[Congressional Record Volume 140, Number 56 (Tuesday, May 10, 1994)]
[House]
[Page H]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: May 10, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
  INTRODUCTION OF THE RURAL HEALTH PROFESSIONAL SHORTAGE ACT AND THE 
                      RURAL HOSPITAL SURVIVAL ACT

  The SPEAKER pro tempore (Mr. Chapman). Under the Speaker's announced 
policy of February 11, 1994, the gentleman from Pennsylvania [Mr. 
Clinger] is recognized during morning business for 5 minutes.
  Mr. CLINGER. Mr. Speaker, most of us agree that a ``one-size-fits-
all'' health care reform plan that fails to recognize the difference 
between small, rural communities and large, urban areas will serve no 
one particularly well, whether you are from New York or Punxsutawney, 
PA.
  When Congress does finally vote on health care reform legislation, we 
must adopt a plan that provides flexibility for States and localities 
to meet their own special, regional health care needs. In particular, 
Congress must not forget that 27 percent of Americans live in rural 
areas which have distinct health policy problems to resolve.
  Aside from the obvious geographic barriers to medical care--such as 
rough terrain, bad weather conditions, and long distances between 
medical facilities--rural communities must overcome certain demographic 
characteristics that make health care delivery a unique challenge.
  Rural populations tend to be older and poorer, so there are higher 
concentrations of Medicare, Medicaid, and uninsured patients. As a 
result, rural hospitals and providers rely primarily on Federal funds 
in the form of Medicare reimbursement for survival.
  As it is, rural hospitals must contend with low occupancy rates and 
operate on shoestring budgets, so the past decade of cuts and freezes 
in Medicare reimbursement have put many rural hospitals in dangerous 
financial situations. Cutting the primary source of revenue for rural 
hospitals has forced many to close their doors altogether.
  In addition to the financial problems of their local hospitals, many 
rural areas suffer from an acute shortage of health care professionals. 
Primary care doctors, physicians assistants, nurses, allied health 
professionals and other medical personnel are in short supply, and most 
rural communities have a difficult time luring professionals from 
training sites in urban and suburban areas where they can make more 
money.
  The maldistribution of health care professionals and the insolvency 
of our rural hospitals pose serious threats to the availability of 
medical care for rural Americans, regardless of whether they can afford 
it or not. Before we even try to control costs and increase access for 
the uninsured, we must first revitalize the health care infrastructure 
in our medically underserved rural areas. Our efforts to reform the 
health care system will be pointless if rural citizens do not have a 
doctor to consult or a hospital to visit.
  That is why--with the help of my Health Care Advisory Committee, 
doctors, nurses and other constituents concerned about health care--I 
have drafted two bills to help solve the real health care problems 
confronting rural America.
  The first bill I am introducing today is the Rural Health 
Professional Shortage Act to improve the supply and distribution of 
medical professionals in rural areas.
  The quality of rural health care is suffering because many young 
doctors, nurses, and other medical professionals elect not to practice 
in rural areas due to existing disincentives and drawbacks to 
practicing there. While some decisions can be attributed to lifestyle 
preferences, there are a number of other factors that influence where 
they choose to live and work.
  For instance, many young professionals are discouraged from 
practicing in rural areas because of lower earnings potential and lower 
Medicare reimbursements for rural providers.
  Because rural professionals are often isolated from colleagues, they 
cannot rely on them for consultation and second opinions. They must 
work long hours, many of which are ``on call'', often with little 
professional support.
  Most health care practitioners prefer working with the latest, state-
of-the-art technology which many rural hospitals cannot afford.
  Also, medical professionals tend to practice in areas close to where 
they were trained, and most academic medical institutions and teaching 
hospitals are located in urban or suburban locales.
  The Rural Health Professional Shortage Act eliminates many of these 
financial and professional disincentives. It provides urban and rural 
physicians ``equal Medicare reimbursements for equal work'' by 
eliminating the urban-rural payment differential, and it financially 
rewards those rural providers who have higher caseloads of Medicare, 
Medicaid and uninsured patients.
