Gunderson Fights For Rural Health
Last week the House eliminated most federal rural health programs. This item summarizes the House action (from a well placed Washington source) and the next item asks you to contact your Senators now for support when they deal with this issue after the summer recess.
"Rural health became a hot topic during Thursday's House floor debate over the Labor/HHS Appropriations Bill for FY96. Led by Reps. Gunderson, Poshard, Roberts and Stenholm, the House Rural Health Care Coalition (RHCC) expressed strong concern about the severe cuts being made to the federal Office of Rural Health Policy and its programs."
"'This appropriations bill shows a definite absence of priorities" said Rep. Gunderson (R-WI), Co-Chair of the 140 - member Coalition. "Cutting the federal Office of Rural Health Policy and the programs they administer does not show a dedication to the health and well-being of rural communities. The Congress must adhere to the macro-priority of deficit reduction, but the micro-applications of that process in this bill clearly do not reflect the priorities we must have as a nation. This is true in the job training, education and rural health provisions of the Labor-HHS-Education Appropriations bill and I cannot in good conscience support it.'"
"Opposition from Democrat leadership (which did not want to improve the bill and make its passage more likely) and Republican leadership (which was trying to preserve certain popular research and social programs) proved too great an obstacle to the passage of an amendment restoring rural health funds. Not wanting to have the Congress on record in opposition to the ORHP, no formal amendment was offered to restore funding. However, through negotiations with members of the Appropriations Committee, the RHCC obtained assurances that House conferees would be supportive if the Senate proposed to restore funds to the ORHP."
"By a final vote of 219 to 208 the bill cuts $9 billion from last year's total appropriation of $61 billion. Most of the Federal Government's rural health programs were terminated including: the federal Office of Rural Health Policy, State Offices, Telemedicine, Research Centers, National Clearinghouse, Recruitment Network, EACH/PRCH, State Trauma, Networks, and the National Advisory Committee."
Your Help Needed In U.S. Senate
Now is the time to write both Senator Herb Kohl and Russ Feingold to let them know that the country's rural health infrastructure requires a federal Office Of Rural Health Policy.
We know that America's health care is a partnership between private and government sectors and that this is no more true than in rural America where Medicare, Medicaid constitute the major source of payment for health services.
The federal Office of Rural Health Policy (ORHP) is necessary to insure that the massive power of Medicare and Medicaid is used to enhance, not harm, the country's rural health infrastructure. As noted below, Medicare casts a long shadow over rural health while rural health is largely ignored by Medicare. ORHP works to keep a rural perspective constantly before the federal bureaucracy.
ORHP is our is our foothold within the federal government to assure that rural realities are identified, communicated and considered. This translates into funding the Office to have research, information, and advocacy capabilities.
Research - rural health has long suffered not from a deliberate intent by the federal government to do harm but from a lack of understanding by federal policy and rule makers. Witness the past and current inequities in Medicare reimbursement consequent to methodologies not designed to reflect rural services or markets. Rural is more than urban with fewer people per square mile. Policy affecting rural communities needs to be driven by a systemic understanding based on facts, not urban based stereotypes of rural life. This is the critical role of ORHP's rural research centers and it must be retained.
Information - The greatest challenge facing rural health providers is the ongoing need for information necessary to meet the ever increasing demand for more available, lower cost, higher quality services. For example, there is good research about how to successfully recruit physicians into rural communities but it must be known and implemented to do any good. Rural relevant research is not practical information until it gets into the hands of the people that can turn ideas into practice. ORHP's Rural Information Center Health Service (RICHS) and ORHP's support for state offices of rural health creates the bridge between academic and government sources of information and the people that can actually use that knowledge to meet the real needs of individuals within the local community.
Advocacy - Washington is a city of well financed lobbyists and insiders constantly promoting the special interests of their patron industries and associations. Congress arguably works to balance these forces and represent the interests of the average constituent. However, the arcane nature of the ongoing regulatory minutia that makes or breaks rural health is beyond the limited time available for any one issue by most congressional offices. The National Advisory Committee on Rural Health with staffing by ORHP is a critical avenue for pushing the Department of Health and Human Services to respond to rural issues otherwise ignored.
Government & Rural Communicate?
