News Releases

Today, U.S. Senator Patty Murray (D-WA) joined in a letter with 31 other U.S. Senators to U.S. Department of Health and Human Services Secretary Kathleen Sebelius and Acting Comptroller General of the United States of the General Accounting Office Gene Dodaro asking that they work to ensure sufficient rural representation on the National Health Care Workforce Commission and the Independent Payment Advisory Board.  These boards were created as part of the new health insurance reform law.  In the letter, the Senators expressed concern that rural families have not been adequately represented on other health care advisory boards to date and requested that the unique needs of these rural Americans be addressed in health reform.

“As we move toward implementation of the Patient Protection and Affordable Care Act, we ask that particular attention be given to ensure sufficient rural representation on the National Health Care Workforce Commission and the Independent Payment Advisory Board,” the Senators wrote in their letter. “Given the key role of these new Boards, membership must be carefully selected to protect and strengthen Medicare beneficiaries’ access to services in rural areas… The Commission needs rural representatives who understand these rural workforce challenges and have knowledge of promising strategies for health workforce training, recruiting, and practice in rural America.”

The National Health Care Workforce Commission is charged with analyzing, coordinating, and recommending to Congress and the Administration national strategies to meet the demand for health care services in a reformed health care system.  This Commission was created as part of the Workforce section of the law, which Senator Murray, helped write to ensure there are enough qualified professionals to provide needed health care services.  The Independent Payment Advisory Board will provide recommendations to Congress regarding health care delivery and outcomes, including promotion of integrated care, care coordination, prevention and wellness, and quality improvement for the Medicare program. 

As a senior member of the U.S. Senate Health, Education, Labor, and Pensions Committee Senator Murray worked to ensure that support for rural families was not overlooked in health insurance reform.  The law ensures rural Americans stable and secure health care by improving access to quality healthcare services, investing in the healthcare workforce, eliminating discrimination for pre-existing conditions and health status, and establishing credits for rural small businesses. Senator Murray also worked to protect the health care choices of rural Americans by providing for more affordable choices and competition among insurance companies in health insurance reform.

A copy of the letter follows:

May 6, 2010

The Honorable Kathleen Sebelius
Secretary
U.S. Department of Health and Human Services
200 Independence Ave., SW
Washington, DC 20201

The Honorable Gene L. Dodaro
Acting Comptroller General of the United States
General Accounting Office
441 G St., NW
Washington, DC 20548

Dear Madam Secretary and Mr. Dodaro:

Thank you for your contributions to the historic health reform legislation.  As we move toward implementation of the Patient Protection and Affordable Care Act, we ask that particular attention be given to ensure sufficient rural representation on the National Health Care Workforce Commission and the Independent Payment Advisory Board.  More than 60 million Americans live in rural areas, and we believe the inclusion of the rural perspective will help ensure that the unique needs of these Americans are addressed in health reform.

The National Health Care Workforce Commission is charged with analyzing, coordinating, and recommending national strategies to meet the demand for services in a reformed health care system.  These strategies will be especially important for rural areas, which face unique challenges in building and maintaining their health care workforce.  For example, while 20 percent of the American population lives in rural areas, only nine percent of all physicians and 12 percent of all pharmacists practice in rural communities.  Rural areas average only about 30 dentists per 100,000 residents, while urban areas average approximately twice that number.  Shortages of nurses and allied health professionals are also pervasive.  Low population density, long distance travel, less exposure to health occupations among children, and insufficient numbers of clinical training sites for health professional students contribute to these shortages, which are only expected to worsen in the coming years.  The Commission needs rural representatives who understand these rural workforce challenges and have knowledge of promising strategies for health workforce training, recruiting, and practice in rural America.

Rural areas are also generally older than their urban counterparts, and rural residents comprise about 27 percent of Medicare beneficiaries.  This means that Medicare is a lifeline for rural communities and the backbone of the rural health system.  We are pleased that the Independent Payment Advisory Board will provide crucial recommendations to improve health care delivery and outcomes, including promotion of integrated care, care coordination, prevention and wellness, and quality improvement. 

Although the law requires a balance between urban and rural membership on the Board, we are concerned that there is a precedent of insufficient rural representation in MedPAC, which often has only one or two rural representatives.  This underrepresentation exists despite the fact that the statute governing MedPAC requires the same balance as is called for on the Independent Payment Advisory Board.  Given the key role of the new Board, membership must be carefully selected to protect and strengthen Medicare beneficiaries’ access to services in rural areas, including the unique circumstances of Critical Access Hospitals.  Moreover, rural communities provide very high-quality health care, despite low Medicare reimbursements.  Many cost-saving innovations are underway in rural America, and the Board needs informed rural experts so that the Medicare can respond to rural needs and also learn from rural successes. 

Thank you again for your leadership and your attention to the need for rural representation on the Commission and the Board.