  My bill also encourages rural communities to ``grow'' their own 
health care professionals and targets scarce resources to individuals 
with rural backgrounds since they are most likely to return to and stay 
in rural areas.
  Finally, the bill provides rural communities and their local 
hospitals the resources and technical assistance necessary to attract 
and retain medical professionals in their areas.
  My second bill, the Rural Hospital Survival Act, recognizes the 
pivotal role hospitals play in the rural health care delivery system as 
the primary sources of medical care in rural areas and integral parts 
of local economies, and it will help to keep many of our struggling 
``critical access'' hospitals open.
  According to the American Hospital Association, 389 rural hospitals 
closed between 1980 and 1992. For those of us living in rural areas, 
closure of a local hospital can significantly reduce our access to 
decent health care and cost the local economy valuable, high-skilled, 
high-wage jobs.
  With fewer beds, fewer admissions, lower occupancy rates, and higher 
per-patient, per-day expenses than metropolitan hospitals, many small, 
rural hospitals struggle to keep their doors open. The Office of 
Technology Assessment estimates that nearly one-third of all rural 
hospitals are operating in the red.
  As I already mentioned, rural hospitals rely primarily on Medicare 
and Medicaid payments, and cuts in reimbursement rates have 
significantly increased the volume of uncompensated care provided by 
rural hospitals, requiring them to provide more care with fewer 
dollars.
  In addition to reimbursements that don't keep pace with health care 
costs, rural hospitals must contend with an unfair Medicare payment 
system that reimburses them less than urban hospitals.
  The heart of the Rural Hospital Survival Act makes important 
adjustments to the Medicare payment system, including a complete 
elimination of payment differentials between urban and rural hospitals.
  The bill establishes a new telemedicine grant program to promote the 
development of advanced data, video, and voice networks among hospitals 
and providers in rural regions. It also renews two grant programs which 
have successfully helped hospitals and communities throughout the 
country improve health care delivery for rural residents.
  Antitrust exemptions would be provided to encourage cooperation and 
joint ventures among rural hospitals. Facilities would be able to share 
equipment, services, and health care personnel without fear of being 
sued.
  And, finally, my bill would establish a commission to study the 
effects of State and Federal regulations, mandates, and paperwork on 
small, rural hospitals and the quality of care they provide.
  Rural Americans have a great deal at stake in the health care debate. 
Not only will health care reform affect the cost, quality, and 
accessibility of their medical care, it will also impact the economic 
futures of their communities.
  While working hard to promote job creation and economic development 
in my largely rural district over the years, I've learned that the 
economic vitality of a rural community is closely tied to the quality 
and availability of medical care in the area. Local economic booms and 
busts closely correspond with the financial standing of the local 
hospital, and the strength of a rural hospital can often serve as an 
accurate barometer of the state of the local economy.
  As a local economy declines and unemployment rises, the increasing 
burden of uncompensated care the local hospital provides fiscally 
strains the facility and affects the quality of care it provides. Often 
small, rural hospitals cannot endure prolonged local recessions, and 
when a hospital is forced to close, it can devastate an already 
struggling local economy.
  One reason is that hospitals are usually one of the largest employers 
in rural communities. When a rural hospital closes, the local area can 
lose dozens, sometimes hundreds of well paying jobs.
  Also, communities who have lost a hospital may have a difficult time 
attracting businesses and residents to their areas. Many companies are 
reluctant to relocate to a region that does not have a hospital or 
decent health care.
  For a rural community to have a decent shot at attracting industry 
and creating jobs, its local hospital must be in sound financial 
condition and its health care delivery system capable of providing 
quality medical care. By strengthening the ailing health care delivery 
systems in our small, rural communities, my two bills will not only 
improve the health of our rural residents, but also the health of our 
rural economies.
  Mr. Speaker, I urge my colleagues to recognize and address the unique 
health care problems affecting rural America by joining me as a 
cosponsor of these two vital bills.

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