[Congressional Record Volume 141, Number 101 (Tuesday, June 20, 1995)]
[Extensions of Remarks]
[Page E1299]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]


              THE RURAL AMERICA HEALTH CARE IMPROVEMENT ACT

                                 ______


                           HON. PAT WILLIAMS

                               of montana

                    in the house of representatives

                         Tuesday, June 20, 1995
  Mr. WILLIAMS. Mr. Speaker, I am introducing legislation that is 
critically important to the health of rural America. Rural Americans 
face unique barriers to obtaining health care--barriers ranging from 
great distances to reach hospitals and medical clinics to harsh weather 
conditions, too often low wages and poverty, and, perhaps most 
importantly, a simple lack of doctors, nurses, and other medical 
professionals as well as modern health care facilities.
  Sixty-five million Americans--fully one-quarter of our Nation's 
population--live in rural areas, yet most of these folks lack access to 
even the most basic health care services. In 1992, 146 counties did not 
have a single physician and 34.8 percent of rural Americans lived in 
areas with fewer than 1 primary-care physician for every 3,500 
residents. This severe inability to obtain basic health care has 
resulted in the poorer general health of rural folks. Rural America has 
a higher infant mortality rate and a 40 percent higher rate of death 
from accidents.
  Out my way in Montana, too many of our rural hospitals and clinics 
are understaffed and financially troubled and too many rural families 
live daily with the anxiety that assistance for an unusual illness or 
serious injury will be miles and hours away.
  Forty-one of Montana's 56 counties suffer from a serious shortage of 
physicians; and 9 counties do not have a single physician. In 22 
counties there is no obstetrical care, putting women with a complicated 
delivery at severe risk. Half of Montana's hospitals, most of them 
small and rural, have endured significant financial losses for most of 
this past decade.
  Mr. Speaker, the decision to live in a rural area should not be a 
decision to accept inferior health care. Rural Americans deserve the 
same quality and access to health care that is available to folks 
living in our suburbs and major cities.
  The legislation I am introducing today, the ``Rural America Health 
Care Improvement Act,'' offers an aggressive and comprehensive approach 
toward alleviating the problems our rural communities face to obtaining 
care. It provides rural and frontier areas with the means to develop 
the capacity to provide quality medical care to their residents. It 
encourages physicians to practice in medically underserved rural areas.
  My bill provides 20 percent bonus payments to physicians who choose 
to serve in health professional shortage areas and offer primary care 
services to their rural patients. Furthermore, it encourages health 
care providers to practice in rural underserved areas by guaranteeing 
physicians, nurse practitioners, nurse-midwives and physician 
assistants a tax credit.
  It also dramatically expands the National Health Service Corps a 
program which offers financial assistance to students and loan 
repayment to graduates in exchange for their commitment to serve in a 
health professional shortage area and requires the National Health 
Service Corporation to place more physician assistants, nurse 
practitioners, and nurse-midwives in our rural communities.
  Nurses and physician assistants play a vital role in our rural health 
care delivery systems. Many of our rural communities rely on health 
professionals other than physicians as the only provider of care in the 
community. In 1990, 34 percent of all physician assistants practiced in 
communities with less than 50,000 residents and 25 percent of all 
midwives practiced in those same areas. My bill recognizes that PA's, 
NP's, and nurse-midwives are more apt to practice in rural areas than 
physicians and therefore provides funds to train nonphysician 
providers.
  My bill in particular provides rural and frontier areas with the 
assistance they need to develop their own community-based health plans 
to offer residents with health insurance. This program facilitates 
community involvement and encourages health care delivery structures 
that are adapted by local folks directly for local needs.
  Furthermore, my bill recognizes that rural hospitals across the 
country are experiencing financial shortfalls. My bill includes a grant 
program for hospitals and outpatient facilities in medically 
underserved rural communities to provide primary-care services. It also 
provides for the development of emergency medical hospitals and nurse-
managed health centers.
  Mister Speaker, I have developed this legislation after countless 
meetings and much discussion with rural community leaders and hospital 
directors, with physicians and other health practitioners who live and 
work in rural areas, and especially with the families and workers and 
small business operators in our small towns and rural communities. This 
bill incorporates their solutions to the health care crisis they live 
and cope with daily. They are practical, specific, nonbureaucratic, no-
nonsense, thoughtful solutions and I hope to see this Congress consider 
and approve them.


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