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Smith, Arrington, and Colleagues Urge Rural Health Inclusion in CARES Act Programs

April 9, 2020
Press Release

Washington, D.C. – Congressmen Adrian Smith and Jodey Arrington led over 70 Members of Congress in writing Secretary of Treasury Steven Mnuchin and Administrator of the U.S. Small Business Administration Jovita Carranza to request the inclusion of county- and community-owned rural hospitals and Rural Health Clinics (RHCs) in the Paycheck Protection Program (PPP) and other financial assistance programs created by the CARES Act. Many of these hospitals and RHCs are currently ineligible because they are defined as government-operated, despite receiving little or no taxpayer assistance. Ensuring access to PPP and other assistance programs is essential during the COVID-19 outbreak as rural health care providers have come under increasing strain, potentially affecting many rural Americans:

“During this pandemic, we cannot forget the millions of Americans who rely on rural hospitals and Rural Health Clinics for their primary care,” said Smith. “We must ensure these lifesaving facilities are all able to stay open to serve rural Americans. In order to do so, county- and community- owned facilities must be included in the programs established by the CARES Act. I thank the administration for its work in this critical effort.”

“The heartbeat of our nation is rural America, and the health care providers who service these communities are critical to protecting small town USA and the food, fuel, and fiber they provide for our nation. I was proud to lead this letter with my friend and colleague, Rep. Adrian Smith, to ensure rural hospitals on the frontline of this pandemic have access to critical relief programs offered through the Small Business Administration,” said Rep. Arrington.


Full text of the letter below:


The Honorable Steven Mnuchin                                 The Honorable Jovita Carranza
Secretary                                                                     Administrator
Department of the Treasury                                        U.S. Small Business Administration
1500 Pennsylvania Avenue                                        409 3rd St, SW
Washington, DC 20220                                              Washington, DC 20416


Dear Secretary Mnuchin and Administrator Carranza:

Thank you for all the work you have done to help our small businesses respond to the COVID-19 crisis in these difficult times. As you work to administer vital emergency assistance programs, we are writing to bring an urgent issue to your attention regarding the Paycheck Protection Program (PPP), and to request you ensure rural hospitals and Rural Health Clinics (RHCs) who have facilities owned or operated by counties or districts are eligible for this program, as well as other critical financial assistance programs.    

H.R. 748, the Coronavirus Aid, Relief, and Economic Security (CARES) Act, was signed into law with our support on March 27, 2020, enacting essential lifelines for struggling businesses. It is critical SBA ensure CARES Act programs, especially PPP, can be used to support our rural hospitals and clinics. We have heard concerns SBA is interpreting the CARES Act language in a way which would preclude rural hospitals and RHCs whose facilities are owned or operated in some way by a district or municipality which they serve from being eligible for certain assistance, despite often receiving no direct funding from these government entities.      

Should Treasury and SBA interpret the language this way, it would negatively impact numerous rural hospitals and numerous RHCs across the country. Prior to the novel coronavirus (COVID-19) pandemic, many of these hospitals and clinics had operating deficits; their cash flow problems have become increasingly dire as rural hospitals and RHCs have been forced to cancel elective procedures, their primary source of revenue.      

During any time period, these rural hospitals and clinics are essential to support rural communities, but they are especially vital during this time of public health emergency. In addition to their irreplaceable role in serving the everyday health needs of our rural communities, many of these health care providers are treating COVID-19 cases in their community and working to contain further spread of the disease. In many communities these hospitals are also the largest active remaining employer in the economy.      

We urge you to take immediate steps to ensure rural hospitals and RHCs are eligible for the relevant CARES Act loan programs such as PPP in order to continue their work on the frontlines of fighting the COVID-19 pandemic, and look forward to serving as collaborative partners in both SBA and other agencies’ work to support rural health care providers as we respond to this crisis.