[Congressional Record (Bound Edition), Volume 155 (2009), Part 15]
[Senate]
[Pages 20680-20681]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           HEALTH CARE REFORM

  Mr. DODD. Mr. President, last night I rose to speak on health care 
reform.
  Today, another 14,000 Americans lost their health insurance.
  That is 14,000 Americans who had health insurance when I spoke on the 
floor last night, but tonight each will go to bed fearing that if 
something happens to them or their family, they could lose everything--
their home, their life savings, their economic security, gone.
  Tomorrow, it will be another 14,000.
  Another 14,000 the day after that.
  And another 14,000 every single day until we finally pass real health 
care reform.
  Between now and when we return from recess, half a million Americans 
will lose their insurance. Some will have preexisting conditions that, 
under our current system, will prevent them from ever finding coverage 
again. Some will have medical issues requiring expensive treatments 
that they will no longer be able to afford. Some will end up in 
bankruptcy. Some will end up on public assistance. And some will end up 
in the emergency room with a sick child whose illness could have been 
prevented with a simple doctor's visit.
  The tragedy caused by our broken health care system is ongoing. It is 
happening right now. And when we come back from recess, I have every 
hope and expectation that we will be ready to work together to stop it.
  I take my Republican colleagues at their word when they say they 
don't want to stall this effort to death, they simply want 
bipartisanship.
  The Affordable Health Choices Act, passed in the HELP Committee, 
didn't win bipartisan support, but it is a bipartisan bill. It 
incorporates 161 Republican amendments, and reflects a spirited and 
robust debate with participation from all sides--exactly the sort of 
debate I expect we can have when we come back from recess.
  We are not going to agree on every detail, and there will be times 
when we have to have a simple up-or-down vote and live with the 
results. But surely we can all agree that the status quo isn't just 
unacceptable--it is unsustainable. That is why doctors and nurses, 
insurance companies and drug companies, Democrats and Republicans--all 
say we need reform.
  Well, it is time for us to make that happen.
  I believe that our bipartisan approach has yielded a good bill.
  If you don't have health insurance, the Affordable Health Choices Act 
will put it within reach by giving you a range of affordable options to 
choose from. It forever banishes the term ``preexisting conditions'' 
from the American vocabulary.
  If you have health insurance, the Affordable Health Choices Act will 
make it less expensive by investing in preventive care to bring down 
the long-term cost of keeping our citizens well, not to mention 
eliminating waste and fraud from our system.
  And if you like your doctor and your insurance plan, and you are 
worried about keeping it, the worst thing in the world you could do 
would be to stand in the way of reform. The Affordable Health Choices 
Act guarantees that you won't see your insurance be taken away at the 
moment you need it most or watch as it is priced out of your family's 
budget.
  Whether you have insurance or not, whether you like your health care 
options or not, whether you are sick or healthy, Democrat or 
Republican, working-class or a small business owner, reform is for you.
  Let us take action on behalf of the 14,000 Americans who will lose 
insurance tomorrow. Let us take action on behalf of the 45 million 
uninsured and the 30 million underinsured. Let us take action on behalf 
of the American people who are looking to us to succeed.
  Mr. JOHANNS. Mr. President, I rise today to bring attention to the 
unique health care challenges faced by the 62 million Americans who 
live in rural America.
  If you took a snapshot of rural America, you would see a population 
that is

[[Page 20681]]

