[Congressional Record Volume 140, Number 71 (Thursday, June 9, 1994)]
[Extensions of Remarks]
[Page E]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: June 9, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
  INTRODUCTION OF THE RURAL HEALTH DELIVERY SYSTEM DEVELOPMENT ACT OF 
                                  1994

                                 ______


                        HON. CHARLES W. STENHOLM

                                of texas

                    in the house of representatives

                         Thursday, June 9, 1994

  Mr. STENHOLM. Mr. Speaker, I am extremely pleased to advise you that 
on behalf of my colleagues Pat Roberts, Steve Gunderson and Jim 
Slattery, as well as other members of the House Rural Health Care 
Coalition, I am today introducing The Rural Health Delivery System 
Development Act of 1994.
  Now in the fourth year of my tenure as cochairman of the House 
Coalition, I continue to feel that this organization has been one of 
the most effective and enjoyable institutional experiences of my 
congressional career. I have found that the nonpartisan, can do 
attitude of Members and staff of this Coalition have served it, and 
more importantly rural America, extremely well.
  Recognizing that we are just one small piece of the larger health 
reform picture, we nonetheless have felt that during this period of 
reform it is absolutely critical that the concerns and needs of rural 
America be heard, respected and responded to.
  Those of us that are part of the House Rural Health Care Coalition 
would like to emphasize that rural communities are not looking for 
hand-outs. They're not asking for the Federal Government to solve their 
problems. They don't want the Federal Government to parachute in with 
magic answers.
  What rural Americans would appreciate is some help with the tools 
they need to deal with their local problems. They want to be able to 
create the systems that meet their local needs. This is true whether we 
are talking about health care, business development, education, or any 
other aspect of rural life.
  During a conference entitled ``Implementing Health Care Reform in 
Rural America,'' Dr. Bruce Amundson last year wrote ``* * * the primary 
goal of reform must be to enhance the ability of rural communities to 
do what communities have historically done in America--assume 
responsibility for the services and institutions that serve their 
residents. This argument simply recognizes the natural tendency in a 
democracy for populations to govern themselves, thereby mobilizing the 
immense energy, power, and creativity of communities to address their 
needs.'' He continues to explain that what health reform should ensure 
for rural communities is community-owned and integrated delivery 
systems that organize the rest of the system from the bottom up.
  That philosophy is precisely at the core of the bill we are 
introducing today. Building on the foundation of programs which we know 
have worked in the past and incorporating some new ideas of what we 
believe will work in the future, we are seeking not to prescribe the 
magic answer for the thousands of rural communities across our country, 
but rather to enabling them to come up with their own answers. In 
taking this approach, we not only enable individual rural communities 
to take responsibility for their own answers; we also give them the 
tools to go beyond the piecemeal approach of some past rural programs, 
equipping them to respond comprehensively to their rural health needs.
  We used two additional criteria in developing this bill. First, we 
focused on consensus concepts agreed to in a bipartisan fashion. 
Second, we included only provisions structured uniquely for rural 
areas. We should mention that there are a number of excellent new 
proposals which aid rural areas as part of their effect, and 
individually many of us support those proposals. However, in compiling 
this bill under the auspices of the House Rural Health Care Coalition, 
we attempted to keep centered on rural beneficiaries.
  In the Rural Health Delivery System Development Act, we give special 
attention to those chronically underserved rural areas which, in spite 
of existing Federal and State programs, continue to lack access to 
affordable, high quality health care services. Even though the Health 
Personnel Shortage Area [HPSA] designation was designed to aid 
communities most in need, some areas consistently remain unserved. Our 
goal is to catch those communities which previously have fallen through 
safety nets, encourage their own self-developed plans and enable them 
to coordinate services to their residents. Through grants and technical 
assistance to those communities, they will be better equipped to 
develop the networks which will increase their access to health care.

  In other efforts to respond to the need for additional health 
professionals in rural areas, we also amend the National Health Service 
Corps Program, allow for student loan deferrals, Medicare bonus 
payments, and better utilization of nonphysician providers. Also in 
this regard, we will fund demonstration projects to increase primary 
care physician residence training in rural areas. Through these 
measures we believe that we can increase the supply of health care 
professionals to rural areas.
  We strengthen two other programs which have shown effectiveness in 
rural areas in the past: Community and Migrant Health Centers and 
Essential Access Community Hospitals [EACH/RPCH].
  Finally, by amending hospital antitrust laws, we hope to make it 
easier for rural hospitals to engage in the cooperation which everyone 
believes reduces duplication and waste, and assures better access to 
care.
  The financing mechanism we have included in the bill is applying an 
affluence test to Medicare part B premiums. Those individuals making 
over $100,000 or couples with incomes of more than $125,000 would be 
asked to pay a greater share of their monthly premiums for part B 
Medicare. Although this provision would affect only 2 percent of the 
Medicare population, it would generate revenues of more than $4 billion 
over 5 years.
  According to the best estimates we have the bill's financing fully 
covers the costs of the programs. Given CBO's tremendous workload 
currently in scoring health legislation, we have not yet gotten a final 
CBO score. However, the primary sponsors of this bill are committed to 
full financing this bill. Should later scoring show an unexpected 
shortfall, we will make adjustments in the bill as necessary.
  With crystal-ball gazing having still not developed into an exact 
science, the authors of this bill make no presuppositions about what 
form health reform will take in the 103d Congress. With a coalition of 
more than 150 Members, rural health supporters come down all across the 
ideological spectrum on those larger issues of health reform. Where we 
remain united is in our support of rural health empowerment. We believe 
that this legislative package we are introducing this week will fit 
into any larger health reform picture. The package has advocates on all 
of the major House committees dealing with health reform and our hope 
is to see these provisions moved forward out of those committees. If 
necessary, we also stand ready to offer any remaining provisions as an 
amendment on the House floor.
  As always it has been a pleasure to work with my colleague Pat 
Roberts on this bill. In addition, the co-chairs of the Health Reform 
Task Force, Representatives Gunderson and Slattery, have been most 
helpful, as have other members of the Coalition's Task Force. I look 
forward to working with all of my colleagues in seeing these provisions 
enacted into law.

                          ____________________