[Congressional Record Volume 145, Number 24 (Wednesday, February 10, 1999)]
[Senate]
[Page S1433]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                      RURAL HEALTH INFRASTRUCTURE

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                         ADDITIONAL STATEMENTS

 Mr. FRIST. Mr. President, the Nation's rural health 
infrastructure is facing immense pressures. Changes in the private 
market, Medicare, Medicaid, and costs of new technologies, treatments 
and education are squeezing many providers out of rural areas. The 
President's budget shows a surprising lack of sensitivity to the 
critical realities in these underserved areas.
  First, the President would cut reimbursement to hospitals an 
additional $9 billion over the next five years. This comes before most 
providers have had time to absorb the full impact of the Balanced 
Budget Act. Rural hospitals have lower patient volumes than urban 
hospitals, and they serve populations with a larger proportion of 
seniors, on average, than urban populations. In addition, nearly 20% of 
rural individuals don't carry health insurance. The burden this imposes 
on rural providers is intensified by the President's reduction of bad 
debt payments to hospitals by 10%.
  Congress has begun to address these problems, and late last year, we 
provided $25 million for state implementation of the Rural Hospital 
Flexibility Program. This program creates cost-based reimbursement for 
Critical Access Hospitals. The money will help states develop and 
implement a rural health plan, develop networks, designate Critical 
Access Hospitals, and to improve rural emergency medical services.
  I must point out that people in rural areas don't have many choices 
of health providers. Thirty-seven states have less than 1% enrollment 
in Medicare risk plans. Often one hospital will serve the needs of many 
communities interspersed through very large regions. We must take great 
care to support, rather than destroy, the rural health infrastructure. 
We may need to reexamine the payment rates to hospitals, but let us do 
so with good data, and an awareness of the special needs of rural 
safety net providers.
  In addition, HCFA has not yet adequately educated beneficiaries or 
resolved the regulatory payment issues surrounding Medicare private 
plan opportunities in rural areas. We in Congress must continue to 
monitor the developments in Medicare+Choice, and make the most of 
opportunities to increase the quality and choice of health care for 
rural Americans.
  The Administration also ignored calls for an increased investment in 
important programs such as the National Health Service Corps, and Rural 
Health and Telehealth--flatlining their funding. The Office of 
Management and Budget also refused a request from the rural health 
caucus to appropriate additional demonstration grant funding for the 
development of emergency medical services networks.
  At a time when the U.S. needs to prepare itself for emergency 
response to public health threats, including bioterrorism and 
identifying and tracking emerging threats such as antimicrobial 
resistance, President Clinton proposes to eliminate the health 
professions education programs intended to increase the number of 
individuals in the public health workforce. These programs include 
support for retraining existing public health workers, as well as 
increasing the supply of new practitioners to address priority public 
health needs.
  As Chairman on the Subcommittee on Public Health, I was especially 
disturbed to find that the President proposes to eliminate programs 
directed at training primary care physicians and dentists with an 
emphasis of practicing in rural areas. The President signed my bill 
reauthorizing these important programs less than three months ago.
  Currently $80 million is spent to assist medical and dental schools 
in developing programs to train family physicians, general internists, 
physician assistants, general dentists and pediatric dentists.
  There is a demonstrated imbalance between primary care providers and 
specialists. The key to correcting this imbalance is to provide 
appropriate incentives at the medical school level to introduce more 
students to primary care settings during their training. Yet, the 
President wants to eliminate it.
  [Last year's request = $77 million ($80 million appropriated)]


                       community-based linkages:

  Today, $54 million is spent to develop and support health 
professional training programs that link community providers with 
academic institutions. President Clinton suggests a $17 million (30%) 
reduction.
  This funding supports:
  Area Health Education Centers (AHECs)--support health care in 
underserved rural and urban areas, including recruitment and support to 
help rural communities retain health professionals.
  Education and Training Relating to Geriatrics--Congress established 
this program to ensure that our health professionals are trained to 
meet the needs of seniors. With the aging of the baby boom generation, 
the number of seniors will double over the next 40 years.
  Rural Interdisciplinary Training Grants--supports projects to train, 
recruit and retain health care practitioners in rural areas.
  [Last year's request = $51 million, $54 million appropriated, fy'00 
request = $37 million]
  I'm disappointed that such important rural programs failed to receive 
adequate funding under the President's budget proposal. It appears that 
the Administration would do well to reexamine their commitment to a 
viable rural health infrastructure, and I urge my colleagues to renew 
their efforts to protect vulnerable Americans in rural areas.

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