[Congressional Record Volume 147, Number 37 (Tuesday, March 20, 2001)]
[Senate]
[Pages S2584-S2585]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

                             By Mr. BURNS:

  S. 569. A bill entitled the ``Health Care Access Improvement Act''; 
to the Committee on Finance.
  Mr. BURNS. Mr. President, I rise today to introduce the ``Health Care 
Access Improvement Act of 2001.'' This bill is designed to dramatically 
expand rural America's access to modern health care.
  The Health Care Access Improvement Act creates a significant tax 
incentive, which encourages doctors, dentists, physician assistants, 
licensed mental health providers, and nurse practitioners to establish 
practices in under-served areas. Until now, rural areas have not been 
able to compete with the financial draw of urban settings and therefore 
have had trouble attracting medical professionals to their communities. 
The $1,000 per month tax credit will allow health care workers to enjoy 
the advantages of rural life without drastic financial sacrifices. But 
the real winners in this bill are the thousands of Americans whose 
access to health care is almost impossible due to a lack of doctors and 
dentists in small town America.
  There are nine counties in the great state of Montana which do not 
have even one doctor. In these rural settings, agriculture is often the 
only employer. Farming and ranching is hard, dangerous work. Serious 
injuries can happen in an instant. And while Montanans have always been 
known as a heartier breed of people, we get sick too. It is 
unreasonable to expect the farmer who has had a run-in with an auger or 
the elderly rancher's widow to drive two hours or more to get stitched 
up or to have a crown on a tooth replaced. As doctors, dentists, 
physicians assistants, mental health providers, and nurse practitioners 
are attracted to the more urban areas, Montanans and others in isolated 
communities will suffer. We must do what we can to ensure that these 
health care providers come to rural America, we must give them some 
incentive to practice in these smaller communities so that citizens 
living in these areas can finally enjoy the medical treatment they 
deserve.
  This problem is not unique to my State of Montana, alone. In fact, 
throughout the United States, we continue to experience scarcity in all 
or parts of 2,692 counties. In rural areas, serious shortages exist in 
the supply of primary care practitioners and specialty care 
practitioners. This is precisely the reason why this bill is so 
important.
  Twenty-nine health care organizations believe strongly in this 
legislation, as well. They actively support the introduction of this 
legislation to provide a tax credit to health care providers 
establishing practices in underserved areas because they realize it 
will help thousands of health care providers make decisions to 
establish their practices in America's underserved communities. So many 
communities whose access to qualified health care professionals has 
been a constant ``revolving door'' will be greatly helped by this tax 
credit. Mr. President, I hold here in my hand a letter on behalf of 
these various groups which I ask to be inserted in the Record at the 
conclusion of my remarks.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  (See exhibit 1.)
  Mr. BURNS. It is important to note that less than 11 percent of the 
nation's physicians are practicing in non-metropolitan areas, less than 
11 percent. This is a significant number, folks. We owe it to the men, 
women, children, elderly and families living in these non-urban 
communities to take steps necessary to increase this percentage and get 
more health care providers to their communities.
  The Department of Health and Human Services uses a ratio of one 
primary care physician per 3,500 population as the standard for a 
primary care Health Professional Shortage Area, HPSA. More than 20 
million Americans live in rural and frontier HPSAs. Most of the State 
of Montana is beyond rural, it's frontier. As of 1997, more than 2,200 
physicians were needed nationwide to satisfy these non-metropolitan 
primary care HPSAs shortages. I think this bill is a step in the right 
direction.

[[Page S2585]]

  Mr. President, I urge my colleagues to work with me and join in 
support of this legislation. Rural Montana, rural America, and health 
service providers all benefit from increased access, service and a 
better quality of life. In short, everyone wins with this legislation. 
I look forward to making this legislation work for so many of the men, 
women and children in need of quality health care.
  I ask unanimous consent that the text of the bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                 S. 569

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Health Care Access 
     Improvement Act''.

     SEC. 2. NONREFUNDABLE CREDIT FOR CERTAIN PRIMARY HEALTH 
                   SERVICES PROVIDERS SERVING HEALTH PROFESSIONAL 
                   SHORTAGE AREAS.

       (a) In General.--Subpart A of part IV of subchapter A of 
     chapter 1 of the Internal Revenue Code of 1986 (relating to 
     nonrefundable personal credits) is amended by inserting after 
     section 25A the following new section:

     ``SEC. 25B. PRIMARY HEALTH SERVICES PROVIDERS SERVING HEALTH 
                   PROFESSIONAL SHORTAGE AREAS.

