IV 

108TH CONGRESS 

1ST SESSION H. RES. 267

Expressing the sense of the House of Representatives that there is a need 

to protect and strengthen Medicare beneficiaries’ access to quality health 

care in rural America. 

IN THE HOUSE OF REPRESENTATIVES 

JUNE 10, 2003

Mr. BEREUTER (for himself, Mr. KING of Iowa, Mr. PETERSON of Pennsylvania, Mr. STENHOLM, Mr. HINCHEY, Mr. TOWNS, Mr. TAYLOR of North 

Carolina, Mr. LEACH, Mr. SHUSTER, Mr. OBERSTAR, Mr. JANKLOW, Mr. 

MORAN of Kansas, Mr. TANNER, Mr. GOODE, Mr. NETHERCUTT, Mr. 

SWEENEY, Mr. PAUL, Mr. LATHAM, Mr. DAVIS of Tennessee, Mr. STUPAK, Mr. RENZI, and Mr. OSBORNE) submitted the following resolution; 

which was referred to the Committee on Energy and Commerce, and in 

addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such 

provisions as fall within the jurisdiction of the committee concerned 

RESOLUTION

Expressing the sense of the House of Representatives that 

there is a need to protect and strengthen Medicare beneficiaries’ access to quality health care in rural America.

Whereas approximately 22 percent of Americans living in 

non-metropolitan areas are Medicare beneficiaries; 

Whereas all Medicare beneficiaries should be able to receive 

equitable access to health care services regardless of 

where they live; 
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•HRES 267 IH 

Whereas hospitals located in cities with a population of less 

than 1,000,000, including those in non-metropolitan 

areas, after October 1, 2003, will receive an inpatient 

hospital base payment rate that is 1.6 percent lower than 

those serving larger populations; 

Whereas 62.3 percent of rural hospitals operated with negative Medicare margins in 2001, and 34 percent of such 

hospitals had negative total margins and an average 

Medicare margin of negative 5.7 percent in the year 

2000; 

Whereas the current Medicare wage index formula harms 

rural providers’ ability to attract and retain health care 

workers; 

Whereas rural areas continue to have problems recruiting and 

retaining skilled health care professionals in part due to 

lower Medicare physician payment rates in rural areas 

than in urban areas; 

Whereas programs, such as the Medicare Incentive Payment 

Program, designed to enhance the recruitment of physicians to rural underserved areas, have been shown by the 

General Accounting Office to be ineffective due to administrative obstacles; 

Whereas, due to the current Geographic Practice Cost Index, 

payments to rural Medicare physicians and other health 

professionals are generally less than such payment rates 

received by their urban counterparts; 

Whereas rural health care providers face significant financial 

barriers, including lower Medicare reimbursement rates, 

lower patient volumes, and fewer opportunities to benefit 

from economies of scale; 
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•HRES 267 IH 

Whereas rural health care providers generally purchase supplies, services, and in some instances, labor, based on national markets; 

Whereas the 10 percent Medicare add-on payment for rural 

home health care agencies expired on April 1, 2003, following the October 1, 2002 implementation of a 15 percent reduction in Medicare home health payments, causing financial difficulties for agencies, and thus decreasing 

access for homebound patients; and 

Whereas non-metropolitan residents are generally older, disproportionately poorer, report poorer health status, and 

use more health care services than their respective metropolitan counterparts, yet Medicare expenditures for nonmetropolitan beneficiaries are approximately 18.4 percent 

lower than such expenditures for metropolitan beneficiaries: Now, therefore, be it

1 Resolved, That the House of Representatives—

2 (1) supports payment rates for rural physicians, 

3 hospitals, and other health care providers that are 

4 adequate, and equitable to their urban counterparts; 

5 (2) encourages Federal efforts to address the 

6 current inequities in Medicare reimbursement rates; 

7 and 

8 (3) encourages Federal efforts to ensure access 

9 to quality, affordable health care.

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