[Congressional Record Volume 140, Number 57 (Wednesday, May 11, 1994)]
[Senate]
[Page S]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: May 11, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
                        RURAL HEALTH CARE REFORM

  Mr. BAUCUS. Madam President, I would like to say a few words with 
respect to health care in general, but more particularly with respect 
to health care reform that affects rural States, particularly those in 
the West.
  The critical issue we face, Madam President, in the West in health 
care reform is increasing access--that is, increasing access to 
quality, affordable health care in areas of the country that do not 
have as many doctors or as many hospitals as our urban areas.
  We in the West face a crisis, Madam President, in rural health care. 
More than 1 out of 4 Americans lives in a rural area that suffers high 
rates of uninsurance and underinsurance, severe chronic shortages of 
care and a high rate of hospital closures. Rural Montana, for example, 
faces these unique concerns in spades. They must be addressed if we are 
going to have meaningful health care reform pass this Congress.
  Rural health care reform needs a comprehensive strategy. I am working 
on incorporating a series of rural provisions into the Finance 
Committee's national health care legislation. In my view, four areas 
need special attention.
  First, we must strengthen small rural hospitals;
  Second, we help establish rural health care networks;
  Third, we must increase the number of doctors, nurse practitioners, 
physician assistants, nurses, and other health care providers in rural 
areas; and
  Fourth, we must lower insurance costs for rural residents;


      how rural needs fit into national health reform legislation

  There are parts of health care reform that will affect everyone's 
access to health care and everyone's health care costs. They include 
universal coverage, insurance reforms and increasing the number of 
primary care physicians. Our work in these areas will improve the 
health care situation everywhere, in rural and urban settings alike, 
and everything in between.
  But other priorities are particular to rural areas, like making sure 
that rural hospitals are available to provide services in remote and 
frontier areas, establishing and increasing communications networks 
between rural areas and larger urban health care facilities, and 
encouraging primary care health professionals to practice in rural 
areas.
  It's not enough to give everyone an insurance card. Having insurance 
does not help if there is no doctor or hospital to go to. As we move 
toward comprehensive health care reform, we need to make sure that we 
are doing all we can for rural areas by including strong provisions to 
increase access and to high-quality rural health care.


  strengthening small rural hospitals--the Montana Medical Assistance 
                            Facility Project

  Much of Montana is considered frontier territory where people are up 
to 100 miles from a medical facility. Now, 100 miles is pretty far away 
on a good day. But factor in a winter blizzard and a friend or a 
relative who needs immediate medical attention, and you may as well be 
traveling to the Moon.
  For Montanans living in Culbertson, MT, this was a very real 
possibility not so long ago when their hospital almost closed. But 
thanks to a Montana project, the Medical Assistance Facility Program, 
Culbertson was able to modify its hospital and receive higher 
reimbursement from the Medicare Program.
  I invited Walter Busch, the administrator of Culbertson hospital, to 
testify before the Senate Finance Committee recently. He explained to 
the committee that you can not have a one size fits all health care 
system. Under the Montana Medical Assistance Facility Program, rural 
areas have the flexibility to design their own hospital by being 
exempted from certain Federal requirements. It also expands the role of 
physician assistants and nurse practitioners.
  As Walter testified, this rural hospital program has been a huge 
success in Montana, rescuing the delivery system in many rural 
communities. Today the program operates under a demonstration grant 
from the Federal Government which is due to expire in 1997. This 
program is far too valuable to rural residents to let go. We must make 
the Montana Medical Assistance Facility demonstration project a 
permanent part of the Medicare Program. This could go a long way toward 
assuring community-based access to health care in rural areas 
nationwide.


 increase the attention paid to rural issues by the federal government

  We need to make sure that the Secretary is made fully aware of rural 
health needs and concerns on a regular basis, and that national health 
reform is analyzed from a rural point of view. Secretary Shalala is 
doing a good job on rural issues, and has even visited our rural 
Montana hospitals, but I believe that rural issues deserve a permanent 
direct line to every Secretary. I have proposed to elevate the Office 
of Rural Health Policy to the position of Assistant Secretary within 
the Department of Health and Human Services.


             improve telemedicine and rural health networks

  We must also support rural communities in their efforts to maintain 
and strengthen their local health care infrastructure by giving them 
the tools they need. It is critical that we develop a grant program 
specifically for telemedicine so that rural health facilities are able 
to increase communications with their urban counterparts. We must also 
provide Federal funding and technical assistance that allow communities 
to develop rural health networks.


        increase the number of doctors and nurses in rural areas

  The nationwide demand for primary health care professionals is 
greater than ever, especially in rural areas. To encourage doctors and 
nurses to practice in rural areas, it is crucial that we increase 
reimbursements. To this end, we should:
  Double the Medicare bonus payment from 10 to 20 percent.
  Provide tax incentives for doctors and nurses who practice in 
underserved rural areas; and
  Increase Medicare reimbursement for primary care doctors.
  We must also strive to increase America's supply of primary health 
care providers. Primary care providers in general provide high-quality, 
lower cost care, yet the United States faces a severe shortage of these 
providers. This is a particular problem in rural areas, that depend on 
a primary care providers for most of their care. Such an effort must 
include:
  Targeted funding for graduate medical education to primary care 
residencies;
  New training funds for nonphysician providers;
  Increased funding for the National Health Service Corps; and
  Creation of a National Council to monitor physician supply, identify 
areas of concern, and propose solutions.


               lower insurance costs for rural residents

  People living in rural areas are disadvantaged when it comes to 
insurance. Urban residents usually receive insurance through their 
employers. Because employers in urban areas tend to be large, they can 
buy insurance at lower rates. Rural residents, on the other hand, 
either buy insurance on their own or work in a small business that has 
to pay higher administrative costs than a large business. In fact, 
small groups and individuals wind up paying up to 40 percent more in 
overhead than large groups. Health reform must eliminate this rural 
disparity.
  I am working on insurance reform that will level the playing field so 
that rural residents can get the same deals as the large groups in 
urban areas. These reforms include requiring insurers to charge 
everyone similar rates and allowing small groups to band together so 
they can get the same discounts as large groups.


                               conclusion

  Improving rural health care in my No. 1 priority. I will not support 
health reform legislation unless it includes measures to strengthen 
rural hospitals, increase the number of doctors and nurses in rural 
areas, and lower health insurance costs for rural communities. National 
health care reform must reflect the unique needs of Montana, and other 
parts of rural America.
  Madam President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Iowa is recognized for 10 
minutes.

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