       ``(a) Allowance of Credit.--In the case of an individual 
     who is a qualified primary health services provider for any 
     month during the taxable year, there shall be allowed as a 
     credit against the tax imposed by this chapter for such 
     taxable year an amount equal to $1,000 for each month during 
     such taxable year--
       ``(1) which is part of the eligible service period of such 
     individual, and
       ``(2) for which such individual is a qualified primary 
     health services provider.
       ``(b) Qualified Primary Health Services Provider.--For 
     purposes of this section, the term `qualified primary health 
     services provider' means, with respect to any month, any 
     physician, physician assistant, or nurse practitioner, who is 
     certified for such month by the Bureau to be a primary health 
     services provider or a mental health provider licensed under 
     applicable state law who--
       ``(1) is providing primary health services full time and 
     substantially all of whose primary health services are 
     provided in a health professional shortage area,
       ``(2) is not receiving during the calendar year which 
     includes such month a scholarship under the National Health 
     Service Corps Scholarship Program or the Indian health 
     professions scholarship program or a loan repayment under the 
     National Health Service Corps Loan Repayment Program or the 
     Indian Health Service Loan Repayment Program,
       ``(3) is not fulfilling service obligations under such 
     Programs, and
       ``(4) has not defaulted on such obligations.
     Such term shall not include any individual who is described 
     in paragraph (1) with respect to any of the 3 most recent 
     months ending before the date of the enactment of this 
     section.
       ``(c) Eligible Service Period.--For purposes of this 
     section, the term `eligible service period' means the period 
     of 60 consecutive calendar months beginning with the first 
     month the taxpayer is a qualified primary health services 
     provider.
       ``(d) Other Definitions and Special Rule.--For purposes of 
     this section--
       ``(1) Bureau.--The term `Bureau' means the Bureau of Health 
     Care Delivery and Assistance, Health Resources and Services 
     Administration of the United States Public Health Service.
       ``(2) Physician.--The term `physician' has the meaning 
     given to such term by section 1861(r) of the Social Security 
     Act.
       ``(3) Physician assistant.--The term `physician assistant' 
     has the meaning given to such term by section 1861(aa)(5)(A) 
     of the Social Security Act.
       ``(4) Nurse practitioner.--The term `nurse practitioner' 
     has the meaning given to such term by section 1861(aa)(5)(A) 
     of the Social Security Act.
       ``(5) Primary health services provider.--The term `primary 
     health services provider' means a provider of basic health 
     services (as described in section 330(b)(1)(A)(i) of the 
     Public Health Service Act).
       ``(6) Health professional shortage area.--The term `health 
     professional shortage area' means any area which, as of the 
     beginning of the eligible service period, is a health 
     professional shortage area (as defined in section 332(a)(1) 
     of the Public Health Service Act) taking into account only 
     the category of health services provided by the qualified 
     primary health services provider.
       ``(7) Only 60 months taken into account.--In no event shall 
     more than 60 months be taken into account under subsection 
     (a) by any individual for all taxable years.''.
       (b) Clerical Amendment.--The table of sections for subpart 
     A of part IV of subchapter A of chapter 1 of the Internal 
     Revenue Code of 1986 is amended by inserting after the item 
     relating to section 25A the following new item:

``Sec. 25B. Primary health services providers serving health 
              professional shortage areas.''.
       (c) Effective Date.--The amendments made by this section 
     shall apply to taxable years beginning after December 31, 
     2001.

                               Exhibit 1

                                                             ADEA,


                        American Dental Education Association,

                                   Washington, DC, March 13, 2001.
     Hon. Conrad Burns,
     United States Senate,
     Dirksen Senate Office Building,
     Washington, DC.
       Dear Senator Burns: The 29 undersigned organizations 
     actively support your introduction of legislation to provide 
     a tax credit to health care providers establishing practices 
     in underserved areas. This tax credit will not only help 
     thousands of health care providers make decisions to 
     establish their practices in America's underserved 
     communities, but also will provide sufficient time for them 
     to establish roots in these communities.
       Many communities whose access to qualified health care 
     professionals has been a constant ``revolving door'' will be 
     greatly helped by this tax credit. It is estimated that more 
     than 20,000 clinicians are needed to eliminate all of the 
     Primary Care Dental, Medical and Mental Health, Health 
     Professional Shortage Areas (HPSAs) now designated across our 
     nation.
       Please accept our endorsement for this critical proposal 
     that will improve America's public health and access to 
     health care in underserved areas. Thank you for offering such 
     an important proposal at the outset of the legislative 
     session and for your continued leadership. Please let us know 
     how we may be helpful to you as we work together to improve 
     access to care. We are committed to provide sustained 
     assistance as you move this proposal forward.
           Sincerely,
                             Richard W. Valachovic, D.M.D., M.P.H.
                                               Executive Director.

       On behalf of the: American Academy of Pediatric Dentistry; 
     American Association of Colleges of Osteopathic Medicine; 
     American Association of Colleges of Pharmacy; American 
     Association of Community Dental Programs; American 
     Association for Dental Research; American Association of 
     Public Health Dentistry; American College of Nurse-Midwives; 
     American College of Nurse Practitioners; American College of 
     Osteopathic Emergency Physicians; American College of 
     Osteopathic Family Physicians; American Dental Association; 
     American Dental Education Association; American Dental 
     Hygienists' Association; American Medical Student 
     Association; American Optometric Association; American 
     Osteopathic Association; American Psychological Association; 
     American Student Dental Association; Association of Academic 
     Health Centers; Association of American Medical Colleges; 
     Association of American Veterinary Medical Colleges; 
     Association of Schools of Allied Health Professions; 
     Association of Schools and Colleges of Optometry; Association 
     of Schools of Public Health; Clinical Social Work Federation; 
     Coalition of Higher Education Assistance Organizations; 
     National Association of Graduate-Professional Students; 
     National League for Nursing and National Organization of 
     Nurse Practitioners Faculties.
                                 ______