Bipartisan bill aims to close rural NC’s health care workforce gaps

By Jaymie Baxley

Two North Carolina congressional representatives — a Republican and a Democrat — have teamed up on federal legislation meant to recruit and retain doctors, nurses and other health care workers in rural communities.

U.S. Reps. Pat Harrigan (R-10) and Don Davis (D-1) say the bill, which they’ve dubbed the REACH Act, is designed to address persistent provider shortages that leave many rural Americans struggling to find care. Short for Resources for Essential Access to Community Health, it would give a refundable tax credit of up to $10,000 to eligible workers in rural areas. 

“As somebody who’s lived in both rural and urban locations, I know that it’s hard to attract professionals out into rural areas,” said Harrigan, who introduced the bill on Sept. 16 and whose predominantly suburban district includes rural Yadkin County. “We wanted to make it easier for communities to be able to do that.”

North Carolina, home to the nation’s second-largest population of rural residents behind Texas, has long struggled to distribute providers evenly across the state. Rural hospitals and medical practices often compete with larger urban systems for workers but lack the resources to match their wages, benefits and quality of life, according to a 2024 study commissioned by the North Carolina Healthcare Association.

The NCHA, which represents more than 130 hospitals, health systems, physician groups and other organizations, supports the legislation.

“Rural hospitals and health systems are working every day to recruit and retain the health care professionals their communities need,” Josh Dobson, the association’s president and CEO, said in a statement. “The REACH Act would give rural providers another tool to compete for talented professionals and strengthen access to care in communities across North Carolina.”

Who would qualify

To receive the credit, a person would need to work at least 900 hours during the tax year in a rural area, as defined under a 2006 federal rural development law. The bill covers four groups: primary care practitioners, mental health professionals, nurses, and medical residents in approved training programs.

The primary care category includes physicians in fields such as family medicine and pediatrics, as well as nurse practitioners and physician assistants. OB-GYNs are also covered. 

Mental health professionals covered under the bill include psychiatrists, psychiatric nurse specialists, psychologists, licensed clinical social workers, licensed professional counselors and marriage and family therapists.

The full $10,000 would go to those with adjusted gross incomes up to $170,000. The credit would shrink above that level and disappear at incomes topping $180,000. If the bill passes, it would apply starting in tax year 2027 and expire after 2033 unless Congress votes to extend it.

Harrigan said the decision to offer a tax credit of up to $10,000 was made after getting feedback from providers and considering average salaries across the occupations covered by the bill.

“It’s a number that — across nurses, nurse practitioners, PAs and docs — was meaningful to all of those different populations of people,” he said. “Ultimately, we just think $10,000 is the right answer to catch people’s attention and to make a fundamental and practical difference in the trajectory of where people decide to go and spend their careers.”

The 900-hour requirement, meanwhile, is intended to make the credit available in communities that need part-time as well as full-time providers.

“It’s got to at least be significant part time [work] because not every community has a full-time need,” Harrigan said, adding that “cold, hard cash is always a motivator for people.” 

“I think it makes it very easy to do the calculations and say, ‘I’m weighing one opportunity versus another, and this one puts more in my pocket.’”

Building on existing efforts 

North Carolina already has programs intended to recruit providers to underserved communities and keep them there. 

The state Office of Rural Health works to bring primary care, dental and behavioral health professionals to rural areas, largely with loan repayment programs. Some federal programs also offer repayment of student loans and other incentives to eligible professionals who work in places where providers are in short supply. 

Davis, whose eastern North Carolina district is largely rural, said the credit is meant to fill gaps those programs don’t address.

“It creates a real incentive to serve rural communities, regardless of student debt, and offers the flexibility to serve multiple communities,” he said. “At the same time, this is designed to complement existing efforts and meet the needs of rural communities.”

Still, Davis stressed that the measure is “not only a rural initiative.” The issue of provider shortages, he said, transcends party lines and geographic classifications.

“When rural communities do not have health care providers, patients are more likely to travel to larger communities for care, increasing demand on hospitals and providers in our urban centers,” he said. “We are all better off when patients can get care closer to home.”

State data show how thin coverage is in places. A report published last year by the N.C. Rural Health Association found 27 counties with no OB-GYNs, four more counties than a decade ago. Twenty-six counties have no psychologists. 

Nine counties had no physicians at all.

The path forward

Although Harrigan said he has gotten positive feedback from colleagues in both parties and from health care advocates, he acknowledged that the measure must still clear some legislative hurdles in the short time left in the 119th Congress, which concludes at the end of the year.

Since the bill would amend the federal tax code, it requires the blessing of the U.S. House Committee on Ways and Means — the chamber’s chief tax-writing panel, which also oversees programs such as Social Security and Medicare.

“It just comes down to whether or not this is palatable for Ways and Means because this is revenue that the federal government is going to miss out on,” Harrigan said. “But we feel like it’s revenue that the government’s going to miss out on for a really good cause that’s going to make a difference in our communities.”

The bill, he added, would let eligible providers keep more of what they earn without increasing government spending.

“Certainly, we would impact potential revenues, but compared with the other methodologies of recruiting this type of talent, this is a lot cheaper of an option for the federal government to lend a hand,” Harrigan said.

The bill has not yet been scored by the Congressional Budget Office, which calculates a measure’s cost to federal coffers, and there are no scheduled meetings for the Ways and Means Committee. U.S. Rep. Tom Barrett (R-MI) is also a co-sponsor. 

There’s no guarantee that the credit would lead to more providers practicing in rural North Carolina, and its effects would depend on how health care professionals respond to the incentive. But Davis and Harrigan, who are both running for reelection this year, suggested that the measure’s bipartisan appeal gives it a better chance of advancing.

“As we engage with our colleagues and other offices review this bill, I believe momentum for the REACH Act will only continue to grow,” Davis said. 

The sentiment was echoed by Harrigan, who said the bill represents the kind of work “we’re sent here to Washington to do.”

“If we can close the gaps there and provide people access to the critical care that they need, that ultimately improves the quality of our society, and I think that we’ve done a good service,” he said.

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