Whether you want to call it timely or ironic, the National Rural Health Association is sponsoring this Fall a forum entitled "Increasing Outreach and Communication Between Government and Rural Health Providers." It will be held October 19-22 in Kansas City. Sessions include:
Looking at the Rural Health Landscape
How Do We Talk To Each Other?
Can Managed Care Work In Rural Areas?
Financing Rural Health Care
If you are not a NRHA member, call them at (816) 756-3140 for a registration packet.
Medicare & Rural Health
The following is from the introduction of a report & recommendations that we prepared for the House Rural Health Care Coalition entitled, Medicare & Rural Health, Medicare casts a long shadow over rural health while rural health is largely ignored by Medicare. Call my office if you somehow escaped our extensive mailing.
"Rural health has a troubled legacy from the Medicare program. The overwhelming and disproportionate share of patients seen by rural providers are Medicare enrollees while in a contrary manner, rural health represents a very minor portion of Medicare program expenditures. The small portion of Medicare expenditures for rural communities makes it difficult for them to gain the attention needed to solve long-standing rural equity issues."
"Rural communities are particularly vulnerable to Medicare further reducing its share of costs paid. Using information from the American and Wisconsin Hospital Associations, we have projected the impact on RWHC hospitals if Medicare baseline spending is reduced by $250 billion. Medicare currently pays rural hospitals in the Cooperative only 88% of costs. With the proposed cuts, Medicare is expected to only pay 75% of costs - yes this is 75% of costs, an even much smaller percentage of charges. (These figures assume that the $250 billion reduction is prorated across all providers, no increased enrollee cost sharing, no change in benefits.)"
This Lemming Won't Rush To Sea
The following is an excerpt from a Commentary in the July 31st Modern Healthcare, "This Lemming won't join healthcare's rush to sea" by Charles Ricks, chief executive officer of the Boston Regional Medical Center and president of the Atlantic Adventist Healthcare Corp..
"...what do you mean community responsibility? We're going to move patients out of their communities for services into those wonderful networks we've developed. They'll be happy to go to our regionalized centers. These centers are for them. They'll understand. It's for their good. We developed them to cut costs and raise quality... this isn't what you asked for?"
"...what do you mean you want us to concentrate within the community for the good of the community and that networking or regionalization should take place as an outgrowth of local planning and not be driven the other way around? Are you suggesting that networking outside a defined geographic area will probably be secondary at best and only work if it actually enhances or better enables us to serve the needs of the local community itself?"
"This sound like heresy to me. Its not what the lemming leaders or consultants are saying, that's for sure... Oh well, I'm tired of running anyway. Guess I'll stay here and take care of my community. Its big enough for me."
Gopher & Health Tracking
The Robert Wood Johnson Foundation has established a "gopher" site on the internet:
A World Wide Web home page is to be announced shortly. Already initiated is a major new foundation initiative, Health Tracking.
"Health Tracking is a new program of The Robert Wood Johnson Foundation
to examine and report on our nation's changing health care system. Health
Tracking is especially focused on how health system changes affect the
American people. Are things getting better or worse for us? Health Tracking
will pull together insights from many different activities the Foundation
and others fund. It will synthesize information from existing sources and
generate new information and analyses."
"Health Tracking will disseminate its findings widely. Public and private decision makers, the media, health care professionals, researchers, and the public will benefit from Health Tracking." More about Health Tracking is available through their gopher.
Wisconsin Health Insurance Reform
I was pleased to be invited to testify on behalf of the Cooperative at the first hearing (held in Reedsburg) for Senator Peggy Rozenzweig's Health Insurance Reform Bill, Senate Bill 201. If that audience of farmers, small business owners and employees was any indication, we may actually and finally see some reasonable and long overdue reform implemented. Speaker after speaker rose to share their problems and anger with the current system.
In addition to representing the Cooperative's adopted position in support of small market insurance reform, I also spoke from personal experience as a small employer and as an employee with significant family health concerns.
Syl Boeder Starts Consulting Corp.
Since the mid-80's, Syl Boeder was the one person at the American Hospital Association who many of us in rural health felt we could trust. Her recent departure from the AHA is a significant loss to them and us but she is now available through S. Boeder Consulting, Inc. for work in healthcare planning and governance.
