Written Testimony to the U.S. Senate Committee on Finance May 16, 2024 Keith J. Mueller, Ph.D.

Gerhard Hartman Professor of Health Management and Policy Director, Rural Policy Research Institute (RUPRI) Chair, RUPRI Health Panel and Director, RUPRI Center for Rural Health Policy Analysis College of Public Health, University of Iowa Chairman Wyden, Ranking Member Crapo, members of the Finance Committee, thank you for holding this hearing on rural health and giving me the opportunity to share. [...] Yet we have seen the resilience of rural health providers and organizations as they rose to meet the challenges of the COVID-19 pandemic and now keep their focus on improving health for members of their communities. [...] As we move to the health care delivery system of the future, which takes full advantage of advances in chronic care management and changing sites of acute care, the roles of rural hospitals have evolved. [...] The changes are obvious in observing the increased number of counties in the darkest shade and the near disappearance of the lightest shade in four of the six states illustrated. [...] There are differences in expanded benefits such as in-home support services (54% in remote compared to 82% in metropolitan counties) and in special supplemental benefits such as food and produce – available in 91% of metropolitan counties and 64% of remote counties.