Over the past decade, the dedication of our physicians and medical researchers has led to advances in medical services and treatments having a profound effect on our lives. We're living longer and are healthier because new tests, treatments and therapies help us detect health problems earlier. The result of those enhancements is the ability it gives our nurses and doctors to more effectively and aggressively treat and fight diseases and illnesses. Unfortunately, problems with health care remain. Prescription drug costs are soaring at a rate of about 20 percent a year. Nearly 44 million people are uninsured and millions more are trying to find a way to keep the health insurance they already have. Employers, individuals and hospitals all feel the ramifications of today's current health care crisis. In rural Missouri, those problems are further exacerbated by other challenges including the increased costs of medical malpractice insurance and an unfair reimbursement rate for rural areas that is driving doctors out of our area and forcing hospitals to close. These problems threaten the access and affordability of health care in rural communities. For the last week, I have traveled throughout the Eighth District meeting with a variety of health care professionals about the challenges facing our health care system. Though I have worked on rural health issues for a number of years, even I was startled by the increased strain providers in our area are feeling due to the excessive costs of medical malpractice insurance. In Missouri, years of needless lawsuits and high jury awards have caused significant increases in the premiums that doctors and hospitals must pay for medical malpractice insurance.

While the Missouri legislature enacted some modest reforms, more reforms are needed and the legislation must be revisited. Otherwise, we will see an increase in many of the problems I have heard about, the most serious of which is the exodus of Missouri's doctors to other states. One of the problems I heard about came during the roundtable we hosted in Rolla. During the meeting, Dr. Barry Bass shared with me some of the complications he has run into when dealing the costs associated with malpractice insurance. Bass, who is a general surgeon in Rolla has seen his rates increase 61 percent B just in the last year. When you stop to consider that in the U.S., the average increase in rates for general surgeons in 2002 was about 25 percent (up from the 10.3 percent increase in 2001), the significance of the problem facing our state becomes clear. Sadly, Missouri doctors like Dr. Bass who have seen their rates increase in this manner are not the exception B they are the norm.

 

This is creating a critical access to care problem in rural America where specialty physicians like orthopedists and ob-gyn practices are leaving because of the "cost of doing business." The current liability system affects all of us. It drives up costs, limits patients' access to care and negatively affects the quality of care patients receive. The Congressional Budget Office has estimated that reform of medical malpractice statutes could help save the federal government $1.5 billion over 10 years - money that can be used to strengthen our country's healthcare system, instead of undermining it with excess litigation. Though states are responsible for the regulation of the insurance industry, including medical malpractice insurance, in 2002 Congress was successful in passing legislation to rein in the high costs resulting from litigation abuses associated with medical malpractice cases. The Democrat led Senate failed to take the legislation up in 2002, but with President Bush's support of such reforms, Congress is likely reconsider reform legislation. I encourage the legislature in Jefferson City to re-examine the current state law, improve it, and protect rural Missouri's access to healthcare professionals. Only then will our doctors be able to keep serving patients in communities like those here in Southern Missouri. In addition to the problems associated with increased insurance costs related to medical malpractice issues, many of the hospitals in Missouri's rural 8th Congressional District are facing other extreme financial difficulties. These difficulties threaten the future of rural health care. One hospital has already closed its doors to patients, and several others are in critical condition. Even one hospital closure can have a disastrous effect on rural communities. Unlike our urban relatives and friends, most rural residents and Medicare and Medicaid beneficiaries do not have the option to choose another health-care provider or travel a short distance to seek health-care services when those in their own community have been eliminated. Part of the reason for these types of problems in rural health care is the changes made in Medicare and Medicaid reimbursements under the Balanced Budget Act of 1997. This budget act had an unexpected and disproportionate effect on rural areas, reducing the amount of money that rural hospitals and other health care providers were paid for their services to elderly and poor beneficiaries. These changes only compound the long-standing policy of lower Medicare reimbursements in rural areas - even though the cost of a given treatment is often the same for rural and urban health care providers. It is time to sensitize people to the needs of health care in rural America. It is time for our health care policies to reflect the fact that both rural health care providers and people living in rural America should not be penalized because they are located outside of urban areas. Most of all, it is time to realize that a one-size-fits-all approach to our national health care system simply is not working for our rural communities. The bottom line is that rural Americans face very unique challenges when it comes to accessing affordable health care. Few issues are more important than access to affordable healthcare for those living in rural communities. Congress needs to take immediate action in the 108th Congress to ensure that our nation's patients, physicians and hospitals have a place in the health care system. As I travel through the district, I will bring back to Congress the things that I have heard from the patients, administrators and doctors who work and live in rural Missouri. Be assured that I will support a reasonable legislative "fix" and will continue to do all I can to share the rural voice in Congress.