ASTHO Responds to House Ways and Means Request for Information on Improving Access to Health Care in Rural and Underserved Areas

October 04, 2023

The Association of State and Territorial Health Officials (ASTHO) is pleased to provide comments in response to the House Ways and Means Committee’s “Improving Access to Health Care in Rural and Underserved Areas” Request for Information. ASTHO is the national nonprofit organization representing the public health agencies of the 50 states, five U.S. territories, three freely associated states, and the District of Columbia. ASTHO members, the chief health officials of these jurisdictions, are dedicated to formulating and influencing sound public health policy and to ensuring excellence in public health practice. Our comments below reflect these priorities and perspectives.

It is important to note that on Dec. 2, 2019, ASTHO responded to a similar RFI about this same topic and our member presented at a congressional roundtable focused on rural health. Attached for your reference is a copy of our 2019 comments. We would appreciate the opportunity to learn how responses to the previous RFI are informing your critical work on this topic. Given the similarities between the two RFI’s, ASTHO is using this opportunity to highlight the important work of our territorial members.

ASTHO appreciates the committee’s intention to identify solutions that can bring new access to care for rural and underserved areas. ASTHO’s membership includes states with large rural and underserved areas, as well as the U.S. territories (Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and the Commonwealth of the Northern Mariana Islands) and freely associated states (Palau, the Republic of the Marshall Islands, and the Federated States of Micronesia). These island jurisdictions are often overlooked in discussions of rural health but share many of the challenges faced by rural and underserved communities in the contiguous United States. Territorial residents are U.S. citizens, and freely associated state citizens serve at high rates in the U.S. military and maintain a special and strategic relationship with the United States.

Many island and state-based communities lack access to high-quality health care, particularly for mental health and substance misuse treatment, dental care, and veteran care. Patients must travel long distances for specialized services, often at significant cost to the health agency. In some instances, patients may forgo treatment until it is more serious and interferes with their daily lives, costing the healthcare system more than if the ailment was prevented in the first place. We urge the Committee to include island jurisdictions in their evaluation of rural and underserved healthcare challenges and opportunities.

Thank you for the opportunity to support policy development and solutions benefitting the health of rural and underserved communities across the nation. To reduce health and social inequities in these areas, please consider ASTHO's recommendations in response to four themes identified in the request for information.

Please download the PDF for ASTHO's full comments on the specific questions included in the Request for Information.