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

Senator Conrad is focused on numerous health care issues that are important to North Dakotans, including:

Access to Rural Providers
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. He has visited every hospital in North Dakota and has seen the tremendously positive impact these institutions have on their communities. As a senior 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, the Senator has been successful in making changes to the Medicare payment rules, which have brought 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 approximately $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.

In the 111th Congress, Senator Conrad introduced 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 improve Medicare reimbursement formulas for rural health care providers. Many rural health care providers, including hospitals, clinics and ambulance squads, operate with overall negative Medicare margins, meaning Medicare reimbursements do not cover the actual costs these providers incur. R-HoPE would take several steps to improve the financial status of rural providers, including boosting Medicare reimbursement payments to rural hospitals, clinics and ambulance squads, as well as creating a new loan program to assist rural hospitals in repairing aging buildings.

More recently, Senator Conrad worked to ensure that Congress' health care reform package included a provision from the R-HoPE bill that boosts Medicare payments for rural providers in North Dakota. The provision, called the Frontier State Amendment, includes a substantial increase in payments to hospitals and doctors who treat Medicare patients, and will allow our providers to continue providing top quality care to all North Dakotans. It is estimated that this provision will mean an additional $650 million for North Dakota over 10 years.

As Chairman of the Budget Committee, 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. 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, the Senator 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 introduced a bipartisan bill in the 111th Congress to further help rural ambulance services. The Medicare Ambulance Access Preservation Act would improve Medicare reimbursement for rural squads and improve the quality of care provided in rural areas. More specifically, it would implement a 6 percent increase for ambulance service agencies that serve urban or rural areas, and a 17 percent increase for ambulance services in super rural areas. This bill is based on the May 2007 Government Accountability Office report on the costs of providing ambulance services to Medicare beneficiaries. The report found that Medicare reimburses ambulance service agencies on average 17 percent below their costs in extremely rural or "super rural" areas and 6 percent below their costs in all other areas.

In addition, the new health reform law includes several provisions from Senator Conrad's bill to improve Medicare payments to ambulance service providers. Specifically, the final bill includes an amendment that Senator Conrad authored during the Senate Finance Committee's consideration of health reform that extends "super rural" ambulance add-on payments through the end of 2010. Additionally, the health reform law extends Medicare bonus payments for both ground and air ambulance services in rural areas through December 31, 2010.

Senator Conrad has also fought against administrative rules that could have resulted in several North Dakota ambulance services closing. Specifically, in 2005, the Senator argued against overly burdensome training requirements that would have harmed the ability of our volunteer EMS squads 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. In 2004, the Senator worked to further 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 a limited number of specialists who will provide services to patients from surrounding areas. Most recently, Senator Conrad was successful in securing an extension of the program through October 2012. He will continue to fight to have this vital program expanded and 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 and uses the information gathered to inform the Senate's legislative agenda on Telehealth.

Senator Conrad is also interested in health information technology (IT) and making our health care system more efficient by adopting an electronic medical record. This technology has the potential to improve the quality of care and reduce health care costs. Given his focus on this issue, Senator Conrad, with key North Dakota organizations, hosted North Dakota's first Health IT Summit in April of 2006. The North Dakota Health IT Steering Committee, which was founded after his Health IT Summit, was formed to advance the use of health IT and improve quality health care and patient safety. In 2009, the Steering Committee was successful in getting the health IT funding bill (North Dakota Senate Bill 2332) approved. SB 2332 established a state health IT office created a state health IT director, established the State health IT loan program and transitioned the HIT Steering Committee to the Governor-appointed ND HIT Advisory Committee (HITAC) with public-private representation. The HITAC, in collaboration with the state health IT director, has developed the health information exchange strategic and operational plan for North Dakota funded through the American Recovery and Reinvestment Act (ARRA).

The ARRA, which was signed into law in 2009 with Senator Conrad's support, provided $19 billion for health IT infrastructure and Medicare and Medicaid incentives to encourage doctors, hospitals, and other providers to use health IT to securely and electronically exchange patients' health information. This would save the federal government billions of dollars and generate additional savings throughout the health sector through improvements in quality of care, care coordination, and reductions in medical errors and duplicative care.

In addition, Senator Conrad is a strong supporter of the Medicaid program, which provides a health care safety net for low income North Dakotans. He also strongly supports the S-CHIP program, which helps ensure that children have access to quality health care.

Health Care Costs
The high cost of health care in North Dakota is also a top concern for Senator Conrad. He 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.

Most recently, Senator Conrad worked hard to make sure the new health insurance reform law provides more security and stability for North Dakota's families and businesses. The fact is the health reform law builds on our current private, employer-based health insurance system by expanding coverage, controlling costs, and improving quality for consumers. It also takes important steps that will begin to put our nation back on a sound long-term fiscal course. In fact, the non-partisan Congressional Budget Office (CBO), which operates as the official scorekeeper and is consistently used by both sides of the political aisle to estimate the financial impact of legislation, has concluded that the health care reform law is fully paid for and will actually reduce the federal deficit by $143 billion over ten years and nearly $1.3 trillion dollars in the following decade. It does so largely by changing the way we pay for health care to reward lower cost, higher quality care, rather than just paying more for more procedures. CBO has also concluded that premiums will be reduced for most Americans compared to what they would pay for the same coverage in the absence of health reform. Because health reform improves the value of every dollar spent on health care by reducing administrative costs, encouraging healthier, lower cost enrollees to enter the market, and improving competition in the insurance industry, many Americans will choose to receive a higher level of coverage at a significant discount.

Senator Conrad will continue to work in the 112th Congress to ensure all North Dakotans have access to affordable and quality health care services.