For Instance with close proximity to a Critical Access Hospital especially during this Governments Sequestration Process another Rural Hospital Facility may be forced to stay in a Prospective Payment system thereby hampering funding for this Rural hospital. Further compounding this effect is if the Governor of a particular state refuses to accept the Federal Governments Medicaid Expansion proposal which in some cases may cost a rural hospital tens of thousands of dollars per month. Also many Rural Hospitals have a daily census hovering around 3-4 patients per month. Even though the Omnibus Budget Reconciliation Acts of 1989 and 1990 [OBRA-89 & OBRA-90] sought to Initially increase rural payments it is not enough. Many of our patients are in remote areas and are hampered by adverse terrain and seek help only when they are extremely ill and our hospitals absorb costs that the Prospective Payment System did not internally calculate. Please join with me and mobilize support for more resource funding for our Rural Hospitals. We need to utilize our resources optimally especially when Jan. 1, 2014 comes when the ACA is in full steam. We can utilize this added revenue even though it may not be a major boost- something is better than nothing.