew up across from a federal national recreation area and we had a neighbor kind of over the mountain, over the hill that was an outfitter and would do like, backpacking, horse packing trips. And I remember one time his horses got loose and somehow made it over the mountain and all congregated in basically our yard and this big open space to our yard and looking out as like a little kid and seeing just what looks like a whole field of wild horses. Very inspirational. That’s awesome. So, yeah, apparently, I have a lot of animals related.

JJ: Well, you are Montana, so not like you’re New York, so that’s awesome. Well, Carrie, thank you for sharing your memorable story and thank you so much for the work you do. And we’re hopeful to see again here and to interview you hopefully in Washington in the next month or so. So, thank you for joining us.

Carrie Cochran: Okay, take care, guys.

JJ: Next time on Rural Health Rising, we have another great conversation with another great guest, so be sure to tune in.

Rachel: And with that, don’t forget to subscribe wherever you get your podcasts. And if you like what you hear, leave us a five-star review on Apple podcasts and tell others why they should listen, too. Your feedback helps more listeners find rural health rising.

JJ: And you can now find us on Twitter. I’m at hillsdaleCEOJJ. Rachel is at ruralhealthrach, and you can also follow the podcast at rural health pod. Until next time, stay safe, stay healthy, and stay strong.

Rachel: Rural Health Rising is a production of Hillsdale Hospital in Hillsdale, Michigan and a proud member of the Health Podcast Network, hosted by JJ Hodshire and Rachel Watt. Audio engineering and original music by Kenji Omer. For more episodes, interviews, and more information, visit ruralhealthrising.com. JJ, we talk about health policy constantly on Rural Health Rising and how important it is for rural hospitals and health care providers to have a seat at the table.

JJ: That’s right, Rachel. There are many ways to have an impact on health policy, but for our listeners who really want to gain experience in policymaking at the federal level, we have a great opportunity to share.

Rachel: The Robert Wood Johnson Foundation Health Policy Fellows Program seeks out midcareer professionals who are interested in federal health policy to learn how to improve the health of our nation and ensure everyone has a fair and just opportunity for health and wellbeing.

JJ: The program starts in September for one year. Applications are open now and close on November 7, but you’ll need at least a few weeks to get your materials together, so don’t wait.

Rachel: If you’re interested in learning more or applying to this prestigious program, visit healthpolicyfellows.org. That’s healthpolicyfellows.org.