[Congressional Record Volume 165, Number 119 (Tuesday, July 16, 2019)]
[Senate]
[Pages S4834-S4835]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                                Medicare

  Mr. ALEXANDER. Mr. President, last month, during National Nurses 
Week, Ballad Health, a healthcare system in East Tennessee, announced 
it would be giving several thousand nurses a raise.
  The head of Ballad Health announced a $10 million investment in pay 
increases for nurses.
  He said: ``Our nurses and those who work with them in the provision 
of direct patient care are heroes . . . however, it is also true that . 
. . we face significant national shortage of these critical health care 
providers.''
  Alan, the head of Ballad Health, said that his investment was, in 
part, because of a new rule proposed by the Trump administration in 
April.
  This new rule will update the formula that determines how much 
Medicare will reimburse hospitals for patient care. The formula takes 
into account, among other things, the cost of labor in that geographic 
area called the area wage index.
  This new rule attempts to level the playing field between hospitals 
in areas that have higher wages, and therefore are reimbursed at a 
higher rate than hospitals in areas with lower wages.
  The Centers for Medicare and Medicaid Services Administrator, Seema 
Verma, wrote in a recent op-ed in The Tennessean in Nashville:

       Many stakeholders have raised concerns that the Medicare 
     hospital payment system disadvantages many rural hospitals. 
     Our proposed rule brings payments to rural and other low-wage 
     hospitals closer to their urban neighbors.

  I say this standing in the Senate Chamber, where we have the chairman 
and the ranking Democrat on the Agriculture, Nutrition, and Forestry 
Committee--two experts on rural areas and rural hospitals in our 
country.
  In recent years, too many rural Americans have seen their local 
hospital close and their doctors leave town.
  Since 2010, 107 rural hospitals have closed across 28 States and 
another 637--about one-third of all rural hospitals--are at risk of 
closing.
  In Tennessee alone, 12 rural hospitals have closed since 2010.
  A recent survey by the Robert Wood Johnson Foundation and the Harvard 
School of Public Health found that one in four Americans in rural areas 
couldn't access healthcare when they need it.
  This new rule will help rural hospitals keep up with the cost of 
providing care and keep those hospitals open.
  Alan from Ballad Health said: ``This proposed change indicates that 
Washington finally understands that rural health systems, like ours, 
have been historically unable to keep up with the real cost growth of 
nursing and other direct care providers.''
  Craig Becker, who leads the Tennessee Hospital Association, wrote in 
The Tennessean earlier this month that this rule ``is good news for our 
State's hospitals and will provide much-needed relief to many of them, 
especially those in rural areas'' and that the rule ``finally will 
address the significant inequities in the Medicare area wage index--the 
first meaningful effort by any administration to address this flawed 
system.''
  This new rule from CMS will help ensure Americans can access 
healthcare close by to their homes by leveling the playing field 
between urban and rural hospitals that rely on the Medicare hospital 
payment system.
  Last month, the Senate Health, Education, Labor, and Pensions 
Committee, which I chair and Senator Murray of Washington State is the 
ranking Democrat, approved, by a vote of 20 to 3, a bipartisan package 
of 55 proposals from 65 Senators to lower healthcare costs that will 
help rural Americans.
  For example, the legislation would ban anticompetitive terms that 
large hospital chains sometimes use in contracts with employers, such 
as the so-called all-or-nothing clauses. These clauses increase prices 
for employers and patients and can block healthcare plans from choosing 
hospitals based on the care quality, the patient experience, or one 
hospital's competitive pricing.
  Banning all-or-nothing clauses will help level the playing field for 
smaller, independent hospitals who are not part of a large corporate 
chain.
  Another provision in the Lower Healthcare Cost Act of 2019 will 
expand technology-based healthcare to help Americans in rural areas 
have access to specialty care.
  I hope the Trump administration and CMS Administrator Verma will 
quickly finish this rule and give Americans better healthcare choices 
and outcomes at lower costs, especially in our rural areas.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Michigan.
  Ms. STABENOW. Mr. President, before our distinguished leader and 
chairman of the Health, Education, Labor, and Pensions Committee 
leaves, I want to thank him for his hard work.
  Having grown up in a small, rural community in Northern Michigan, I

[[Page S4835]]

can speak directly to how important healthcare services are. My mother 
was director of nursing at a small hospital, and I know, since that 
time, they have gone through many changes, barely holding on to the 
hospital. We have had a number of hospital closings and consolidations.
  There is important work that has happened in the health community. I 
want to congratulate the distinguished chairman and also indicate that 
the Presiding Officer and I, as we were doing the farm bill--it is my 
honor and privilege to work with the Presiding Officer--we were part of 
the solution, including language on telehealth in rural development to 
actually help expand services, and I think telehealth is an important 
way to do that as well.
  I thank the chairman for his comments.