[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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