(Wenatchee, WA) - Today, U.S. Senator Patty Murray (D-Wash) convened a roundtable discussion in Wenatchee to explore the health care challenges facing Washington's rural communities.

Senator Murray's opening remarks, as prepared for delivery, follow:

Thank you Joan (Joan Baird Glover, moderator). I want to welcome all of you to this discussion. I want to thank everyone who's helped organize this roundtable especially the Washington Health Foundation.

There is no doubt that our state is facing a health care crisis. We see it when patients can't get the care they need. We see it in the shortage of doctors and nurses. We see when seniors can't afford prescription drugs. And we see it in overcrowded emergency rooms.

Over the past few months, I've held roundtable discussion like this in Spokane and Sequim, so I know that the health care crisis is especially severe in rural communities. I'm here today because I want to bring together patients, doctors, and leaders in the community to focus on solutions we can achieve together.

I'm especially proud that we've got folks here from different political viewpoints. To meet this challenge, we're all going to have work together and share our best ideas, and I hope today we get off to a strong start. We've got a great panel here, and I'm looking forward to hearing their comments. I'm also looking forward to hearing from those of you in the audience. You've made an effort to be here and to be part of this discussion, and I thank you.

Recently, the Centers for Disease Control and Prevention issued a report on rural health. It showed that Americans who live in rural areas fare significantly worse in many key health measures than those who live in the suburbs and large metropolitan areas. Every rural community has its own unique needs from a lack of health care capacity which Kay Sparks is going to address, to the needs in tribal communities, which Mel Tonasket is going to speak about. And I'm eager to hear about the challenges you're facing.

As you may know, Congress is now in recess until September. We just spent many months working on a host of health care issues. I want to update you on where we stand on Medicare, prescription drugs, Medicaid, nursing, and CAP grants. And I'm proud to say that I've got some good news to report.


Let me start with Medicare because it is foundation of health care in Washington state. Medicare is a safety net for 37 million Americans and their families. Without it, millions of seniors and the disabled would be denied access to affordable, quality health care. But Medicare needs help. It's under-funded and outdated. And it doesn't focus on prevention.

One of the big problems with Medicare is the way it pays for services. Medicare payments vary by region -- depending on labor and practice costs. If you live in Florida or New York, the reimbursement costs are high. If you live in Iowa or Washington state, the reimbursement rates are much lower for the exact same services.

That has a big impact on the care we can provide here in Washington state. Today, Washington state ranks 42nd in Medicare reimbursements. The national average reimbursement per beneficiary is $5,490. Washington state only gets: $3,921 per patient. As a result, patients cannot get the access they need. Doctors are no longer accepting new Medicare patients. And our emergency rooms are overcrowded.

It's really about fairness. Today, Washington seniors pay the same into Medicare, but don't get the same benefits as seniors in other states.

Working with many in our state, I've written a bill to address this inequity. It's called the Medi-Fair Act (Senate Bill 2568). My Medi-Fair act brings states up from the bottom, and it promotes efficient health care and healthy outcomes. So far, my bill has been endorsed by the Washington State Hospital Association, the Washington State Nurses Association, and the Washington State Medical Association. In fact, doctors from the Wentachee Valley Medical Center came over Seattle to lend their support when I unveiled my bill at the end of May. The folks at the Wenatchee Valley Medical Center have been working with my office on Medicare reimbursement for a while now. They're committed to educating policy makers about the needs in Central Washington, and I'm looking forward to hearing from Dr. Fred Bockenstedt today.

Since introducing my bill, I've been meeting with Senators from other low-reimbursement states. We've formed a Medicare Fairness Coalition. And I have a commitment from the Majority Leader that we will address the fairness issue when the Senate takes up the Medicare/Medicaid provider package. Let me mention that for a moment.

Medicare/Medicaid Provider Package

I'm working with my colleagues on a $30 to $40 billion Medicare provider package similar to what the House recently passed. We want to: restore the 5.4% cut that physicians were hit with in January, eliminate the scheduled 15% reduction in home health care, increase the hospital payment rate, close the wage index for rural hospitals, and restore the scheduled Medicaid DSH reductions. I believe that Congress will enact a Medicare provider package this year. The only question is: Will the President sign it? So far the President has called for a package that would be budget neutral. Many of us in Congress don't see how you can meet the tremendous needs without spending an additional cent. So we'll do our part in Congress and hope the President will recognize the urgent need.

