Senator Kent Conrad | North Dakota

Health Care

"As one of the most rural states in the nation, North Dakota faces tough challenges in providing quality health care to all of its citizens. My objective for North Dakota is to maintain and enhance the accessibility, affordability, and quality of health care in our state."
--Kent Conrad

As one of the most rural states in the nation, North Dakota faces special challenges in providing quality health care to all its citizens. More than 90 percent of North Dakota's rural counties lack full access to affordable, quality health care. Senator Conrad is focused on numerous health care issues that are important to North Dakotans, including:

Access to Rural Hospitals
Emergency Services
Health Care Services for North Dakota
Health Care Cost

Access to Rural Providers
Senator Conrad recognizes that one of the keys to maintaining North Dakota's health care system is supporting the state's rural hospitals, many of which depend on Medicare reimbursement to remain viable. Senator Conrad has visited every hospital in North Dakota and has seen the tremendously positive impact these institutions have on their communities. As a member of the Senate Finance Committee, Senator Conrad has been a leader in fighting to address Medicare payment flaws that have harmed rural health care providers across North Dakota. In recent years, Senator Conrad has been successful in making changes to the Medicare payment rules, which will bring increased payments to rural hospitals, as well as physicians, home health care agencies, nursing homes, rural health clinics and renal dialysis facilities across the state.

In the 108th Congress, Senator Conrad was successful in securing nearly $177 million in improved payments to North Dakota health care providers as part of the Medicare Modernization Act of 2003. These funds have helped to address the payment inequities between North Dakota hospitals and large urban facilities in other parts of the country and have kept many of our rural hospitals open.

More recently, Senator Conrad introduced new rural Medicare legislation designed to further close the gap in reimbursement and extend several of the provisions included in the 2003 Medicare bill. The bipartisan Craig Thomas Rural Hospital and Provider Equity Act, or R-HoPE, would significantly overhaul Medicare's rural health policy by creating a fund for small town hospitals to repair crumbling buildings, providing for home health care and boosting payments to rural ambulance squads. In addition, the bill extends a key provision that has helped several North Dakota hospitals receive higher Medicare payments to better account for the labor costs of serving in a rural state. Senator Conrad's bill has already won support from health care organizations including the National Rural Health Association, the American Hospital Association and the American Ambulance Association. He will continue to work to have this legislation considered by the full Senate.

Senator Conrad has also fought to ensure critical rural health programs, such as the Rural Hospital Flexibility program and the Rural Health Outreach grant program, receive adequate funding. These vital programs are used to meet a variety of health care needs in rural America, including developing local public health programs and helping support the smallest, critical access hospitals in North Dakota.

Specifically, Senator Conrad wrote a budget for fiscal year (FY) 2008 that rejected President Bush's cuts to vital rural health programs and instead provided $163 million, a $146 million increase above the President's request. Without these efforts, several rural health care programs would have been eliminated. In addition, Senator Conrad has consistently been the lead supporter of the annual appropriations request for vital rural health programs.

Emergency Services
Senator Conrad recognizes that access to emergency medical services (EMS) is vital in every community across America, particularly in rural communities where individuals may have to travel long distances to reach the closest hospital.

In recent years, there has been increasing concern about access to emergency care as the number of individuals able to provide these services continues to decline. In many communities, the majority of emergency medical personnel are unpaid volunteers, particularly in rural areas. As rural economies continue to struggle, and individuals have less and less time to volunteer, it has become increasingly difficult for rural EMS squads to recruit and retain personnel.

Senator Conrad has fought to ensure access to emergency services in rural areas by increasing Medicare reimbursement. For example, during debate on the Medicare Modernization Act, Conrad supported efforts to provide a 2 percent add-on payment for rural ambulance squads and a 25 percent bonus payment for trips over 50 miles.

Although the Medicare bill took steps to help ambulance services, many rural squads still operate on negative margins. Senator Conrad has recognized this, and recently introduced a bipartisan bill to further help rural ambulance services. The Medicare Ambulance Payment Extension Act would improve Medicare reimbursement for rural squads and improve the quality of care provided in rural areas. The bill has been endorsed by several organizations, including the American Ambulance Association, the National Rural Health Association and the National Association of Emergency Medical Technicians.

In addition, Conrad has fought against Administrative rules that could have resulted in several North Dakota ambulance services closing. Specifically, in 2005, Conrad argued against overly burdensome training requirements that would have harmed the ability of our volunteer EMS services to recruit and retain personnel. Moreover, in 2006 Senator Conrad was successful in blocking the elimination of the “Super Rural Bonus” for 11 ambulance services across the state that would have represented over a 23 percent cut in funding, forcing these services to close.

