[Congressional Record Volume 143, Number 79 (Monday, June 9, 1997)]
[Senate]
[Pages S5423-S5424]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. HARKIN:
  S. 860. A bill to protect and improve rural health care, and for 
other purposes; to the Committee on Finance.


      the rural health care protection and improvement act of 1997

  Mr. HARKIN. Mr. President, I rise today to introduce the Rural Health 
Care Protection and Improvement Act of 1997. This legislation is 
critical to the survival of the fragile health care systems and 
infrastructure in rural areas and small towns across America.
  Rural Americans are more often poor, more often uninsured, and more 
often without access to health care than other Americans. The health 
care system in many small towns in Iowa is on the critical list--we 
have too few doctors, nurses, and other health care professionals and 
many of our rural hospitals are barely making it.
  Iowa ranks first in the percentage of citizens over age 85 and third 
nationally in the percentage of the population over age 65. Because of 
our demographics our health care providers in Iowa depend heavily on 
Medicare payments. And many of them are struggling. One reason they are 
struggling is because of the gross inequities between rural and urban 
Medicare payment rates. In fact, the House Ways and Means Committee 
recently published a report estimating that Iowa loses $0.7 billion a 
year because of current Medicare payment policies. The higher cost of 
living in areas such as New York City and Miami in no way justifies the 
huge disparity in payment rates. The current system rewards waste and 
inefficiency and penalizes States like Iowa whose health care providers 
practice a conservative, cost-effective approach to health care.
  The legislation I am introducing today would correct this wrong-
headed system. This bill would make Medicare payments to managed care 
plans fairer for rural areas by readjusting the AAPCC so that rates are 
more equitable between rural and urban areas.
  But even more importantly, this bill corrects the inequities in the 
regular fee-for-service Medicare Program. AAPCC rates are unfair 
because they are tied directly to Medicare fee-for-service payments, 
and fee-for-service payments are very low in rural areas.
  Even with a correction in managed care payments, over two-thirds of 
Iowa seniors will likely continue to receive care under the standard 
fee-for-service system. This bill corrects fee-for-service rates, so 
that seniors in rural areas

[[Page S5424]]

will at last be able to receive the quality and access to health care 
they deserve.
  Mr. President, my legislation would also reauthorize and extend the 
Rural Health Transition Grant Program. This grant program helps small 
rural hospitals and their communities adapt to the changing health care 
marketplace. Specifically, the grants help hospitals adjust to 
reductions in the need for inpatient services and increased demand for 
outpatient and emergency services and help rural hospitals meet the 
increasingly difficult task of recruiting staff.
  Rural hospitals use these funds for a variety of programs. For 
example, Marengo Memorial Hospital, Mitchell County Hospital, Franklin 
General in Hampton, and Kossuth County Hospital as well as other 
hospitals used funds to help develop rural health care networks. 
Pochahontas Community Hospital and Community Memorial Hospital in 
Sumner used funds to recruit health professionals and Holy Family 
Hospital in Estherville used funds to improve emergency services.
  These grants are provided over 3 years. They represent a small but 
vital source of revenue for hospitals struggling to adjust to a new 
health care environment. Unfortunately, these grants were not 
reauthorized last year, and there are many hospitals that were promised 
transition grant funds but for whom the money is no longer available. 
This legislation would help ensure that these few hospitals are able to 
finish out their grants and meet the changing needs of their patients 
and communities.
  Mr. President, the health care system is undergoing tremendous change 
and our rural hospitals must adjust to this new environment. The 
Transition Grant Program helps hospitals modify the type and extent of 
services so they can better serve rural communities.
  Mr. President, the legislation I am introducing will help improve 
access and enhance the quality of health care in rural areas. And it 
will help shore up the fragile health care infrastructure in our rural 
communities and small towns.
                                 ______