[Congressional Record Volume 153, Number 195 (Wednesday, December 19, 2007)]
[Senate]
[Page S15974]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                         MEDICARE REIMBURSEMENT

  Ms. MURKOWSKI. Madam President, I wish to take a few moments to speak 
on the issue of Medicare reimbursements for physicians, particularly 
those in rural and frontier States. We have moved forward a temporary 
fix of Medicare reimbursement for physicians, essentially for 6 months. 
I wish to speak to the issue for Alaska and other rural parts of the 
country.
  In Alaska, many of our Medicare beneficiaries, even without this 
potential 10-percent reimbursement cut, lack the ability to see a 
primary care physician unless they have the means somehow to pay out of 
pocket for doctor visits. Without congressional action on a long-term 
strategy--longer than 6 months--to increase Medicare reimbursements, 
these cuts threaten access to care as fewer and fewer doctors are able 
to afford seeing Medicare patients. An American Medical Association 
survey shows that 60 percent of physicians reported they would be 
forced to limit the number of new Medicare patients they treat if the 
impending reimbursement cuts go through.
  I get so many calls on a daily basis from seniors asking me to fix 
Medicare. They want to be able to continue to see their doctor. I know 
I am not the only Member who receives these calls. It is unfortunate, 
but America's seniors every year are thrust in the middle of this 
Medicare reimbursement debate out of fear that they are going to lose 
their health care provider to Medicare cuts.
  In 2003, with great fanfare, we provided a Medicare prescription drug 
benefit. At that time, I asked the question: We can have a wonderful 
drug benefit, but what good is the benefit if there is no physician to 
write the prescription?
  The Presiding Officer knows how big a State it is; she has had the 
opportunity to come for a visit. We are bigger than California, Texas, 
and Montana combined. ``Rural'' in Alaska has a new meaning. The 
physician shortage crisis in Alaska has been magnified because of our 
geography, distance, and size.
  What many people might not realize is what is happening to our 
population. We have always been viewed as a young pioneering State 
where the average age is the early 20s and predominantly male--a 
wilderness image. But we have grown and matured. Our elderly population 
is the fastest growing senior population per capita in the Nation 
behind Nevada. That is a statistic which would surprise many people.
  The Mat-Su Valley, an area just north of Anchorage, is the fifth 
fastest growing region among seniors nationally. Yet, think about that 
statistic and compare it with what is happening with our physician 
ratio. Alaska has the sixth lowest ratio of physicians to population in 
the United States. Outside of the Anchorage area, our ratio of 
physicians to population is the worst in the Nation.
  To put it into context, we had a field hearing the first part of the 
year to understand how bad the situation is as far as access to care. 
To reach the national average of physician-to-patient ratio, Alaska 
needs a net increase of 980 physicians statewide or 49 more physicians 
per year. I go into some of these hospitals, VA clinics, and community 
health centers. They have been waiting years trying to find not only 
doctors but all within the medical profession, whether it is outpatient 
therapists all the way up to cardiologists. Fairbanks, our second 
largest city, got its first cardiologist this year.
  According to the Anchorage Daily News, our largest newspaper, it 
costs 65 cents on the dollar to care for a patient in Alaska, and yet 
Medicare only reimburses 22 to 35 cents on the dollar. In addition to 
low reimbursement, we have other factors that drive the cost up. We 
have higher salaries, a higher cost of living, higher equipment costs, 
and higher transportation costs. Higher energy costs add to that.
  We had a field hearing earlier in the year and had an individual 
testify before the committee. He was later quoted in the Anchorage 
Daily News:

       The costs [to practice] were so exorbitant and the fees for 
     reimbursement were so low for Medicare patients, at the end 
     of the day I could actually owe money for working a ten-hour 
     day.

  The sustained growth rate formula which has been in place since 1997 
calls for nearly 40 percent in cuts over the next 8 years, even as 
practice expenses continue to increase. So how do we expect to entice 
more physicians to practice and care for our seniors, our veterans, if 
we threaten to cut Medicare reimbursements every year?
  We know the time for Congress to act is now. I ask my colleagues, 
those on the Finance Committee, let's work on legislation that will 
provide a long-term reimbursement fix to ensure continuous care for the 
elderly, who may otherwise be left without access to care in the 
neediest of times. This is something we all must work to advance.

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