[Congressional Record (Bound Edition), Volume 150 (2004), Part 1]
[Extensions of Remarks]
[Pages 672-673]
[From the U.S. Government Publishing Office, www.gpo.gov]




    INTRODUCTION OF THE PACIFIC INSULAR AREAS RURAL TELEMEDICINE ACT

                                 ______
                                 

                       HON. MADELEINE Z. BORDALLO

                                of guam

                    in the house of representatives

                        Friday, January 30, 2004

  Ms. BORDALLO. Mr. Speaker, today I am introducing the ``Pacific 
Insular Areas Rural Telemedicine Act'' to provide for better treatment 
of Guam, American Samoa and the Commonwealth of the Northern Mariana 
Islands (CNMI) in the health care service supports under the 
Communications Act of 1934, as amended by the Telecommunications Act of 
1996. This bill amends the Act to re-designate the ``urban area'' for 
Guam, American Samoa, and the CNMI to be Honolulu, Hawaii. This bill 
also seeks to define the maximum allowable distance for the Pacific 
Insular Areas to be the distance between the capital cities of each 
jurisdiction and Honolulu, Hawaii. Finally, this bill would specify 
that the urban rate to be used for rate comparison purposes for the 
rural health care support mechanism will be the urban rate for Hawaii.
  The Rural Health Care Program (RHCP) is a universal service support 
mechanism that provides reduced rates to rural health care providers 
for telecommunications services related to the use of telemedicine and 
telehealth. Currently, the RHCP can fund up to $400 million annually to 
ensure that rural health care providers pay no more than those in urban 
areas for the same or similar telecommunication services. This support 
is determined based on mileage or a comparison of urban and rural 
rates.
  Under the mileage based support, the RHCP will pay the difference in 
charges between the standard urban distance (SUD) for each state and 
the maximum allowable distance (MAD). Under the urban/rural rate 
comparison, the RHCP will support the difference between the rural 
health care provider's charges and what the rural health care provider 
would have been charged if it were located an urban area of the state.
  The designation of an ``urban area'' and ``rural area'' determines 
which health care providers and carriers are eligible for support under 
the RHCP. In their initial rulemaking for the RHCP, the Federal 
Communications Commission (FCC) designated the urban areas for these 
Pacific insular areas to be Tutuila in American Samoa, Agana in Guam, 
and Saipan in the CNMI. These designations were made despite the fact 
that none of these cities have a population of over 50,000, the 
threshold used by the FCC in making an urban area designation for a 
state. By defining the jurisdictions' capital cities as the ``urban 
area'' for the RHCP, the health care providers in these Pacific insular 
areas have been informed that the RHCP telecommunication discounts 
would only be applicable to interconnecting health care facilities in 
remote locations within their jurisdictions. For Guam, there are no 
health care facilities that would benefit from this definition. For 
American Samoa and the CNMI, the only health care facilities that would 
qualify are those located on remote islands within the political 
boundaries of their territories.
  The health care providers in the Pacific insular areas reflect the 
size, remoteness, and economic status of their communities. They seek 
access to advanced medical facilities, specialists and health 
professions education programs to better serve their rural and remote 
communities. The populations of these Pacific insular areas are 
approximately 57,000 for American Samoa, 155,000 for Guam, and 69,000 
for the CNMI. These jurisdictions, in their entirety, are classified as 
``rural areas'' and qualify for the rural development programs of the 
U.S. Department of Agriculture. The FCC designation of the capital 
cities of these jurisdictions as ``urban'' has prevented the HCPs in 
these remote, rural areas access to much needed services.

[[Page 673]]

  The FCC has recognized that its current regulations may disadvantage 
health care providers in the Pacific insular areas. In 2002, the FCC 
issued a Notice of Proposed Rulemaking (NPRM) to review the rural 
health care universal service support mechanism and requested comments 
how to address this issue. Comments submitted by the health care 
providers in Guam, American Samoa, the CNMI and telecommunications 
carriers that service these jurisdictions, and by Federal agencies and 
other programs providing health services raised the need to redesignate 
their ``urban area'' to enable the maximum allowable distance to be 
based on their geographic location. The governments of these 
jurisdictions specifically requested that their urban area be re-
designated to the closest urban area with advanced medical facilities. 
Honolulu, Hawaii is the closest urban area to each of these 
jurisdictions with advanced medical facilities as well as an accredited 
medical school. However, the FCC, in its recent Report and Order, 
indicated that it is beyond their statutory authority under 47 U.S.C. 
254(h)(1)(A) to designate an urban area outside of a state, whose 
definition includes the territories and possessions, as the benchmark 
for comparison for the insular areas.
  The residents of Guam, American Samoa, and the CNMI contribute to the 
Universal Service Fund and represent the types of communities that were 
envisioned to be served by the RHCP. The health care providers in the 
Pacific insular areas are in need of telecommunication connections with 
health care providers and with health professions education programs 
outside of their jurisdictions in order to obtain needed specialty 
services and access to advanced health professions education and 
continuing education programs. However, the current costs of these 
telecommunication connections are too high to make the connections 
feasible. The Rural Health Care Program, the program that was designed 
to serve rural communities and which would make such a critical 
difference in these jurisdictions, currently does not benefit those 
most in need.
  In closing, I want to thank my colleagues, Mr. Faleomavaega, Mrs. 
Christensen, Mr. Acevedo-Vila, and Mr. Abercrombie for cosponsoring 
this bill. I urge support for this legislation so that we may provide 
for fair treatment of the Pacific insular areas in the health care 
service supports under the Communications Act of 1934. Designating 
Honolulu, Hawaii as the ``urban area'' for Guam, American Samoa, and 
the CNMI is the most logical, sensible, and possible approach to 
resolve the deficiencies in the implementation of the RHCP for these 
jurisdictions. I look forward to working with the leadership in moving 
this legislation.

                          ____________________