By Gretchen Dobervich

Right now, policy developments in Washington, D.C., are placing our rural North Dakota hospitals and other health care providers at significant risk of shutting down, choking off health care access for thousands of patients in rural communities who have few other options.

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Last month, an agency in Washington, the Centers for Medicare and Medicaid Services (CMS), issued a troublesome ruling that will raise prices on prescription drugs for millions of Medicare beneficiaries who rely on the 340B drug program for reduced rates on medications (340B is simply the place in federal law that establishes this program). A federal judge just upheld this regulatory effort last week. This could negatively affect rural North Dakotans.

This innovative program, established more than two decades ago, has long been hailed as a government program that works for rural America, because it has held down prescription drug costs for millions of limited income patients, many of whom are served by Medicaid, Medicare or are uninsured. The 340B drug program matches hospitals and other providers that serve large concentrations of Medicaid and uninsured Americans with the makers of highly prescribed medicines, who then sell their drugs at lower costs to the medical providers, such as the rural hospitals.

In turn, rural patients and rural health providers win. The rural hospitals and clinics that serve a large number of lower income patients get discounted drugs, passing on the savings to patients. The drug manufacturers still gain market access to millions of patients who normally would not be able to afford such prescriptions.

Now more than ever, we need action from Washington to prevent further cuts to our rural North Dakota health care providers. Providing care in rural communities is neither easy nor cheap. Many, but not all, rural North Dakota hospitals have experienced a bit of a financial turnaround over the last three years. One of the reasons is the 340B program. Keeping rural facilities open means rural citizens have access to local care with local providers. It also means rural keeping rural jobs. Our officials in Congress need to be reminded of these key factors:

■ First, we have older populations in rural communities, and as we age, it's no secret we go to the doctor and hospital on a more frequent basis.

■ Second, diabetes, addiction, cancer and heart disease present at greater numbers in rural communities than non-rural communities.

■ Finally, our communities are home to so many of our nation's bravest citizens - military veterans. A higher percentage of veterans are from rural areas (even more so in rural North Dakota). As our veterans come back from campaigns abroad, they absolutely need access to care to assist them with injuries incurred while serving their country.

If we can help our congressional members understand the importance of this program to the citizens of rural America, we can preserve the entire 340B program and continue to deliver low-cost, necessary medicines to rural North Dakota communities.

We need to support U.S. Rep. Kevin Cramer, Sen. Heidi Heitkamp and Sen. John Hoeven in standing up for our communities to preserve the 340B program for our rural hospitals and healthcare providers but most of all for our rural North Dakota citizens.

Gretchen Dobervich is chairwoman of the North Dakota Rural Health Association.