[Congressional Record Volume 154, Number 108 (Friday, June 27, 2008)]
[Senate]
[Page S6311]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




               RURAL HEALTH CARE AND WAGE INDEX PROBLEMS

  Mr. SESSIONS. Mr. President, I thank the Senator from Pennsylvania 
for raising some important issues with regard to the way our Medicare 
system works--and Medicaid, too, for that matter. In many areas of the 
country at least half the health care that is provided goes through 
those programs. I would like to associate myself with what I understood 
to be one comment that he made about rural health care and wage index 
problems.
  Hospitals in America are reimbursed at different rates. If you are a 
hospital in a smaller area, the Federal Government calculates how much 
you should be reimbursed based on what they call a wage index, and that 
wage index pays substantially less or results in a payment 
substantially less than is given to hospitals in urban areas for the 
very same procedure and the very same care.
  We tried to make some progress, and did make some progress, a few 
years ago under the leadership of Senator Grassley. He understood the 
issue. He believed it was adverse to some of the smaller communities in 
Iowa. We had some discussion about it. We made some progress, but it is 
still very dramatic.
  Let's say the average is $100 for a procedure; this is what a 
hospital would be paid. If your wage index is 80, then you would be 
paid $80. If your wage index were 120, you would be paid $120. If you 
have two hospitals, one of them with a higher wage index, it gets paid 
$120, and a poorer, rural hospital would get paid $80.
  This has some ramifications that go beyond common sense in that the 
equipment that a rural hospital needs to utilize may be utilized less 
often, and therefore is more expensive per procedure, than one that 
will be utilized in a wealthier hospital in a wealthy area. I think 
this is a big issue.
  In response to the concern about the bill, I understand there is a 
firm view of Members on this side, and the President, that the Medicare 
Advantage program not be eliminated in this bill. That is basically 
what has happened. We want to see many, if not all, the reforms in 
here, or most of these reforms, but there are one or two matters that 
this side of the aisle feels very strongly about. If we could work 
those out, I think we could pass that legislation in prompt order.
  Some would say it has been blocked by those on this side, and some on 
this side say it has been blocked by the unwillingness to discuss the 
concerns that we have, and therefore it is blocked on the other side.
  I see our distinguished majority leader.
  I yield the floor.
  The ACTING PRESIDENT pro tempore. The majority leader is recognized.

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