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 SEPARATE  STATEMENT  OF  COMMISSIONER  MICHAEL  J.  COPPS 
 Re:  Rural  Health  Care  Support  Mechanism  (WC  Docket  No.  02-  60) 
 I  am  pleased  very  pleased  to  see  this  rural  health  care  item  on  our  agenda  today.  This  is  a  program  that  we  need  to  put  to  work.  We  need  to  put  it  to  work  because 
 rural  America  lags  the  rest  of  the  country  in  access  to  premium  health  care,  and  we  need  to  do  it  now  more  than  ever  because  of  the  heightened  threats  of  bio-  terrorism  and  health 
 catastrophe  that  follow  in  the  wake  of  9/  11.  Rural  America  wasnt  where  it  should  have  been  in  access  to  good  health  services  before  9/  11,  and  if  terror  visited  there  now,  all  the 
 reports  tell  us,  rural  America  is  less-  equipped  to  deal  with  it  than  we  are  in  the  metropolitan  areas,  and  goodness  knows  we  need  a  lot  of  improvements  here,  too. 

 For  those  who  are  interested  in  seeing  how  rural  health  care  providers  can  make  use  of  telecommunications  infrastructure  to  provide  needed  services,  its  there  to  see.  In 
 growing  numbers  of  places,  you  can  see  telemedicine  and  telehealth  improving  the  quality  of  life  in  rural  communities  by  providing  patients  in  remote  areas  with  access  to 
 services  that  would  otherwise  have  been  unavailable.  We  are  seeing  patient  diagnostic  services,  patient  follow-  up  care,  educational  offerings  for  rural  health  care  professionals, 
 and  the  dissemination  of  all  sorts  of  critical  health  related  information. 
 Last  week,  I  had  the  opportunity  to  learn  about  this  first-  hand  when  I  spent  some  quality  time  in  the  south  central  Wisconsin  town  of  Beaver  Dam,  at  the  Beaver  Dam 
 Community  Hospital.  I  had  the  opportunity  there  to  have  a  long  conversation  with  the  people  who  run  this  rural  facility  and  the  people  responsible  for  the  telecommunications 
 technologies  used  to  provide  patient  care. 
 Here  at  the  Commission  we  now  understand  that  our  Rural  Health  Care  Program  has  not  lived  up  to  its  potential.  We  set  aside  as  much  as  $400  million  annually,  but  in 
 the  first  five  years  of  the  program,  just  over  $30  million  was  disbursed  to  rural  facilities.  This  is  not  on  the  scale  of  what  I  suspect  the  Commission  had  in  mind  when  the  program 
 was  first  set  up,  and  it  is  certainly  not  on  the  scale  of  what  Congress  had  in  mind  when  it  directed  the  Commission  to  ensure  that  health  care  providers  serving  rural  communities 
 have  access  to  services  on  par  with  those  available  in  urban  areas.  And,  as  I  said  a  minute  ago,  it  falls  even  farther  short  of  what  it  should  be  in  light  of  9/  11. 

 In  response,  we  change  our  rules  today.  In  particular,  we  expand  our  interpretation  of  eligible  health  care  providers,  provide  flat  support  for  Internet  access 
 and  revise  our  standard  for  urban  area  rate  comparisons.  I  support  these  changes  because  I  believe  they  will  improve  the  Rural  Health  Care  Program  in  a  manner  that  is  consistent 
 with  our  statutory  mandate. 
 But  other  problems  serious  problems  remain  and  they  keep  this  program  from  being  utilized  the  way  it  should  be  utilized.  My  conversations  in  Beaver  Dam,  and  my 
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 earlier  conversations  in  the  remote  town  of  Levelock,  Alaska,  convince  me  that  basic  lack  of  outreach  and  a  cumbersome  application  process  may  be  the  real  culprits  here. 
 The  Rural  Health  Care  Program  is  only  as  strong  as  the  community  that  knows  about  it.  And  you  know  what?  A  lot  of  communities  dont  know  about  this  program. 
 So,  for  openers,  we  need  to  work  much  more  closely  with  the  American  Hospital  Association,  state  health  care  organizations,  rural  government  associations  and 
 telecommunications  carriers  serving  rural  communities  to  get  the  word  out.  Like  so  many  of  our  universal  service  programs  designed  for  end-  user  beneficiaries  without 
 outreach  they  risk  irrelevance,  perhaps  even  extinction. 
 Then  there  is  the  application  process.  It  needs  a  major  overhaul.  At  Beaver  Dam  Community  Hospital,  they  spent  six  months  to  secure  what  wound  up  being  only  a  single 
 month  of  funding.  Figuring  out  the  appropriate  discount  rate,  securing  necessary  information  from  telecommunications  carriers  and  completing  the  mountain  of  related 
 forms  is  a  time  consuming  and  arduous  task.  The  application  calls  on  health  care  professionals  to  master  the  complexities  of  such  things  as  total  billed  miles  and  the 
 intricacies  of  all  sorts  of  convoluted  tariff  rates.  These  rural  hospitals  have  limited  staff,  they  have  urgent  priorities,  and  in  a  matter  like  this,  where  months  of  work  translate  into 
 a  couple  thousand  dollars  of  one-  month  support,  they  question  if  the  paper  chase  is  at  all  worth  it.  From  what  I  saw,  I  dont  blame  them.  And  I  fear  Beaver  Dams  experience  is 
 not  unusual.  I  know  that  USAC  has  recently  made  some  improvements,  including  a  new  database  of  urban  rates  and  enhanced  electronic  filing  capabilities  and  also  making  the 
 second  year  application  easier,  and  I  congratulate  them  for  that.  But  we  can,  we  should,  and  we  must  do  more.  We  are  justifiably  concerned  with  deterring  waste  and  abuse,  but 
 we  should  recognize  that  the  complexity  of  the  process  here  is  deterring  worthy  applicants  and  that  is  really  waste  and  abuse. 

 I  commend  the  Chairman  and  the  Wireline  Competition  Bureau  for  developing  this  item  today,  and  I  am  encouraged  that  the  Chairman  and  Commissioner  Abernathy 
 made  a  trip  last  week  to  visit  the  University  of  Virginia  Office  of  Telemedicine.  Raising  the  profile  of  this  program  helps.  Todays  Order  helps.  And  tackling  some  of  these  other 
 problems  would  help.  This  program  involves  national  security  and  our  national  well-being.  We  can  all  be  zealous  advocates  for  this  cause.  I  look  forward  to  working  with 
 my  colleagues,  the  Bureau,  rural  health  care  providers  and  the  industry  to  make  this  program  what  it  deserves  to  be. 
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