[Congressional Record Volume 155, Number 80 (Monday, June 1, 2009)]
[Senate]
[Pages S5898-S5899]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




          CRAIG THOMAS RURAL HOSPITAL AND PROVIDER EQUITY ACT

  Mr. BARRASSO. Mr. President, it will come as no surprise to many that 
rural health care issues are near and dear to my heart. Prior to my 
service in the Senate, I practiced medicine in Casper, WY, for almost a 
quarter of a century. I have firsthand knowledge of the obstacles 
families face in obtaining medical care throughout rural America. I 
also understand the challenges hospitals and providers must overcome in 
delivering quality care to families in remote areas with limited 
resources.
  To give a snapshot of Wyoming's health care landscape, we have only 
26 hospitals spread over nearly 100,000 square miles. With vast 
distances, complex medical cases, and increased demand for technology 
and advanced medical care, the rural health care delivery system is not 
a one-size-fits-all system. I have fought, and will continue to fight 
each and every day, to protect Wyoming's hospitals, providers, and the 
patients they serve. This is one of my top legislative priorities. That 
is why I am an active member of the Senate rural health caucus. For 
decades the caucus has built a reputation of bipartisan and bicameral 
collaboration and cooperation. Each Congress we come together to design 
rural and frontier-specific health care legislation. These efforts have 
produced incredible results.
  For example, when Congress enacted the Medicare Modernization Act of 
2003, it included a comprehensive health care package specifically 
tailored with rural communities, rural hospitals, and rural providers 
in mind. The Medicare Modernization Act finally put rural providers on 
a level playing field with other doctors and hospitals across the 
country.
  In Wyoming, that meant hospitals in Worland, Lander, and Torrington 
could keep their doors open and serve patients as close to home as 
possible. With the passage of that act, Congress put into place 
commonsense Medicare payment equity provisions critical to maintaining 
access to quality health care in isolated and underserved areas. Rural 
and frontier America achieved a significant victory. There was much to 
celebrate. But the mission is not complete. Several of the act's rural 
health provisions have expired, and many are set to expire soon.
  That brings us to the Craig Thomas Rural Hospital and Provider Equity 
Act or R-HoPE. I have joined Senators Conrad, Roberts, and Harkin in 
introducing a comprehensive rural health care bill. The legislation is 
titled the ``Craig Thomas Rural Hospital and Provider Equity Act.'' 
This bill reauthorizes expiring rural provisions included in the 
Medicare Modernization Act. It also takes additional steps to address 
inequities in the Medicare payment system. These inequities continually 
place rural providers at a disadvantage.
  But there are additional challenges. We have a great need for 
adequate outpatient reimbursement in smaller towns, towns such as 
Rawlins, Kemmerer, and Laramie. Rural hospitals such as these are more 
dependent on Medicare payments as part of their total revenue. In fact, 
Medicare accounts for approximately 70 percent of total revenue for 
small rural hospitals. Rural hospitals have lower patient volumes. But 
these same hospitals must compete nationally to recruit doctors and 
nurses. This is due to an alarming shortage of nurses and other health 
care professionals across the country. Additional burdens are placed on 
these hospitals and providers due to higher rates of uninsured and 
underinsured patients who live in rural areas. Also, seniors living in 
rural areas have more financial needs and have increased rates of 
chronic disease. This legislation would preserve achievements in the 
Medicare Modernization Act and give much needed relief to rural 
doctors, nurses, and hospitals.
  First, this bill equalizes payments that are known as Medicare 
disproportionate share hospital payments. These are payments that help 
hospitals cover the extra costs associated with serving a high 
proportion of low-income and uninsured patients. It is time we bring 
rural hospital payments in line with the benefits big city hospitals 
receive when they are providing medical care to the uninsured.
  Second, the bill recognizes that low-volume hospitals do have a 
higher cost per case, which further puts Wyoming's similar hospitals in 
the red. This bill would give these unique rural hospitals extra 
payments, payments that will give Wyoming's low-volume hospitals the 
resources to continue to provide high-quality, lifesaving medical care. 
There are several hospitals in my State located in Laramie, Rawlins, 
Kemmerer, and Lander that need this critical provision.
  In addition to the Medicare hospital payment provision, this bill 
also strengthens over 3,500 rural health clinics across the country. 
Many of these communities depend on these clinics for important 
preventive health care. Currently, rural health clinics receive an all-
inclusive capped payment rate that has not been adjusted, except for 
inflation, since 1988. That is 21 years. So to recognize the rising 
cost of health care, this measure would raise the rural health clinic 
cap from $72 to $92. This increase makes it comparable to the 
reimbursement urban community health centers currently receive.
  Since every small town cannot support a full-service hospital, rural 
health clinics are a key component to deliver medical care all across 
Wyoming. To see how critical this program is, all we have to do is 
visit two towns in northeastern Wyoming: Moorcroft, a population of 
807; and Hulett, population of 434. Residents in these ranching and 
mining towns depend on their rural health clinics to receive primary 
medical care as close to home as possible.
  Finally, the legislation would help rural areas maintain important 
emergency medical services. Rural EMS providers are primarily 
volunteers. They have difficulty recruiting, difficulty retaining, and 
spend additional time educating EMS personnel. These volunteers have 
day jobs as farmers, ranchers, teachers, and lawyers. They volunteer 
because the community needs their help.
  Not all Wyoming cities and towns have the resources to pay for this 
service. Even less have the means to buy and upgrade essential 
lifesaving equipment. This legislation will allow ambulance providers 
to collect payments for transporting patients to the hospital after 
they answer a 911 call--regardless of the final diagnosis of the 
patient.
  Wyoming is blessed with pristine landscapes. These landscapes, 
though, also present significant challenges. Longer distances, bad 
weather, and other challenges make obtaining and providing quality 
health care often difficult. Our unique circumstances require us to 
work together to share resources and to develop networks.
  I believe the Federal Government must continue to recognize the 
important differences between urban and rural health care and respond 
with appropriate policy. Washington must remember that one payment 
system does not fit all. Rural providers provide care for their 
patients under circumstances much different than their urban 
counterparts.
  This legislation is designed to make sure rural hospitals, rural 
clinics, rural ambulance providers, rural home health agencies, rural 
mental health providers, rural doctors, and other critical health 
clinicians are paid accurately and fairly.
  I strongly encourage my colleagues with an interest in rural health 
to cosponsor this legislation.
  Mr. President, I yield the floor and suggest the absence of a quorum.

[[Page S5899]]

  The ACTING PRESIDENT pro tempore. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. NELSON of Florida. Madam President, I ask unanimous consent that 
the order for the quorum call be rescinded.
  The PRESIDING OFFICER (Mrs. Hagan). Without objection, it is so 
ordered.

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