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On May 30, 2001, Senator Murray spoke at a forum on healthcare in Olympia. About 600 people filled The Olympia Center to discuss the federal role in solving the local crisis.

Senator Murray's opening and closing remarks follow:


I want to welcome all of you, and I want to thank everyone who's helped organize this conference. I especially want to thank the Olympian, which has provided extensive coverage of the health challenges here. It's a great public service, and it's clearly part of the solution.

There are two reasons why I felt it was so important to hold this forum with Senator Cantwell and with all of you. First, there are real challenges here. Residents have trouble just getting basic care because they don't have insurance or because they don't have enough insurance. Medical networks like the Memorial Clinic are closing making it harder for people to get access to the care they need. Doctors, frustrated with problems like low reimbursement rates, are leaving Thurston County. So there's a shortage of doctors. There's also a shortage of nurses and the other professionals we rely on. Clearly, there are a lot of challenges, and that's the first reason I'm here -- because there are real problems to address.

The second reason I'm here today is because I know that what happens at the federal level has a real impact on care here in Olympia and throughout our state. We know that many factors have contributed to today's difficulties -- everything from strong growth, to medical costs, regulations, and employment trends. And we know the federal government also bares some responsibility for the problem. While the federal government can't fix everything, it must be part of the solution and that's what we're talking about this evening. So I'm here because there are problems to be solved and because the federal government must be part of the solution.

Now there are a lot of health care concerns from managed care to prescription drugs, from regulatory burdens to low reimbursement levels. If we don't have time to talk about your specific issue, please share your concern with me or my staff. If we don't get to your written question tonight, I'll answer it in the mail. My point is that this discussion is not the last word on health care in Thurston County. I've been meeting with patients and medical professionals for years on these issues. And the reason I worked hard to get on the Senate's public health committee is because health care is a priority for me. So if we don't cover something that's important to you, please let me know so I can best represent you in the U.S. Senate.

I want to start by explaining how we got here, because these problems didn't just crop up overnight. Many different trends brought us here. Our population is getting older, and people are living longer. We're using more prescription drugs and better technology. We don't have enough doctors and nurses to meet our needs. The costs are rising, but our public health programs don't pay providers enough to cover their costs. To survive, doctors and hospitals are raising their rates. But employers, can't afford the growing costs of providing insurance, so many are cutting back on health coverage. We see the impact here in Washington state, where lawmakers are trying to meet skyrocketing health care costs while staying within budget limits.

All of these factors -- and a few others -- have come together to create the situation we face today. This is not new. For years, we've known that our health care system was stretched beyond its limits. That's why back in 1993 and 1994, we tried in Congress to pass universal health insurance. We tried, but we were thwarted. So over the years we've taken an incremental approach. For example, we created new health coverage for children of low-income working parents (CHIP). We made health insurance more portable when you leave a job. We reduced barriers to coverage for people with pre-existing conditions. And we made sure that disabled workers could return to work without losing their medical coverage.

More recently, we've been trying to get prescription drug coverage for seniors and protections for patients in managed care. Unfortunately, we've been thwarted again. Now that Democrats control the Senate, you can bet we're going to make sure Congress focuses on those issues.

So we have taken steps at the federal level to solve these problems. Tonight you will find that some of the things this community depends on are being threatened with cuts by the Bush Administration. If those cuts go through, things will get a lot worse.

So let me give you an overview of where things stand and why what happens to the uninsured affects the entire community. Many of the problems we're facing overall reflect what's happening to folks who don't have health insurance or who don't have enough insurance. These are people who work, who pay taxes, and who are trying to support a family, but they can't afford insurance. Unfortunately, there's not much of a health care safety net left today. When they can't get care, they end up in the emergency room with more severe problems and higher costs. As communities try to pay for their care, it strains the entire system. Sooner or later, people who do have insurance end up feeling the impact. Suddenly their health network has collapsed or their doctor has left town. So what started as a crisis for just the uninsured has now spread to affect the insured too.

It's clear we've got to solve the problem at its source: the folks who can't afford insurance. And there are two ways to do that: either help them get insurance or help them get care directly. As I mentioned, a few years ago, we tried to make sure that everyone could get insurance. That effort didn't succeed. We're still working on providing insurance to people on a smaller scale. In fact, earlier this year I worked with other Senators to expand coverage for the uninsured by $20 billion. This additional funding can be used to expand Medicaid, to provide health care for children, to expand Community Health Care Centers, and to provide tax incentives for individuals and businesses. So part of the solution is expanding insurance coverage. But that takes time, and as you've seen, people need care today.