Health Care Services for North Dakota
Senator Conrad is always working to find new, innovative ways to bring health care services to North Dakota. One such effort is the "J-1 visa waiver" program, which he successfully amended to make it easier for foreign medical graduates to work in rural communities. In 2002, Senator Conrad worked to expand this program to allow North Dakota communities to employ a greater number of foreign doctors in areas that do not have enough doctors, nurses and other health care providers. This expansion will help ensure patients in smaller and more remote communities continue to have access to vital medical services. Working in a bipartisan manner, Senator Conrad was successful in pushing for this measure to be passed in both the Senate and House of Representatives. In 2004, Senator Conrad was successful in reauthorizing his Conrad State 30 Program. As part of this effort, Senator Conrad worked to expand the program so that states will have flexibility to determine which of their communities need physicians and specialists. This will allow hospitals in urban areas, such as Fargo and Bismarck, to recruit specialists who will provide services to patients from surrounding areas. Most recently, Conrad was successful in securing a two-year extension of the program through June 2008. Conrad will continue to fight in 2007 to have this vital program made permanent.

Telemedicine, also known as Telehealth, is another innovation in health care that North Dakota is beginning to utilize with help from Senator Conrad. Telehealth allows patients in remote rural areas to consult with specialists via video. This option gives North Dakotans access to cutting edge medical care without having to drive long distances to reach a clinic or specialist. In many instances Telehealth can help prevent more serious or expensive procedures by providing an early diagnosis.

In 1993, Senator Conrad formed the Steering Committee on Telehealth to raise awareness about this innovative treatment option. Legislation introduced by Senator Conrad helped address several of the barriers to Telehealth and a portion of his bill, the Comprehensive Telehealth Act of 1997, was enacted into law as part of the Balanced Budget Act of 1997. As a result, Medicare now reimburses doctors for providing Telehealth services to seniors and the disabled in underserved rural areas. In past Congresses, the Senator has convened a series of educational meetings to explore new developments related to expanding the use of Telehealth. Experts in the field, government agency representatives, and Members of Congress attended these meetings. Senator Conrad has continued to hold this educational series in the 110th Congress and uses the information gathered to inform the Senate's legislative agenda on Telehealth.

Senator Conrad is also interested in the use of telehealth in public health emergencies. Most recently, he was successful in getting his proposal, the National Emergency Telemedical Communications Act (NETCA), included in broader bioterrorism legislation. NETCA would establish a regional grant program to create telehealth networks that can help respond to bioterrorist attacks or other public health emergencies. Conrad will work in 2007 to secure funding for this newly authorized program.

In addition, Senator Conrad is interested in health information technology (IT) and making our health care system more efficient by adopting an electronic medical record. He believes this technology has the potential to improve the quality of care and reduce health care costs. Given his focus on this issue, Senator Conrad hosted North Dakota's first Health IT Summit in April 2006. In 2007, he has continued to work with the North Dakota Health IT Steering Committee, which was founded after his Health IT Summit, to expand the use of electronic medical records in North Dakota.

Health Care Costs
The high cost of health care in North Dakota is also a top concern for Senator Conrad. He has fought for 100 percent tax deductibility of health insurance premiums for the self-employed. He also supported the Medicare Modernization Act, which is helping many seniors better afford needed medications. Senator Conrad has also supported measures to bring U.S. drug pricing in line with lower prices offered in other countries and to improve North Dakotans' access to lower-priced generic drugs.

One of Senator Conrad's highest priorities in the U.S. Senate has been to make prescription drugs more affordable for seniors. The new Medicare prescription drug benefit has the potential to help thousands of North Dakota's seniors get the drugs they need; however, Senator Conrad has expressed serious concerns – in public forums and private meetings – about the Medicare program's implementation of this new benefit.

Senator Conrad has also supported other efforts to reduce health care costs and protect access to vital health care services. As a member of the bipartisan Mainstream Coalition on Health Care Reform, he worked on a compromise that would have helped to hold down the rapidly growing costs of health care. Senator Conrad is also a strong supporter of the Medicaid program, which provides a health care safety net for low income North Dakotans. In addition, he is a strong supporter of the S-CHIP program which also helps ensure that children have access to quality health care. Most recently, Conrad's FY 2008 budget document included provisions that could dramatically increase the number of children with health insurance. Senator Conrad will continue to work in the 110th Congress to ensure all North Dakotans have access to affordable and quality health care services.