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 Pennsyl-
vania, 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. STU-
PAK, 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 subse-
quently 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 bene-
ficiaries’ 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;
•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 nega-
tive 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 physi-
cians to rural underserved areas, have been shown by the 
General Accounting Office to be ineffective due to admin-
istrative 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;
•HRES 267 IH 
Whereas rural health care providers generally purchase sup-
plies, services, and in some instances, labor, based on na-
tional markets; 
Whereas the 10 percent Medicare add-on payment for rural 
home health care agencies expired on April 1, 2003, fol-
lowing the October 1, 2002 implementation of a 15 per-
cent reduction in Medicare home health payments, caus-
ing financial difficulties for agencies, and thus decreasing 
access for homebound patients; and 
Whereas non-metropolitan residents are generally older, dis-
proportionately poorer, report poorer health status, and 
use more health care services than their respective metro-
politan counterparts, yet Medicare expenditures for non-
metropolitan beneficiaries are approximately 18.4 percent 
lower than such expenditures for metropolitan bene-
ficiaries: Now, therefore, be it
Resolved, That the House of Representatives—
(1) supports payment rates for rural physicians, 
hospitals, and other health care providers that are 
adequate, and equitable to their urban counterparts; 
(2) encourages Federal efforts to address the 
current inequities in Medicare reimbursement rates; 
and 
(3) encourages Federal efforts to ensure access 
to quality, affordable health care.
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