[Congressional Record Volume 153, Number 95 (Wednesday, June 13, 2007)]
[Senate]
[Pages S7641-S7643]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. CONRAD (for himself, Mr. Roberts, Mr. Harkin, Mr. Salazar, 
        Mr. Domenici, Mr. Bingaman, Mr. Smith, Mr. Nelson of Nebraska, 
        Ms. Snowe, Mrs. Murray, Mr. Thune, Mr. Dorgan, Ms. Collins, Mr. 
        Johnson, Mr. Enzi, and Mrs. Lincoln):
  S. 1605. A bill to amend title XVIII of the Social Security Act to 
protect and preserve access of Medicare beneficiaries in rural areas to 
health care providers under the Medicare program, and for other 
purposes; to the Committee on Finance.
  Mr. CONRAD. Mr. President, it is with mixed emotions that I rise 
today to introduce the Rural Hospital and Provider Equity Act of 2007, 
or R-HoPE. This proposal is the result of months of work with my friend 
and colleague, Senator Craig Thomas, who just passed away. In fact, 
Senator Thomas and I were getting ready to introduce this bill the week 
we lost him.
  This particular legislation is the product of work that Senator 
Thomas and I have done over many years as cochair of the rural health 
caucus. So it is a poignant moment for me to come to the floor to 
introduce this bill. I am asking my colleagues that we name this bill 
the Craig Thomas Rural Hospital and Provider Equity Act of 2007, as we 
pay tribute to the service of our colleague, Senator Thomas.
  I can think of no better champion of rural health than Senator Craig 
Thomas, and there is not a more appropriate way to honor his Senate 
career than by enacting this legislation that will carry his name.
  As Senator Thomas and I continually argued in this Chamber, Medicare 
shortchanges many rural hospitals and providers. Before the Medicare 
Modernization Act, rural providers received one-half the payments that 
urban areas received--one-half to provide exactly the same treatment 
for exactly the same illness. That was unfair.
  Senator Thomas and I teamed up at the time to make changes that were 
in the Medicare prescription drug bill that began to level the playing 
field, but those provisions are about to run out.
  I would be the first to admit that health care can be more expensive 
in urban areas than rural areas, but it is not twice as much. When I 
ask the doctors and hospital administrators of my State if they get a 
rural discount when they buy technology for hospitals, they laugh, they 
chuckle, they say, no, they don't get any rural discount. We know now 
it actually costs more to recruit doctors to rural parts of the country 
than it does more urban settings, and we know while there is some cost 
differential, it is not a 100-percent cost differential.
  The Medicare bill, the prescription drug bill recognized this 
disparity in reimbursement and took steps to close the gap. Even with 
the additional funding, many rural hospitals and providers continue to 
experience negative margins.
  If we are to maintain access to health care in rural areas, we cannot 
allow providers to lose 3 percent on nearly every patient they see. But 
that is what is occurring in rural America today.
  Congress needs to take steps to fairly reimburse rural providers for 
the care they provide. The Craig Thomas R-HoPE bill will build on the 
progress made in the medicare Prescription Drug Act and add new 
provisions that would protect access to rural health care.
  First, the bill will fulfill the promise made to those living and 
traveling in rural areas that they don't have to travel far for 
hospital care. The bill would also provide more reflective 
reimbursement for the cost of labor in rural areas. I should say 
reimbursement that more fairly reflects the costs in rural areas since 
they are often competing with more urban areas in the global health 
care marketplace.
  In addition, our proposal would provide the resources currently 
lacking in rural hospitals to repair crumbling buildings. It also 
includes two changes to the Critical Access Hospital Program and will 
put these facilities on a sounder financial footing.
  Second, R-HoPE will promise that rural Americans can see a doctor 
when they are sick. As is the case with most rural States, much of 
North Dakota is designated as a health professional shortage 
area. Recruiting doctors is extremely difficult. Our bill would extend 
the provision in current law that provides incentive payments for 
doctors who practice in rural areas.

  Third, our bill would guarantee that when there is an emergency, 
there is an ambulance there to respond. Many rural ambulance services 
are closing because of lower Medicare reimbursement, resulting in 
response times far above the national average. R-HOPE would protect 
rural ambulance services and those living and traveling in these parts 
of the country by providing a 5-percent bonus payment for 2008 and 
2009.
  Finally, our bill takes a number of steps to help protect the 
availability of other health care providers, such as rural health 
clinics, home health agencies, and mental health professionals. This 
bill achieves the goal Senator Thomas and I have had for a number of 
years, that rural America enjoy the same level of health care access 
and affordability more urban areas enjoy. Rural America is the heart of 
our country. We cannot turn our backs on these areas and their health 
care needs.
  Before I close, I also want to recognize Senator Thomas's staff 
member, Erin Tuggle, who has worked tirelessly on this legislation on 
behalf of rural health care and served Senator Craig Thomas so very 
well. She played a key role in developing this legislation, along with 
my staff, and I thank her for her efforts.
  It is my hope this legislation, which will carry Senator Craig 
Thomas's name, will help strengthen our rural health care system. I 
can't think of a better tribute to my friend and our colleague, Senator 
Craig Thomas.
  At this point, I wish to indicate that Senator Roberts is my leading 
cosponsor, Senator Roberts of Kansas, and we are joined by Senator 
Harkin, Senator Salazar, Senator Domenici, Senator Bingaman, Senator 
Smith, Senator Nelson of Nebraska, Senator Snowe, Senator Murray, 
Senator Thune, Senator Dorgan, Senator Collins, Senator Johnson, and 
Senator Enzi. I ask unanimous consent that they all appear as 
cosponsors of this legislation.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. CONRAD. I should also indicate before I close that this bill has 
now been endorsed by the National Rural Health Association, the 
American Hospital Association, the American Ambulance Association, the 
American Telemedicine Association, the National Association for Home 
Care & Hospice, the American Association for Marriage and Family 
Therapy, the National Association of Rural Health Clinics, the North 
Dakota Hospital Association, and the Federation of American Hospitals, 
all of them joining together to send a message that this legislation is 
needed and it is needed now.
  This is one way we can pay a tangible tribute to the service of 
Senator Craig Thomas. I think all of us who knew him and worked with 
him knew him as

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a quintessential gentleman, and I hope very much that others of our 
colleagues will join us in cosponsoring this legislation in this 
tribute to Senator Thomas.
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