Rural Health Care Will Get Big Boost in Final Medicare Bill

October 20, 2003
While Congress struggles to find the ways and means to finance prescription drugs for Medicare recipients, it has little trouble agreeing that rural areas need more money and resources to provide adequate care to America's rural elderly.

Both parties, both houses of Congress and President Bush are all on record as supporting higher rural payments by Medicare. It's likely that rural health care will get at least a $25 billion boost over the next decade for doctors, hospitals and other services in the Medicare bill that's now being hammered out.

Although there's little evidence that the rural poor are less healthy than those in urban areas, there's no question that Medicare pays lower rates in rural areas, where older patients tend to be more common. After all, rural residents make up nearly one-fourth of the 40 million people on Medicare.

Agreement, as usual, ends quickly. The House and Senate have adopted different methods of financing the increase in rural spending, for example, and each hotly criticizes the other's approach.

The House bill would trim payments to hospitals nationwide to finance increased rural payments. The Senate, on the other hand, would try to trim overpayments used in hospital settings, freeze subsidies for medical training and add fees for lab tests.

As usual, there are many longstanding myths -- many originally propagated by special interest groups -- that must be dealt with.

For example, everyone knows it's hard for rural seniors to find medical care. Right? In fact, say Capitol Hill analysts, that doesn't appear to be true; 97% of rural physicians are taking new elderly patients and there's little evidence that rural seniors are sicker than their urban counterparts.

While it is true that payments to providers are lower in rural areas, that may not mean rural residents aren't getting necessary care. In fact, the opposite may be true. A study by Dartmouth researchers found that areas with high payments tend to have an surplus of doctors, who tend to order more tests and specialized regimens that may do little to improve health.

Even travel times don't vary all that much. One study found that the percentage of patients who had to travel an hour or more to get medical care wasn't all that different in urban and rural settings.

One thing's for certain: the chairman and ranking Democrat on the Senate Finance Committee, which handles Medicare, are Sens. Charles Grassley (R-Iowa) and Max Baucus (D-Mont.), both representing states that are rural by anyone's definition. Political differences aside, they're not likely to turn aside appeals for more aid to rural states.