Building the Federal Office of Rural Health Policy

Building the Federal Office of Rural Health Policy


Well during the 1980s the
rural economies went bad and rural hospitals started to close and this
engendered a lot of interest on the part of the Congress, in particular the Senate
Select Committee on Aging. And they held hearings and tried to figure out what
kinds of things you needed to do in order to keep rural hospitals open and
improve rural healthcare. There needed to be a focal point in the federal
government for rural health issues and they decided that they would create an
office of rural health. Like any other startup it was all about the people its
people in the beginning that made this happen. There are a lot of pretty strong
personalities in that original group. We had Jeff Human who was the director and
he was able to keep us together. At that point I had been acting director of the
National Health Service Corps and deputy director at the National Health Service
Corps before that and that’s a program that places doctors into rural areas. I
had a pretty good sense of those kinds of issues, the need for health personnel
in rural areas. We had all come out of the 60s, we were definitely looking
for a cause and none of us particularly rural, or knew anything rural or whatever
and I think we shared this ethic. It was an issue of equity and so that bonded us.
We didn’t really have any power or authority. In the beginning we didn’t even have any programs we were just a policy office. There are a lot of challenges in
the beginning we didn’t have any money, we didn’t have any positions, we didn’t
have any office space, we didn’t have any authority. On the first day I got the
job I got a request to go down to Senator McCain’s office. He said basically,
we don’t expect you to perform miracles in this office but we do expect you to
pay a lot of attention to the issue of closing rural hospitals and we expect
you to keep us appraised of what we can do to help solve that problem. Most of
what we did never would have happened without the
National Rural Health Association. At the time they were new, we were new and two
things that they did that were critical. One was we created kind of this triangle
if you will it was us and them and the hill and so they connected us with
people down there who are interested in doing something and also helped us and
that was absolutely critical early on. One thing that we did was particularly
important and that was to establish a National Advisory Committee on Rural
Health. This meant we had a citizens advisory committee working with us and
they had a voice that we didn’t have, but once we had the National Advisory
Committee on Rural Health and once they began to take aggressive positions as a
citizen advisory committee then I could say well the department really has an
established position on that but the National Advisory Committee on Rural
Health, under the direction of former governor Bob Ray of Iowa has taken the
following position and that did get listen to. Members on the hill got this
report with the recommendations and we sent it to anybody who cared we also sent it to the press and so it
was a way of pointing out issues, challenges, and problems and also
solutions in these recommendations was awesome and how we got away with sending it to the hill, for years. None of us really knew anything about
research and so NRHA hooked us up with a staffer from Burdick, Senator Burdick who was from North Dakota. Her name was Mary Wakefield. So Mary took me out to North Dakota and we spent a couple of days in this rural research center and the director was Kevin Fickenscher. So we wandered around for a few days and I learned all of this stuff about a
research center and how it operates and what they do. I don’t know anything about research but
I could see that that the North Dakota office was just doing a great job. Came
back, shared it, got some input in the office and wrote guidance for the first
Rural Health Research Center’s grant program. One of the first things we did
was create a let’s say program of putting out bite-sized information to
legislators and policymakers both in rural communities in the Congress and
the administration and in the be the business world the people who owned and operated hospitals. And we created really a program of issuing policy briefs once
or twice a month and it became very effective and we begin to be looked at
as a place where people could get answers. The idea was that we really didn’t
understand, fully, problems of access to healthcare and what the best solutions
would be, problems of hospitals closing and what the best remediation strategies
would be and that these centers could help us to establish that. The Federal Office of Rural Health Policy has been really a uniquely successful element in government and I wish I could
say that for other parts of the federal government but I really do respect them
and what they’ve done.

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