Mr. President, I am pleased to introduce the Rural Hospital Assistance Act of 2008.Back in December, I stood before this body explaining that we were only passing asix-month Medicare bill in order to provide the opportunity for us to address a number ofpriorities. One of the biggest priorities I identified was the need to ensure access to ruralhospital services.
The type of rural hospitals that top the priority list are what are known as "tweeners."These hospitals are too large to be critical access hospitals, but too small to be financially viableunder the Medicare hospital prospective payment systems. It is absolutely imperative that thesetweener hospitals get the assistance they need in order to keep their doors open. They are oftennot only the sole provider of health care in rural areas, but are also significant employers andpurchasers in the community. Also, the presence of a hospital is essential for purposes ofeconomic development because businesses check to see if a hospital is in the community inwhich they might set up shop.
While the Medicare bill that Congress just enacted improves the situation for sometweeners, many more are left in financial peril. Mr. President, it is unfortunate thatcomprehensive payment reforms for tweener hospitals were not included in the bill that justpassed. As you know, I have long proposed a number of tweener payment improvements inprevious bills this Congress and they were included in the agreement that Senator Baucus and Ireached for this year's Medicare bill. Unfortunately, the core tweener hospital paymentimprovements were dropped from the bill once the process became partisan.
It is for this reason that I am introducing this bill. We must improve the financial healthof tweener hospitals and ensure that people have access to health care.
Mr. President, most tweener hospital are currently designated as Medicare DependentHospitals and Sole Community Hospitals under the Medicare program. While the bill thatrecently passed Congress improves payments for Sole Community Hospitals, there are noprovisions that benefit Medicare Dependent Hospitals. This bill would benefit MedicareDependent Hospitals by not adjusting their payments for area wages unless it would result inimproved payments.
Also, a major driver of the financial difficulties that tweener hospitals face is the fact thatmany have relatively low volumes of inpatient admissions. Back when we passed the MedicarePrescription Drug, Improvement, and Modernization Act of 2003, I made sure that this lawincluded an add-on payment for low volume rural hospitals. This bill would improve theexisting low-volume add-on payment for hospitals so that more rural facilities, both MedicareDependent Hospitals and Sole Community Hospitals, with low volumes would receive theassistance they desperately need.
And to offset the increases in spending from these tweener hospital paymentimprovements, this bill would address another priority that we wanted to include in a morecomprehensive Medicare bill. Many know my position regarding physician owned hospitals andmy concern about the effect these facilities have on health care access and costs as well aspatient safety. There has been much debate regarding these facilities over the years especiallywith physician owned limited service hospitals. This bill would eliminate the exceptions underthe physician self-referral laws for physician-owned hospitals and provide a limited exceptionfor existing facilities.
Mr. President, as you can see, we still have much to do when it comes to ensuring accessto health care in rural America. I look forward to working with my colleagues on this urgentmatter.
Thank you, Mr. President. I yield the floor.
