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Public Statements

Medicare Reimbursement

Floor Speech

Location: Washington, DC

MEDICARE REIMBURSEMENT -- (Senate - December 19, 2007)

Ms. MURKOWSKI. Madam President, I wish to take a few moments to speak on the issue of Medicare reimbursements for physicians, particularly those in rural and frontier States. We have moved forward a temporary fix of Medicare reimbursement for physicians, essentially for 6 months. I wish to speak to the issue for Alaska and other rural parts of the country.

In Alaska, many of our Medicare beneficiaries, even without this potential 10-percent reimbursement cut, lack the ability to see a primary care physician unless they have the means somehow to pay out of pocket for doctor visits. Without congressional action on a long-term strategy--longer than 6 months--to increase Medicare reimbursements, these cuts threaten access to care as fewer and fewer doctors are able to afford seeing Medicare patients. An American Medical Association survey shows that 60 percent of physicians reported they would be forced to limit the number of new Medicare patients they treat if the impending reimbursement cuts go through.

I get so many calls on a daily basis from seniors asking me to fix Medicare. They want to be able to continue to see their doctor. I know I am not the only Member who receives these calls. It is unfortunate, but America's seniors every year are thrust in the middle of this Medicare reimbursement debate out of fear that they are going to lose their health care provider to Medicare cuts.

In 2003, with great fanfare, we provided a Medicare prescription drug benefit. At that time, I asked the question: We can have a wonderful drug benefit, but what good is the benefit if there is no physician to write the prescription?

The Presiding Officer knows how big a State it is; she has had the opportunity to come for a visit. We are bigger than California, Texas, and Montana combined. ``Rural'' in Alaska has a new meaning. The physician shortage crisis in Alaska has been magnified because of our geography, distance, and size.

What many people might not realize is what is happening to our population. We have always been viewed as a young pioneering State where the average age is the early 20s and predominantly male--a wilderness image. But we have grown and matured. Our elderly population is the fastest growing senior population per capita in the Nation behind Nevada. That is a statistic which would surprise many people.

The Mat-Su Valley, an area just north of Anchorage, is the fifth fastest growing region among seniors nationally. Yet, think about that statistic and compare it with what is happening with our physician ratio. Alaska has the sixth lowest ratio of physicians to population in the United States. Outside of the Anchorage area, our ratio of physicians to population is the worst in the Nation.

To put it into context, we had a field hearing the first part of the year to understand how bad the situation is as far as access to care. To reach the national average of physician-to-patient ratio, Alaska needs a net increase of 980 physicians statewide or 49 more physicians per year. I go into some of these hospitals, VA clinics, and community health centers. They have been waiting years trying to find not only doctors but all within the medical profession, whether it is outpatient therapists all the way up to cardiologists. Fairbanks, our second largest city, got its first cardiologist this year.

According to the Anchorage Daily News, our largest newspaper, it costs 65 cents on the dollar to care for a patient in Alaska, and yet Medicare only reimburses 22 to 35 cents on the dollar. In addition to low reimbursement, we have other factors that drive the cost up. We have higher salaries, a higher cost of living, higher equipment costs, and higher transportation costs. Higher energy costs add to that.

We had a field hearing earlier in the year and had an individual testify before the committee. He was later quoted in the Anchorage Daily News:

The costs [to practice] were so exorbitant and the fees for reimbursement were so low for Medicare patients, at the end of the day I could actually owe money for working a ten-hour day.

The sustained growth rate formula which has been in place since 1997 calls for nearly 40 percent in cuts over the next 8 years, even as practice expenses continue to increase. So how do we expect to entice more physicians to practice and care for our seniors, our veterans, if we threaten to cut Medicare reimbursements every year?

We know the time for Congress to act is now. I ask my colleagues, those on the Finance Committee, let's work on legislation that will provide a long-term reimbursement fix to ensure continuous care for the elderly, who may otherwise be left without access to care in the neediest of times. This is something we all must work to advance.

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