Lawmakers urge more Medicare spending in rural U.S.

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Lawmakers urge more Medicare spending in rural U.S.

By Julie Rovner

Reuters Health, June 10, 2003

WASHINGTON - A group of U.S. House members from rural areas on Tuesday threatened to vote against the massive Medicare-reform bill that would add a drug benefit unless it also includes major increases for health care in rural America.

"If we don't have a hospital and a doctor, prescription drugs are only a small component of what we need" in rural areas, Jerry Moran, R-Kan., co-chair of the House Rural Health Care Caucus, told reporters at a briefing.

The caucus is urging House leaders to include $32 billion in spending increases for rural hospitals, physicians, home health agencies and ambulance services in the $400 billion Medicare measure expected on the House floor later this month.

"I will vote 'no' on the bill unless the changes are included," said Rep. John Peterson, R-Pa., who called his district "the most rural east of the Mississippi."

Moran and Peterson, along with JoAnn Emerson, R-Mo., and Tom Osborne, R-Neb., said that for their constituents, the potential loss of health care services because of low Medicare reimbursements is a far greater threat than the program's current lack of prescription-drug coverage.

If a town's single doctor leaves, said Osborne, "pretty soon the young people leave because there's no one to care for their children. And when the young people leave, pretty soon your town starts to unravel."

Peterson said it is a "myth" that health care costs less in rural areas than in urban and suburban ones.

"The technology costs the same," he said, as do the costs of malpractice insurance, recruiting health professionals and other aspects of modern health care.

Yet Medicare continues to pay less for rural care "based on historic use of health care services," Peterson said. "If you ran a business on historic trends, you'd go broke."

The House members did say they were heartened by a letter from President Bush to Senate Finance Committee chairman Charles Grassley, R-Iowa, backing a $25 billion package of spending increases for rural health care as part of the Medicare bill in that chamber.

"That's the best news we've had in recent days," Moran said.

The package the House members are pushing would eliminate the historic difference between rural and urban hospitals' "standard payment" under Medicare. It would also make other payment increases to rural facilities, as well as boost fees for physicians, home health agencies, and ambulance services in rural areas.

A source close to the development of the bill that House leaders are expected to unveil by the end of the week said it would include "the largest rural-provider package ever," but not as much as the rural caucus is seeking.