Dr. Bruce Dahlman (flannel shirt) encouraged Sen. Tina Smith to push for passage of the H.R. 1834 Medicare for All Act so that everyone can have equal access to medical care. Dahlman works in the ER when he is in Grand Marais. He and his wife Kate, an RN, have served with African Inland Mission (AIM) since 1992. Photo: Brian Larsen of the Cook County News Herald

From the Cook County News Herald - November 29, 2019

U.S. Senator Christine (Tina) Smith was in Grand Marais on Monday afternoon, November 25, to learn what works and what does not work for Cook County’s rural health care system.

Earlier in the day, Smith stopped in Two Harbors to meet with public officials, local educators, employers, and business leaders to discuss economic development in the region. 

A top priority, said the senator, is to address the high cost of health care. Too many Minnesotans are burdened by the high cost of their health care coverage, and others are going without insurance or prescription medications. She said she was working with her colleagues on both sides of the aisle to address the underlying issues that make health care expensive, starting with the high price of prescription drugs.

While here, the senator took a tour of Sawtooth Mountain Clinic and the North Shore Health hospital and care center before sitting down and taking questions from staff, department heads, and members of the public, which included business leaders and governmental leaders.

Dr. Bruce Dahlman (flannel shirt) encouraged Sen. Tina Smith to push for passage of the H.R. 1834 Medicare for All Act so that everyone can have equal access to medical care. Dahlman works in the ER when he is in Grand Marais. He and his wife Kate, an RN, have served with African Inland Mission (AIM) since 1992. Staff photo/Brian Larsen

“I’m interested in learning what makes small towns in rural Minnesota work,” said Smith, adding that she especially wanted to know what made “great facilities like [North Shore Health/Sawtooth Mountain Clinic] this one work?”

“What can we do better at the federal level?” she asked, “to improve the county’s health care system?”

Senator Smith listened as she was told that the high cost of housing made it hard for the health care system here to attract and keep employees. Large fluctuations in population between summer and winter make it hard to staff emergency services, and the vast area for emergency services to cover also presents its challenges. 

On the issue of housing, Senator Smith said, “This is an issue everywhere. This is a national problem.”

At one time, said the senator, the federal government worked hard to make housing affordable, “But then backed away from it.” She said she would try to make that a priority again in the senate.

Another suggestion was to have the government set up a program so that rural physicians and health care workers could have their educations paid for. Rural counties can’t pay the same wages that larger urban centers can pay, which makes it difficult for new doctors, nurses, radiologists, physical therapists etc., to afford to work in a remote area.

When the senator asked what was working for the county, North Shore Hospital administrator Kimber Wraalstad pointed out that collaboration between North Shore Health, Sawtooth Mountain Clinic, Cook County Public Health and Human Services, and Grand Portage Health Services was a strong point. Wraalstad cited a partnership between the county and North Shore Health as an example. She said Public Health and Human Services received a grant for mental health services, and the hospital had the workforce to make sure services were available for people in need of help.

An audience member pointed to the success of Cook County Higher Education, which has provided classes so that many people could qualify for entry jobs into the hospital/ care center, but then also achieve higher degrees to advance as well. 

Finding enough mental health care providers

On the subject of mental health, Smith says there should be no difference in the way people are treated, whether they have a physical or mental health issues. “There is still a stigma around people who have mental health problems,” she said, adding that she is working to enforce federal laws that require equitable coverage of mental health and medical care, and she is fighting for expanded access to mental health services across the age continuum.

Dr. Bruce Dahlman pointed out that in a small county of 5,000 people, all of the same federal rules and regulations apply here that apply for larger hospitals. Those larger hospitals have larger staffs and more resources that allow them to comply with those rules that are difficult for smaller, rural hospitals to make work.

Rural communities face unique barriers that limit access to quality, affordable health care, said Smith. As co-chair of the bipartisan Rural Health Caucus, Sen. Smith said she is working with her colleagues to eliminate the health disparities between rural and urban communities.

One way to do that, suggested one lady, would be to change the rules on what constitutes “rural” under the federal definition. Under the current definition, St. Cloud and Cook County are considered rural. It was suggested to Smith that an area that has a landmass the size of Cook County and few people living in that area should be reclassified as a territory, which would make it easier to get more federal funding.

Another hospital worker who works in the radiology department said her department has three full-time employees, and based on the business it receives, they are classified as being overstaffed. Sadly, those three people have to cover the department 24-7, which leads to burnout.

Many rural hospitals like North Shore Health have discontinued their birthing services, but as noted in the discussion, North Shore Health and the Sawtooth Mountain Clinic provide a wide variety of maternal care up to and after the birth of the baby. A piece of legislation that seeks to help new or expecting mothers is the Rural MOMS Act.

Senator Smith and senators Lisa Murkowski (R-Alaska), Doug Jones (D-Ala.), and Shelley Moore Capito (R-W. Va.) co-authored the Rural MOMS Act.

The act, said Smith, is to improve rural maternal and obstetric care data by directing the CDC to coordinate efforts concerning maternal mortality and morbidity, to report on women’s health conditions according to socio-cultural and geographic contexts, and to emphasize research on pregnancy-related deaths.

The act calls for awarding new rural obstetric network grants to establish regional innovation networks to improve maternal mortality and morbidity as well as birth outcomes, and expand existing federal tele-health grant programs to include birth and postpartum services as part of tele-health networks and to allow federal funding to be used for ultrasound machines, fetal monitoring equipment, and other pregnancy related technology.

If the act passes, new rural maternal and obstetric care training demonstrations to support training for family medicine physicians, obstetricians, nurse practitioners, physician assistants, midwives, doulas, and other professionals that provide maternal care services in rural community based settings will be held. A report on maternal care in rural areas will identify gaps in maternity care, disparities in maternal health in rural areas by race and ethnicity, recommendations to standardize data collection on maternal mortality and morbidity, and activities to improve maternal care in rural areas.

At the conclusion of the meeting, Dr. Dahlman gave an example of a couple that had a 10-year-old daughter who had been suffering with stomach cramps for two years. They brought her into the emergency room when they finally had health insurance. He said it was unacceptable for people to have to wait that long for health care, and he said, “You know what the answer is? It’s H.R. 1834.” And he asked the senator to push for the passage of H.R. 1834, the Medicare for All Act.