Prescription Drugs

Another challenge we face concerns prescription drugs, which today are helping seniors live longer, healthier lives. Unfortunately, prescription drugs are a major expense for seniors and the disabled. Like many of you, I'm frustrated that Congress hasn't passed a real prescription drug bill. In the Senate, there are two competing visions for a drug benefit. My approach is to follow the Medicare model -- to provide prescription drugs as a seamless part of Medicare. Others take a different approach. They want seniors to get limited coverage through an insurance-only program.

In July, the Senate voted on several drug bills. Unfortunately, no bill was able to get the 60 votes needed to pass. The bill I support was introduced by Senators Bob Graham and Zell Miller. It's S. 2625. It has: no deductible, a $25 premium, low copayments, protection from catastrophic expense, and extra help for low income seniors. It's the most effective bill I've seen to help seniors in Washington state.

This issue is not going away, and I'm going to keep pushing for a bill that will provide real benefits to seniors and the disabled. I'm happy to say that we did pass a reform package that will close some loopholes that have delayed the introduction of less-expensive generic drugs without jeopardizing real innovation.


I want to mention Medicaid because our state desperately needs more Medicaid funding to meet the needs of low-income families and seniors. In the Senate, we passed an amendment to increase the federal match for Medicaid and the Social Services Block Grant. That could mean another $200 million for Washington state.

Unfortunately, the President has said he opposes increasing the federal match for Medicaid. In fact, when Tom Scully - who runs Medicare and Medicaid - was in Bellevue recently -- he said that Washington state should not get any more money. I'm going to keep fighting, but I need your help to convince the Administration that we need to increase the match.

Nursing Shortage

Next I want to mention the nursing shortage that's impacting all of Washington especially rural communities. If we're going to provide quality health care, we need to attract and retain good nurses. I know that Joan Norman of Central Washington Hospital is going to update us on the challenges in nursing.

I'm proud to report that this year I've secured a $1 million appropriation to help us find and implement ways to keep nurses in our communities. The funding will be used by the Washington Health Foundation over the next year to survey 20,000 nurses in Washington state about retention issues. After we have the facts, my funding is going to set up six specific demonstration projects throughout the state so we can begin putting the best approaches to work for our communities.

In addition, we recently passed the Nurse Reinvestment Act. It begins to address the nursing shortage through increased scholarships, faculty improvements, and best practices. I think it's a good start.

Rural Hospital Flexibility Grants

I want to mention a few other efforts that are critical to rural communities like the Rural Hospital Flexibility Grant Program, which has helped keep small hospitals open in Washington state.

In the Senate Labor, HHS Appropriations bill, we provide: an additional $10 million over last year's funding, and $25 million more the President has requested.

We also restored the proposed reduction of $13 million for the Rural Outreach grant program, and restored the proposed $33.5 million reduction in telehealth. These important programs provide critical investments in rural hospital and rural communities.


Finally, I want to mention the Community Access Program, which is a bottom's-up approach to health care. Under CAP, local communities develop solutions to their biggest problems and get funding from the federal government to put those plans into action. I'm a strong supporter of the CAP program. Every year, as a member of the Labor HHS Subcommittee, I fight for additional funding to help communities like Wenatchee. One CAP grant is helping here and throughout Chelan, Douglas, and Okanogan counties.

Unfortunately, the Bush Administration wants to eliminate the CAP program. The Administration offered a budget that cuts CAP by $120 million. I'm proud to report that this year we restored the $120 million for the CAP program.

Last year, my staff joined with the folks at Community Choice when they kicked off their CAP grant. Today I'm looking forward to getting an update from Tom Jones about what they've been able to accomplish over the past year.

So that's an overview of some of the big issues we're working on in the Senate. As I conclude, I just want to say that while the challenges can seem daunting, you have great leadership here in the community. You've got folks who are committed to providing Wenatchee and Central Washington with first-rate health care, and I am committed to working with all of you to make that happen.