[Congressional Record Volume 142, Number 97 (Thursday, June 27, 1996)]
[Extensions of Remarks]
[Pages E1211-E1212]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




  THE RURAL HEALTH IMPROVEMENT ACT OF 1996--ENSURING ACCESS TO HEALTH 
                   CARE FOR AMERICA'S RURAL CITIZENS

                                 ______
                                 

                          HON. STEVE GUNDERSON

                              of wisconsin

                    in the house of representatives

                        Thursday, June 27, 1996

  Mr. GUNDERSON. Mr. Speaker, the House and Senate have made great 
strides toward producing a bill to bring about affordable health care. 
While Mr. Poshard and I applaud the Congress for working on the issues 
of affordability and portability of health insurance, the problem in 
rural areas is not only affordability and portability but also 
accessibility.
  Rural hospitals are closing throughout the country because Medicare 
payments are inadequate to cover costs. The current Medicare

[[Page E1212]]

structure does not provide sufficient flexibility to allow hospitals to 
network or merge, vital steps which rural hospitals must take to ensure 
survival. While the 1995 Balanced Budget Act contained several 
provisions that would have accomplished many of our goals, those 
provisions were felled by President Clinton's veto pen.
  During floor consideration of H.R. 3103, the Health Care Availability 
and Affordability Act, I tried to offer an amendment that would have 
addressed many rural concerns. Although my amendment was not allowed, I 
received a personal assurance from the House leadership that rural 
health would be dealt with yet this year.
  In mid-May, I gave a speech before the National Rural Health 
Association in which I outlined the primary needs of rural health care 
as I saw it. Following that speech, we held several meetings with the 
core membership of the Rural Health Care Coalition and our constituent 
health associations.
  The result is a comprehensive consensus bill that reflects a broad 
view of how to better provide access to health care for rural America.
  This bill seeks to increase access to health care for rural citizens 
in four areas:
  First, it reduces the wide variation existing between urban and rural 
areas in the Medicare adjusted average per capita cost [AAPCC] payment 
made to health maintenance organizations (HMOs). While HMOs serving 
some urban areas are receiving upwards of $650, the AAPCC payment in 
1995 for Vernon County, WI, was $211. This kind of disparity results in 
HMOs falling over themselves to serve urban areas while shunning rural 
Americans who have paid the same Medicare tax all of their lives.
  Improving the payment formula will actually allow for greater health 
care options and competition in rural America. This bill will help to 
make HMOs and PSOs an option for Medicare beneficiaries in western 
Wisconsin, an option that does not currently exist.
  Second, it encourages rural providers to form networks to reduce 
costs, share services, and provide more efficient services. It does so 
by providing grant money for communities to create rural health 
networks, creating two new categories of hospitals under Medicare, and 
encouraging community health centers to expand into areas not presently 
served.
  This bill also provides to States and private entities (1) grants to 
develop comprehensive plans to increase access to health care for rural 
communities, and (2) technical assistance and development grants to 
assist hospitals in creating provider networks.
  At a time when we are trying to balance the budget, the Federal 
Government can no longer carry under-utilized facilities. However, 
rural communities cannot afford to go without essential emergency and 
primary care services. To address these needs, we create two new 
categories of limited-service hospitals under Medicare. Rural Emergency 
Access Care Hospitals provide only 24 hour emergency care to 
communities in need of an emergency facility, but not a full-service 
hospital. Rural primary care hospitals may provide a broader range of 
services and for a period of up to 4 days.
  Further, in order to bolster an expansion of community health 
centers, our bill directs the Secretary of DHHS, when making new grants 
under the Public Health Service Act, to give priority to areas not 
presently served by community health centers [CHCs] and to CHCs located 
in or adjacent to community hospitals.
  This bill also expresses the sense of the Congress that the Federal 
Trade Commission should promptly complete its review of the anti-trust 
standard to be applied to provider networks. Rural providers need anti-
trust relief that will allow them the flexibility necessary to provide 
adequate care with limited resources, and to ensure that network 
arrangements do not violate current laws and regulations. A thorough 
review will reveal whether there is a need for further legislation in 
this sensitive area.
  Third, this bill provides incentives to physicians and other health 
care professionals to locate and provide services in rural areas. We 
exempt National Health Service Corps loan repayments and scholarships 
from federal income taxes and direct the Secretary of DHHS to give 
priority placement to areas that have created community rural health 
networks.
  In addition, this bill increases the Medicare incentive payment 
already paid to providers in health professional shortage areas [HPSAs] 
from 10 to 20 percent. However, we limit the payment to primary care 
providers in rural HPSAs, where recruitment efforts are more difficult.
  Finally, it provides a good first step toward recognition of tele-
medicine as an emerging technology with enormous potential in rural 
medicine. Our bill directs the Secretary of Health and Human Services 
to develop a payment methodology under Medicare for tele-medicine 
services provided in rural areas.
  Mr. Poshard and I, as well as key coalition members, realize that the 
introduction of this bill represents the first step in the legislative 
process. We are committed to working with the chairmen on the 
committees of jurisdiction to ensure that essential rural health access 
provisions are enacted into law this year.

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