Maintaining rural health care takes act of Congress

Suppose you had the power to set your own prices.

Pull up to a gasoline pump, check the price ($4.05 per gallon for 10 percent ethanol), fill 'er up and head toward the clerk.

You tell him, "I'm only paying you $3.18 today."

Wait a minute, the gas station owner says. That fuel cost us much more than that, plus we have to pay the clerk, the rent and utilities to keep the station open.

"Sorry," you say, and walk away. There's nothing you can do about it. He's forced to make up the loss by charging someone else more, or closing his doors.

That's the position hospitals, especially small "critical access hospitals" like those in Southwest Nebraska, doctors and other health-care providers would have been in if Medicare would have had its way.

It took an act of Congress -- literally -- to override President Bush's veto of legislation to rein in the agency.

On a 383-41 vote of the House and 70-26 vote of the Senate, Congress forced into law legislation that blocks scheduled 10.6 percent cuts in Medicare payments to seniors' physicians nationwide, which would have translated into a loss of $70 million in Medicare reimbursements to Nebraska physicians over the next 18 months.

"We stood united to provide vital assistance to Medicare patients in Nebraska who were unsure whether they would continue to have access to life-sustaining medical care," said Sen. Ben Nelson. "Now, physicians can continue to provide the medical care those seniors rely on. By approving common-sense legislation, Congress protected health care for the more than 265,000 Medicare beneficiaries in our state alone."

In addition, the law overturns a 2003 Centers for Medicare and Medicaid Services regulation that prohibits critical access hospitals from being reimbursed at cost for laboratory services unless patients are "physically present in a critical access hospital" when laboratory specimens are collected.

That sounds like a regulation promulgated by someone who had never been outside a city, let alone visited the wide open spaces out west, or had to care from an ailing or elderly parent or spouse who lives there.

Without the act of Congress earlier this week, many seniors would be forced to travel many miles for simple lab tests that are now provided at alternative sites -- or worse, not had access to needed care.

Sixty-five rural hospitals in Nebraska lost an estimated $2.1 million a year or more in fees for lab services in rural health clinics, nursing homes and home-health settings.

Health care providers who receive less for their product are forced to make up the money elsewhere -- through private-pay patients, for instance -- or to stop providing the service. For rural Nebraska, that would be a tragedy.