Lawmakers press HHS on rural hospital finances and Indian Health Service commitments

Several members told Secretary Robert F. Kennedy Jr. that rural hospitals and the Indian Health Service (IHS) require urgent attention, pressing for steps to address reimbursement, shortages and longtime structural problems.

The committee chair described chronic rural health problems in his state, saying “Rates of heart disease, diabetes, and cancer in my state of Alabama exceed the national average,” and noting that in 2010 “at least 14 hospitals in Alabama closed their doors.” He asked whether HHS and CMS would review the area wage index, which adjusts Medicare wage reimbursements and—because the index must remain budget‑neutral—can leave low‑wage rural hospitals at a competitive disadvantage for staffing.

Kennedy said he would work with members and with CMS leadership and provide technical studies to show the impact of the area wage index, but he stressed that statutory change is necessary to alter the wage‑index framework: “Change has to be statutory, and we will do our job at providing technical support, including the kind of studies that you just mentioned,” he said. He described the economic and community importance of rural hospitals and said the administration had taken steps to exempt IHS from hiring freezes and to protect its funding and staffing where possible.

Why this matters: Rural hospital closures and workforce shortages can remove nearby emergency care and disrupt local economies. Lawmakers asked for concrete commitments and studies the committee can use in appropriations and statutory reform work.

Discussion vs. direction vs. decision - Discussion: Members detailed local impacts and asked whether CMS and HHS had or would take corrective action on the area wage index and rural hospital viability. - Direction/assignment: Secretary Kennedy pledged to provide technical assistance and studies and to work with members and CMS to seek statutory remedies. - Formal action: No statute or rule was enacted during the hearing; members requested further documentation and follow‑up.

Clarifying details - Rural hospital closures: the chair said at least 14 Alabama hospitals closed in 2010 (as stated during opening remarks). - IHS: Kennedy said he “spent 20% of my career working on tribal issues” and pledged to protect IHS funding, exempting it from some internal personnel reduction measures and supporting tribal autonomy for resource management.

What’s next: Committee members asked for technical analyses of the area wage index disaggregated by state and hospital type; the secretary committed to work with CMS and provide support for statutory solutions.