[Congressional Record Volume 145, Number 66 (Monday, May 10, 1999)]
[Senate]
[Page S4942]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           RURAL HEALTH CARE

  Mr. THOMAS. Mr. President, I wanted to come in this morning when we 
had a break in regular business to talk about something that is very 
important to me and to Wyoming. As a matter of fact, it is also 
important in States such as Kansas. I am speaking about promoting 
health in rural areas.
  I am joining with several colleagues in introducing a bill promoting 
health in rural areas, a bill designed to increase access to quality 
health care services in rural areas. Rural health care has been a 
priority of mine since I have been in the House and Senate. As cochair 
of the Rural Health Care Caucus, I am pleased that health care in rural 
areas is an issue that we can address in a bipartisan way.
  So I am very pleased to work with colleagues, including the Presiding 
Officer, Senator Roberts; Senator Grassley; Senator Harkin; Senator 
Baucus; Senator Daschle; Senator Conrad, and Senator Collins, to craft 
this bill. It is always a pleasure to work with people who have similar 
issues, and certainly we do in rural areas.
  This bill provides some incentives, regulatory relief and Medicare 
payment equity, needed to ensure rural families have access to quality 
health care, the kind of health care that they deserve. Those of us who 
come from low-population areas have unique problems. We talk about 
education, we talk about schools, and we talk about the delivery of 
health care. Quite frankly, it is different in Greybull, WY, than it is 
in Philadelphia. So when we have national programs such as Medicare, it 
is important that we recognize some of the problems that exist in rural 
areas are unique and, indeed, need to be dealt with differently--
problems such as the lack of physicians and health care providers in 
rural areas, and the idea that Medicare reimbursement has actually been 
unfair and unequal and not uniform throughout the country.

  I recall last year when we were talking about Medicare payments to 
HMOs, the payments that were available in some places in the east were 
$700 a month. In the Midwest, it was $250 a month under the same kind 
of program. So there is some unfairness there. Certainly, we have 
experienced limited access to mental health. I think this is 
particularly true for young people. In rural areas, you simply don't 
have the kinds of rural health care access that is necessary and should 
be provided.
  One of the techniques that will be used increasingly, I am sure, in 
rural health care is telemedicine, where you can go from a family 
practitioner to a specialty on telemedicine and get at least many of 
the same quality kinds of health care advantages.
  Many of these problems were explored last summer when we held a forum 
in Casper, WY. We brought in people interested in health care, not only 
providers and patients but others. Many ideas were talked about there, 
such as how we can strengthen health care in Wyoming. We came up with a 
consensus in a number of these areas, and this bill contains many of 
those recommendations. I am pleased about that.
  Here are some of the solutions. One of the things we discovered in 
our health care seminar is that in big cities you have all the 
different kinds of specialists and different techniques for health 
care, but you don't have them in small towns. So it is necessary, then, 
to have a network so you can tie it in. Small towns aren't often able 
to have a fully qualified hospital that will receive payments for 
Medicare from HCFA. So we had to arrange to have what we call ``acute 
care hospitals'' that can provide a lesser but equally important 
service, so that people could have emergency care, for example, and 
then be transported to another place, or the full service hospital. So 
you need a network there.
  We need assistance in recruiting physicians, as you can imagine. It 
is difficult sometimes to bring in doctors--particularly specialists--
to low-population areas. So these are some of the problems that we 
talked about.
  This bill ensures rural health care representation on the Medicare 
Payment Advisory Commission. There is an advisory commission that has 
oversight responsibilities, and there is no assurance that there would 
be anyone there with a background and experience in a rural area. These 
are the things we have done. Specifically, it increases the 
reimbursement rates for hospitals and clinics.
  Medicare reimbursement rates have been unfair and inadequate. Health 
care costs have been undervalued. You should receive the same kind of 
value care there as somewhere else. The cost of living is somewhat 
less, perhaps, but not to the extent that the payments have been made 
different.
  We think one of the results of that, of course, is the difficulty to 
get providers to come there. Their reimbursement is less than it is in 
Florida or other places for doing the same thing. So we revised the 
rates.
  The bill increases payments to sole community hospitals and, of 
course, that is what we have. My first recollection in talking about 
this is when the Presiding Officer was in the House and we talked in 
Kansas about having a special program for small town hospitals, and 
that happened and has worked well. Recruiting and maintaining 
providers, of course, is a problem. In Wyoming, we have 22 underserved 
areas. That means there is less than one primary care physician for 
every 3,500 people living in those areas. It is also appropriate, of 
course, to advocate for other professionals, such as nurse 
practitioners and physician assistants. In many areas, those are the 
types of professionals that will be in small towns.

  Telemedicine, of course, can be the salvation of rural America, and 
it is moving quickly.
  This bill expands the number of telemedicine services reimbursed by 
Medicare, which will be very useful in establishing a well-coordinated 
network of physicians, midlevel practitioners, hospitals and clinics. 
This is especially important if you have a nurse practitioner or 
physician assistant, for instance, in a small town and they need advice 
from a specialist. They can do that using telemedicine.
  Mental health. As you can imagine, access to mental health care is 
quite limited in rural areas. So this bill expands and ensures coverage 
by Medicare for mental health types of things. I mentioned the MEDPAC. 
Two years ago, Congress established the Medical Payment Advisory 
Commission, designed to make policy recommendations in part A and part 
B of Medicare. Unfortunately, on the current 15-member board, only one 
member is from a rural area. This bill requires that at least two be on 
the board to give adequate input.
  In conclusion, I am very pleased with this bill to promote better 
health care in rural areas. It provides assistance to many rural 
communities that have trouble getting the quality health care that 
people receive in bigger cities. This is designed to do that. It is 
possible that we can debate it this year. The Rural Health Care Caucus 
will be working, and perhaps it will be part of a broader health care 
effort. This is a good start, and I am pleased to be a part of it.

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