Ensuring Access to Healthcare in Rural and Remote Areas

Floor Speech

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Ms. TOKUDA. Mr. Speaker, since my first day in Congress, access to quality, affordable healthcare and mental health services has been among my top priorities.

I represent one of the most rural and remote districts in the country. I have seen and heard firsthand the devastating consequences of inadequate access to care.

On Molokai, a constituent shared with me the weight and pain she felt over the loss of her daughter. The treatment and end-of-life care her daughter needed wasn't available on island, so she was forced to leave her children and family behind and tragically passed away without them by her side.

On Lana'i, a kupuna sat me down and said: ``I love living here . . . but it is a difficult place to be born and to die.'' If you need obstetric care, assisted living, or end-of-life care, you have to board a plane, most often alone.

In Wai'anae, a close friend and community leader held up a CDC report in his hand and expressed his anger and frustration that the life expectancy of residents living on the rural west side of O'ahu was a decade less than those living in downtown Honolulu.

In the small, close-knit community of Kauai, too many people have a family member or friend who took their own life. With limited access to mental health professionals and services, our Garden Isle has historically struggled with high rates of suicide and suicide attempts.

In Kona, on the Big Island of Hawaii, a woman cried as she told me that her sister died because she couldn't get the emergency care she needed in time. She then asked me if I knew what the golden hour was, that critical window of time between emergency medical care and a medical trauma happening.

I told her I did. My mother missed hers. She was in a car accident, and the hospital in our community didn't have the appropriate trauma services to deal with her injuries, so she was taken to the next town, where she passed away shortly after getting to the ER.

For many of my constituents, they are just one diagnosis away from a major illness and the impossible financial and family decisions that will come with it. Yet, they live in geographically isolated areas-- their homes, where they continue to be denied their right to healthcare.

While Hawaii's geography and demographic makeup are, in fact, unique, these barriers to healthcare are similarly felt elsewhere across the country.

More than 60 million Americans, one-fifth of the United States population, live in rural areas. Compared with their urban counterparts, rural Americans are generally older and have less resources and poorer healthcare conditions.

While they may require more medical attention and care, rural Americans often have more limited access to care as a result of physician shortages, lack of reliable transportation options, insufficient health insurance coverage, and increased exposure to environmental and occupational hazards.

These disparities in healthcare access highlight the need for greater attention and resources aimed at improving healthcare and outcomes in rural and remote communities.

That is why I am proud to co-lead the Bipartisan Rural Health Caucus. Together with the gentlewoman from Tennessee (Mrs. Harshbarger), we have revived this bipartisan coalition to ensure every American, no matter their ZIP Code or circumstances, has access to the care that could literally save their lives.

When it comes to my hope for rural healthcare, it comes down to the four As.

Accessibility: The distance a patient must travel by car, plane, or ferry to receive medical services;

Affordability: The cost for a patient to get the care they need;

Acceptability: The extent to which a patient receives culturally and linguistically appropriate services in healthcare; and

Availability: The extent to which providers have the requisite resources, such as personnel and technology, to meet the individual needs of patients.

In a time of such deep divisions in our country and Congress, we must find ways to come together to recognize the urgent needs of our constituents and do better for all of our people.

The Bipartisan Rural Health Caucus will look beyond the partisan gridlock of Washington to tackle the rural healthcare crisis in the United States.

From the pristine, sandy beaches of Hawaii to the Great Smoky Mountains of Tennessee, rural Americans are asking Congress to step up and take meaningful action to save their hospitals and clinics, address health inequities, strengthen their healthcare workforce pipeline, ensure fair and adequate reimbursement for providers, and reduce healthcare costs.

For the health and well-being of all of our people, I invite my colleagues to join us in this movement to enhance access and delivery of healthcare and mental health services for rural and remote communities throughout our country.

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