So we've pushed forward on the other solution -- providing direct care for the uninsured and underinsured. At the federal level, I want to mention two programs that do that. First is the Community Access Program (known as CAP). This is not a federal mandate on communities. It's just the opposite. It's a bottoms-up approach. It gives communities the money to find out what the challenges are and to develop local solutions. Because it's flexible, that money can be used in different ways in different communities depending on their specific problems. Here in Western Washington, it might be a lack of doctors. In Eastern Washington, there might be more of a need to provide insurance. The CAP program is flexible enough to address those different needs. Right now, 18 Washington counties are finding solutions through the CAP program. Another four counties have applied for grants. Just two months ago, the Choice Regional Network here in Thurston County received a CAP grant of $850,000 to define the unmet needs in the South Sound and to support community-based solutions. So the CAP program is flexible, and it gives local communities the tools they need to meet

The problem is President Bush wants to eliminate the CAP program. That will have a big impact on care here, and Kristen West is going to talk about that. So the first federal program is the CAP program, and it's being threatened by the Bush Administration.

A second federal effort is the Community Health Centers Program. Vickie Ybarra from the Yakima Valley is here to talk about this program. Currently, it funds about 83 care centers and clinics throughout our state. These centers provide preventive and primary health care services especially for children. During the last session of Congress, I worked with advocates like the Washington Association of Community and Migrant Health Centers to increase our investment. In March, Sea Mar Community Health Centers received almost half a million dollars to open a new clinic here in Thurston County. That will make a difference. Fortunately, the Community Health Center program is NOT on the chopping block. That's good. But expanding care centers won't have much of an impact if communities can't coordinate that care. We need the CAP program and the Community Health Center program together to have the most impact. Those are two federal programs that help our communities coordinate and deliver direct health care services to the uninsured and underinsured.

I've focused on just those two programs, but as Secretary Selecky will point out there are other critical federal investments in programs like Chronic Disease and Prevention, the Maternal Child Health Block Grant, Ryan White Care Act programs, and the Substance Abuse and Mental Health Services Block Grant. We need to keep our investment in those programs.

There's one other issue I want to mention: the reimbursement rates doctors receive from Medicare and Medicaid. Those rates are too low, and they're now a disincentive for doctors to provide care here. This is not a new problem. The reimbursement rates are determined by formulas that were developed in the 1970's when Washington had lower medical costs, shorter hospital stays and a smaller population. But today, those rates are encouraging doctors to leave for other communities. This is an important issue for me. It's something I've been working on for several years, and we are making some progress. Already we've restored cuts that were imposed back in 1997. I've worked to expand payments for rural hospitals, and I've worked to increase reimbursement rates for Medicare-Plus-Choice plans. So there is a lot at stake at the federal level, and at the end of tonight's discussion, I want to share with you some ideas for things you can do to help protect our interests.

In closing, I want you to know that Thurston County is well positioned to overcome these challenges. I deal with many different issues throughout our state. No matter what the issue, there are often a few of the same stumbling blocks in the way. When people aren't aware of the problem, it's hard to make progress. When there isn't a conversation in neighborhoods, local meetings, and in the local media, it's hard to make progress. And when there isn't a desire to come together and make a difference, it's hard to make progress. Those problems won't keep this county from making progress. You're aware of the challenges. You're talking about them and debating them, and by coming here tonight you're showing that you want to work together to overcome them. Those are three of the strongest tools any community can have as it works to make progress. Let's use those tools to make sure the people of this county get the support they need from the federal level.

Thank you.


First, I want to thank all of you and all of our panelists for being here tonight. I'm leaving here with a better sense of the challenges we face and with a dramatic sense of how committed you are to finding solutions. 3 of 4Tonight is not the end of our work to provide care for the uninsured or to address the other challenges facing this region. So let me conclude by suggesting three things you can do to solve the problems we've talked about.

First, don't let President Bush eliminate the CAP program. We've got to convince the President and Congress that CAP plays a critical role in helping communities solve local health problems. More than 22 of our counties are doing CAP-supported planning. We've got to keep this vital tool available to communities.

In the coming months, I'll be working in the Senate to save the CAP program, and I'm going to need your help to show people in our state and in Congress what's at stake. The more you can do to create an awareness -- whether it's through local media or meeting with other elected officials -- the easier it will be to save the CAP program. When I fight for the CAP program on the Senate floor in the coming months, I'm going to need specific examples of what's at stake for our communities. I need letters that I can hold up that shows what CAP means to families. So share those stories with me either by letter or email. The more specific you can be about what CAP means to this community, the greater the impact you will have.

Second, be part of the CAP process at the local level. Share your input on the needs and solutions so that our local CAP efforts will reflect the true needs and concerns of your community.

Finally, let's keep the conversation going. Tonight we're collecting questions that we didn't have time to answer, and my staff is here as well, but it's not just about tonight. Let's keep each other posted on the progress we're making. So thank you for coming tonight. Thank you for being part of the solution.

I do want to say a final word to the folks who are trying to provide the care -- in the clinics, the doctor's offices and the hospitals. I know this is a tough time. I know that many are leaving. But we need you to stay more than ever and we're working on the problems you face. I hope that tonight's discussion has shown you that you're not in this alone. We're all in this together. And our success will depend on each of us doing the best we can whether it's in the Senate or the emergency room. So hang in there, we need you. Thank you and good night.