Opinion: The Federal Government Should Repair Our Rural Healthcare Crisis – Not Make it Worse with Price Controls 

Today, nearly every county in Missouri is experiencing a shortage of primary care providers. As federally-designated Health Professional Shortage Areas (HPSAs), this means that residents, especially in rural communities, are struggling to access care close to home. The shortage is made worse by a wave of physician retirements and high rates of burnout that are pushing many physicians to leave the workforce prematurely.

The common denominator in Missouri’s physician shortage? A hopelessly broken Medicare system, in which the federal government sets rates and undervalues private practice.

Over the past 20 years, physician payments under the Medicare Physician Fee Schedule (MPFS) have fallen by 33% when adjusted for inflation. At the same time, the cost of running a practice has risen 60%, leaving physicians struggling to keep up with the rising cost of medical supplies, equipment, and overhead. We are asking physicians to do more – see more patients, work longer hours, and cope with more burnout – with less pay and fewer resources.

Unfortunately, this is what happens in countries that adopt socialized medicine schemes, and we are now seeing the consequences of artificially-low, government-set rates playing out in the U.S.

Independent physician practices have had to make difficult choices, including cutting staff or reducing the number of Medicare patients they see just to keep the lights on. While some may choose early retirement, other physicians feel compelled to leave private practice in favor of hospital-based settings. Between 2012 and 2022 the share of physicians in private practice fell from 60.1% to 46.7%. Meanwhile, the share of physicians working in hospitals as direct employees or contractors increased from 5.6% to 9.6% during that same time.

The impact is profound for small towns across Missouri, as these communities have long relied on trusted, local physicians who know their patients well and understand their needs. When those practices close or are absorbed into large health systems, this forces patients to travel farther for treatment. Further, hospital-based care comes at a higher cost and is not as transparent. To prove that point, the Show-Me Institute has found that the price of hospital services over the past decade has skyrocketed over 45%.

The crisis of health care access will not solve itself, especially since demand for care continues to increase. Chronic disease is on the rise, especially in the most rural parts of the country. Missouri’s rural residents have higher rates of cancer, diabetes, heart and kidney disease, – all leading causes of death. Yet, Missouri has fewer physicians (all specialties and primary care) per 100,000 citizens, than the U.S. as a whole.

So, how are we to reverse this trend and bring more physicians to high-need areas? To begin, Congress must reverse the 2.8% Medicare cut that went into effect at the beginning of this year, which is already straining doctors nationwide, nowhere more so than in rural communities.

To that end, lawmakers have introduced the Medicare Patient Access and Practice Stabilization Act (H.R. 879), which would reverse this cut and provide a 2% payment update. This bipartisan bill will help stop the bleeding for rural independent practices, will strengthen the stability of Medicare, and most importantly will boost health care access for rural patients. It would be a solid first step towards necessary and needed long-term Medicare reform that values private practice, removes price controls, and reflects inflation.

I strongly urge the entire Missouri Congressional Delegation, House Republican Leadership, and all Congressmen and women who want to sincerely solve this crisis to support the passage of H.R. 879 to meet the growing demands of our state, and that of the entire nation. The health of all rural communities in the country desperately depends on it.