"Most recently, Ms. Boeder directed AHA's member service activities for hospital and system trustees, and supervised activities of constituency sections servicing small or rural hospitals, aging and long-term care hospitals and services, psychiatric and substance abuse hospitals and services, and rehabilitation hospitals and services." You can reach her at (708) 854-5261 or by FAX at (708) 426-9574.
WI In Top Quartile Of HMO Use
In general, the greater the HMO enrollment, the greater the pressures on health care providers to contain costs. Wisconsin ranks 10th among the states with 23 percent of its population enrolled in Health Maintenance Organizations based on data distributed by the Wisconsin Rural Health Development Council. The following map divides the states into four quartiles states by the percentage of their total population enrolled in HMOs.
Data Source: Morgan Quinto Press using data from Group Health Association of America for enrollment as of December 31st, 1993; population based on 1993 Census population estimates. Alaska (0%) and Hawaii (23%) included in calculation of quartiles but not shown.
Washington Post Summer Shorts
Brief excerpts of particular interest from the Washington Post:
8/6 - Elderly Attitudes Key To GOP Plan
"The Congressional Budget Office has estimated the most efficient HMOs - 'staff and group' models, with their own buildings, panels of doctorscan provide roughly the same quality of care as traditional no-restrictions fee-for-service plans for young and old with about 20 percent fewer services per person. Other types of managed care and HMO hybrids save relatively little, the CBO said."
"One way to guarantee Medicare will save large amounts by moving people into private plans is to give them a voucher worth a fixed amount and then cap the annual increase in the voucher at some low level such as 5 percent to 6 percent. But if costs rise faster it could hurt the elderly by making them pay more money out of their pockets or accept reduced services."
"Nobody knows how many Medicare beneficiaries would sign up instead of opting to remain in the current fee-for-service system. So far only about 9 percent have signed up for an HMO option, although the number is growing."
8/6 - The Rise And Folly Of The GOP?
"What a difference eight months make. January's Capitol Hill champagne has been replaced by August's bile. Speaker Newt Gingrich's promise to the National Rifle Association of no new gun contr - l laws, coupled with his support for legislative riders to cripple the Environmental Protection Agency, are beginning to scare Northern GOP House members, at least, out of what has been an electoral reveriea suspension of reality."
"Back in December, the public approved of congressional Republican policies and programs by 52 percent to 28 percent, according to Times-Mirror survey data. In June the public disapproved by 45 percent to 41 percent. A more recent NBC poll shows even further deterioration of Congress's standing."
"It's too soon to say, but the Contract With America is in some danger of undergoing a major political metamorphosis: Late 1994's radical (as in 'bold') agenda is becoming late 1995's radical (as in 'crazy') agenda. More and more of what the House sets in motion is starting to look to mainstream voters like a right-wing caricature."
8/7 - Pruning vs. Uprooting
"While most political metaphors are athletic or martial ('Tug of War Between Clinton, Congress' etc.), the big debate among Republicans over the past few weeks has been horticultural: pruning vs. upro - ting."
"The subject, of course, is federal spending. The question is not whether Congress will reduce discretionary spending for next year, but how. The traditional approach is to trim lots of programs a little bit. 'But what happens when you prune,' Rep. Sam Brownback (R-Kan.) explains, 'is that things grow back stronger... To stop this from happening, you've got to pull them up by their roots.'"
"Today, the pruners remain dominant, but they're losing ground.
First, the uprooters won a battle to kill the National Endowment for the
Arts within two years. But the biggest victory came early Thursday morning
when the House passed the bill that funds labor, health and education,
uprooting 170 separate programs."
"A major source of inspiration for Brownback and other uprooters was a cover story by management guru Peter Drucker titled 'REALLY Reinventing Government' in the February issue of the Atlantic Monthly. Drucker argued against what he called "patching," against mere downsizing and reforming. "To reform something that malfunctions... can only make things worse," he wrote. 'The best thing to do with such programs is to abolish them.' Drucker writes, 'All political theory, from Locke on... deals with the process of government... None deals with the substance. None asks what the proper functions of government might be and could be.' It's time to correct that deficiency."