[Congressional Record Volume 140, Number 97 (Friday, July 22, 1994)]
[Senate]
[Page S]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: July 22, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
                           RURAL HEALTH CARE

  Mr. DOLE. Mr. President, with the health care debate taking on more 
force and intensity, I would like to say a few words about the 
importance of not losing sight of the special needs of rural Americans.
  Rural Americans make up about 20 percent of the population. And 
contrary to what some may believe, rural Americans are as diverse a 
group as Americans living in any other part of the country. That's why 
when proposing health care reforms, rural Americans are no more likely 
to adapt to a one-size-fits-all model than are Americans living in any 
other part of the country.
  Mr. President, when Senator Packwood and I crafted our health reform 
plan, which I am proud to say enjoys the support of 40 Senators, we 
gave special consideration to rural Americans.
  Access to health care providers can be just as much of a challenge in 
rural America as is cost. That is why the Dole-Packwood bill has 
special provisions to improve access to health care in rural America. 
Many of these provisions are quite technical, but let me just summarize 
what they would accomplish.
  More primary care: The way Medicare reimburses medical education 
would be changed so that young physicians can be trained in places like 
community health centers, or other outpatient settings, where more 
primary care providers are likely to be trained.
  Improved reimbursement for nurse practitioners and other nonphysician 
providers to encourage more of these providers to practice in rural 
areas.
  Better access to rural hospitals by extending payments for Medicare-
dependent hospitals through 1998. The Dole-Packwood proposal recognizes 
that these payments may make the difference between a hospital keeping 
its doors open or not.

  Establishment of telecommunication grants in rural areas, so that 
providers practicing in these areas have better information and the 
ability to communicate with providers in distant areas.
  Mr. President, these are just a few of the specific rural provisions 
in the Dole-Packwood proposal. In addition, many of the insurance 
market reforms and tax changes contained in the proposal will go a long 
way toward helping rural Americans.
  For example, rural Americans are more likely to be self-employed or 
work for a small business that does not provide health insurance. In 
fact, over 90 percent of the businesses in my home State of Kansas have 
fewer than 10 employees.
  Under current law, individuals who purchase their own insurance are 
not able to deduct the cost of that insurance. The Dole-Packwood 
proposal would phase in full deductibility of health insurance so that 
those who are self-employed or who buy their own insurance are treated 
the same as those employed by large businesses.
  Mr. President, the Dole-Packwood proposal contains a number of 
insurance reforms which make insurance more readily available to 
individuals and small businesses. For example, we provide for the 
elimination of pre-existing condition exclusions and we require that 
insurers guarantee coverage to everyone. Additionally, we provide 
Government subsides for individuals with incomes up to 150 percent of 
poverty.
  Finally, Dole-Packwood does this without a single mandate, without a 
single cent of new taxes or an increase in existing taxes, and without 
a single penny added to the deficit. All Americans--rural or 
otherwise--know that the price of health care should not be jobs or the 
endangerment of our children's future.
  I would like to submit for the Record a more detailed listing of some 
of the provisions in the Dole-Packwood proposal that are specifically 
targeted to rural areas.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

  Provisions in Dole-Packwood Proposal Specifically Targeted to Rural 
                                 Areas

       1. Extend Essential Access Community Hospital Program and 
     Rural Primary Care Hospital Program (E.A.C.H./R.P.C.H.) to 
     all States. Currently only 7 States have these grants 
     available to them. The purpose is to enable these smaller 
     hospitals to continue in their mission to provide primary 
     care services to the residents of rural areas.
       2. Better access to rural hospitals by extending payments 
     for Medicare dependent hospitals through 1998. The Dole-
     Packwood proposal recognizes that these payments may make the 
     difference between a hospital keeping its doors open or not.
       3. Expand the medical assistance program to all States. 
     Currently, this program is limited only to the State of 
     Montana--a State which has had a lot of success assisting 
     small rural communities to establish medical facilities.
       4. Non-refundable tax credits for health care personnel who 
     establish practices in medically underserved communities.
       5. Improved reimbursement for nurse practitioners and other 
     non-physician providers to encourage more of these providers 
     to practice in rural areas.
       6. Federal funds available for the development of health 
     care networks in underserved rural communities. Grants and 
     low-interest loans would assist with resources needed to 
     develop rural health care facilities.
       7. States may designate medically underserved areas which 
     will then receive special considerations, including service 
     from health plans in adjoining geographic areas, increased 
     compensation for health services, and Federal assistance for 
     development of health care services.
       8. Establishment of telecommunication grants in rural 
     areas, so that providers practicing in these areas have 
     better information and the ability to communicate with 
     providers in distant areas.
       9. Provides resources for medical transportation for rural 
     and frontier areas.
       10. Upgrades the Federal Office of Rural Health to increase 
     the attention to rural health care needs in the Federal 
     establishment.
       11. More primary care: The way Medicare reimburses medical 
     education would be changed so that young physicians can be 
     trained in places like community health centers, or other 
     out-patient settings, where more primary care providers are 
     likely to be trained.
       12. Increased Federal support for primary care services for 
     groups most likely to be uninsured or high risk: childhood 
     immunization, maternal and child health, breast and cervical 
     cancer prevention, HIV early detection, tuberculosis 
     prevention, and health care for the homeless.
       13. Increase support for public health service programs, 
     including community health centers, migrant health centers, 
     and federally qualified health centers.
       14. Prospective Payment Assessment Commission [PROPAC] will 
     conduct studies and make recommendations on ways to improve 
     access to health care for vulnerable populations in rural 
     areas.

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