[Congressional Record Volume 155, Number 97 (Thursday, June 25, 2009)]
[Senate]
[Pages S7077-S7078]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. BARRASSO (for himself and Mr. Wyden):
  S. 1355. A bill to amend title XVIII of the Social Security Act to 
improve access to health care for individuals residing in underserved 
rural areas and for other purposes; to the Committee on Finance.
  Mr. WYDEN. Mr. President, along with my friend, Senator Barrasso, I 
am introducing legislation to keep rural America from becoming a health 
care sacrifice zone. Our legislation, the Rural Health Clinic Patient 
Access and Improvement Act, will make it more financially attractive 
for doctors and other providers to treat patients in rural areas. Both 
Senator Barrasso and I have heard from the folks back home about how 
hard it is to get doctors and mid-level practitioners in rural areas. 
My constituents have had to travel hours to get treatment when they 
need it. This bill takes major strides to ensure access to health care 
by building on the successes of the rural health clinic program. When 
it comes to health care, rural residents should not have to accept 
second-class status.
  As the Senate takes up comprehensive healthcare reform, this Congress 
must not lose focus on the health needs of folks in rural areas. Too 
many Oregonians cannot get the kind of affordable and comprehensive 
coverage or access to care their Members of Congress receive. In 
addition, many patients in rural Oregon, even those with good health 
benefits, do not have access to providers or have to travel long 
distances to get medical care.
  Meanwhile, providers lack incentives to go to--or stay in--rural 
areas. It is a lot more lucrative for them to work in big cities where 
they can work in state-of-the art facilities and earn top dollar. 
According to the Oregon State Office of Rural Health, a major obstacle 
facing Oregon's rural health clinics is the severe shortage of health 
care providers willing or able to work in a rural area. One out of 
three Oregon rural health clinics was recruiting in 2008.
  That is why Senator Barrasso and I come here to introduce the Rural 
Health Clinic Patient Access and Improvement Act. Simply put, our bill 
would help improve access for patients in rural areas, while increasing 
reimbursement rates and giving incentives to providers in rural areas.

[[Page S7078]]

  The Rural Health Clinic Patient Access and Improvement Act increases 
the all-inclusive Medicare payment rate for rural health clinics by 
more than 20 percent per visit from an average of $76 to $92. This bill 
would provide an additional $2 bonus for rural health clinics that 
participate in a quality improvement program. Quality of care should be 
a focus for all providers.
  The bill will allow for better collaboration between community health 
centers and rural health clinics. It also creates a 5-state 
demonstration project to recruit and retain providers in rural 
communities by subsidizing a portion of the provider's medical 
liability costs if they practice in a rural health clinic. These 
reforms will help ensure rural residents have access to the same level 
of quality care as those in other parts of the country.
  This bill builds upon the success of Oregon's 54 rural health clinics 
that serve 26 out of 36 counties across the state. These rural health 
clinics help to ensure access to primary care for the underserved 
elderly and low-income populations. Ninety-eight percent of Oregon's 
rural health clinics are willing to see Medicare and Medicaid patients 
as well as patients with no insurance. Not only are they willing to see 
these patients, but 96 percent are currently accepting new patients. 
Many rural residents--whether they are uninsured, publically insured or 
have private insurance--would have nowhere to go to receive primary 
care without rural health clinics.

  When it comes to health care, people want to go to a provider they 
know and trust. One of the reasons rural health clinics have been so 
successful is that they have become an integral part of their 
communities. A great example of this is Gilliam County Medical Center. 
Gilliam County hosted a succession of short-term physicians placed in 
the community through the National Health Service Corps. In the 1970s, 
the community, in conjunction with the State, sought a more permanent, 
stable health care provider situation. The Oregon legislature 
appropriated $20,000 as seed money to attract a team of health 
professionals to the community and the residents of Gilliam County 
created the South Gilliam Health District to support Gilliam County 
Medical Center, a certified rural health clinic.
  Two physician assistants, David Jones and Dennis Bruneau who were on 
the faculty at the University of Washington PA program at the time they 
heard about the opportunity with the clinic were hired. Dave, Dennis, 
their spouses, who also work at the clinic, and supervising physician 
Dr. Bruce Carlson created a team that continues to sustain one of the 
most stable and long-term small rural primary care clinics in the 
state.
  Dr. Carlson visits the clinic one day every 2 weeks to see those 
patients in need of his services and provide overall medical direction. 
Otherwise, the clinic is staffed full-time by physician assistants 
Jones and Bruneau. David's wife is a medical technician who works in 
the clinic and Dennis' wife serves as the clinic manager. When Dr. 
Carlson is not in Condon, he has his own medical practice 70 miles away 
in Hermiston, OR, which is also the location of the nearest hospital to 
Condon.
  Not all rural areas are alike and the rural health clinic program 
gives these providers the flexibility they need to be the regular 
source of care of primary care in their communities. Regular access to 
primary care, as you know, is one of the key tests of whether or not 
you will receive the preventive health screenings that can mean the 
difference that could save your life. They allow for health problems to 
be caught early on so that they can be headed off for just a little 
money, instead of at later stages, which require costly specialty care 
that runs up the bill for the patient and the taxpayer.
  Oregonians in rural areas have the same right to quality, affordable 
medical care as those living in urban areas, but they do not have it 
under our current system. This bill will expand access to health care 
for folks in rural areas and level the playing field for rural health 
clinics by giving them the tools they need to attract and retain 
quality medical providers.
  I want to thank Senator Barrasso and his staff for their hard work in 
bringing this important bipartisan legislation before the Senate.
  I hope my colleagues will join Senator Barrasso and me, and support 
this much needed and bipartisan bill.
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