older, poorer, and has less access to health care than other places in 
the country. Because many rural residents are elderly, they need more 
health care services.
  However, rural residents have greater transportation difficulties 
reaching health care providers and often have to travel long distances 
to reach a doctor or hospital. Very few public transportation systems 
are available, and so many folks wait until they are very sick before 
turning to the health care system. This makes the already challenging 
job of managing chronic conditions even more difficult. Rural areas 
report higher rates of chronic conditions, including heart disease and 
cancer. One contributing factor to these chronic conditions is the 
higher obesity and smoking rates of children and adults who reside in 
rural areas.
  Compounding the problem, rural residents also tend to be poorer and 
make on average $7,000 less per year than their urban counterparts. 
Nearly 24 percent of children who live in rural America are in poverty. 
Poverty affects the types of foods being offered at the dinner table as 
the price of fruits and vegetables can often bust a tight food budget.
  It can also force people to put off medical care. According to a 
recent study, rural residents are more likely than their urban 
counterparts to report having deferred care because of cost. It can be 
a vicious cycle.
  While health coverage is vitally important to these rural residents, 
the greatest crisis is access to care. We could give health insurance 
to everyone, but if your county has no doctor or hospital, the best 
insurance will make little difference. This is a simple concept, but an 
important one.
  In rural America, the cornerstone of the health care delivery system 
is the critical access hospital. These hospitals, made up of 25 beds or 
less, provide the most basic access to medical services and serve as a 
rural safety net for emergency services. Of the 90 hospitals in 
Nebraska, 65 of them are critical access hospitals. Clearly their 
importance in rural America cannot be overstated.
  However, it is difficult for many rural hospitals to keep their doors 
open. One reason is that there is less patient volume than in many 
urban settings. In addition, Medicare payments to rural hospitals and 
physicians are dramatically less than those to their urban counterparts 
for equivalent services. This correlates closely with the fact that 
more than 470 rural hospitals have closed in the past 25 years.
  Rural areas also struggle to keep other aspects of their health care 
infrastructure in place. For example, 20 percent of counties in 
Nebraska do not have a local pharmacist who can fill prescription 
medications for their residents. I could go on and on with a similar 
story on home health services, long term care, durable medical 
equipment, and other critical health care services.
  However, one of the biggest challenges facing rural America is 
difficulty recruiting and retaining health care professionals. Medical 
professionals sometimes do not want to set up practice where doctors 
are few and major metropolitan hospitals require hours of travel. 
Currently, 50 million Americans who live in rural America face 
challenges in accessing health care. There are too few providers to 
meet their basic primary care needs. According to the U.S. Department 
of Health and Human Services, while a quarter of the population lives 
in rural areas, only ten percent of physicians practice there. There 
are over 2,000 health professional shortage areas in rural and frontier 
areas of all States and U.S. territories compared to 910 in urban 
areas. Ninety out of 93 Nebraska counties are facing health care 
profession shortages in one or more areas of practice.
  Unless something is done to address this problem, the situation will 
almost surely become a crisis. This scenario is quickly appearing on 
the horizon as rural America has a higher percentage of physician 
generalists who are nearing retirement than urban areas.
  Fewer doctors and lack of health care access could decimate rural 
residents and their rural communities. Young families will not move to 
a place where they cannot access health care for their children, and 
older residents will be forced to move to places where they can find 
care.
  This potential rural reality has major implications for the rest of 
the country and will affect the health and well being of everyone. For 
example, rural America produces the food and the fiber that our country 
needs to survive. Young farmers and their families will not come back 
to live and work in an area where they cannot receive health services 
should an accident or sickness occur. The farming profession is already 
a gamble and not having access to health care is something most people 
aren't willing to risk. If people are forced to leave rural America due 
to lack of health care, then a whole new set of challenges will arise 
that we are not currently prepared to address. Any health care 
solutions or reforms must account for current rural health care system 
realities and future challenges.
  I have long said that the best solutions originate outside the 
beltway, the same holds true with health care. Blanket policies crafted 
from within the DC beltway do not always meet the needs of Nebraskans. 
In fact, they often add additional burdens onto the current system and 
compromise the ability to access quality health care.
  That is why I encourage my colleagues crafting health care reform 
legislation to incorporate the solutions offered in the Craig Thomas 
Rural Hospital and Provider Equity Act. I am a sponsor of this 
legislation and look forward to a number of its provisions being 
enacted.
  Additionally, I hope any health care reform will offer critical 
access hospitals flexibility in determining their bed count to account 
for seasonal and emergency situations which might affect admissions 
rates. Any comprehensive legislation must address the unique payment 
issues facing rural hospitals like reimbursing them for lab services 
provided in nursing homes and rural health clinics, and increasing 
Medicare payment rates for rural health clinics. Finally, legislation 
should extend the rural community hospital demonstration project and 
provide incentives to encourage providers to practice in physician 
scarcity areas.
  The health care delivery system in rural America is already stressed. 
We cannot afford a big mistake with health care reform, because if we 
get it wrong, the fragile rural health care delivery system may never 
recover. Mark my words; if we enact policies that drive providers and 
facilities out of business, no one is waiting in the wings to take 
their place. Therefore, I urge caution and thorough debate of all 
health care reform proposals as unintended consequences must be 
minimized.

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