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Bipartisan coalition introduces bill to give rural Americans fair representation on Medicare, Medicaid boards

Press Release

Location: Washington, DC

U.S. Reps. Greg Walden (R-Ore.), Mike Thompson (D-Calif.), Cathy McMorris Rodgers (R-Wash.), Mike Ross (D-Ark.)., and Jim Matheson (D-Utah) today announced the introduction of legislation to give rural Medicare and Medicaid beneficiaries equal representation on the boards that set policy for the public programs.

Not enough rural voices on the policy making boards

The Medicare Payment Advisory Commission (MedPAC) and the Medicaid and CHIP Payment and Access Commission (MACPAC) establish policy and provide recommendations for improving Medicare and Medicaid, and have been instructed by Congress to balance the unique needs of urban and rural beneficiaries.

But in practice, rural representation on the boards lags far behind the actual number of rural enrollees in Medicare and Medicaid:

* About 26 percent of Medicare recipients are from rural America, yet according to the National Rural Health Association (NRHA) just 3 of the 17 MedPAC board members have significant experience delivering health care in rural America and can adequately represent the interests of rural patients.

* About 20 percent of Medicaid recipients are from rural America. The MACPAC board also has 17 members.

NRHA CEO Alan Morgan said: "You would certainly expect to see rural representation on any national health care advisory body. We are concerned that the current composition of the MACPAC does not have adequate rural representation. All federal health care advisory bodies should ensure that the rural voice is represented."

Solution: Ensure rural representation

The bipartisan group of lawmakers have introduced legislation that would ensure the proportion of members on MedPAC and MACPAC representing rural beneficiaries is no less than the proportion of the total number of Medicare and Medicaid patients residing in rural areas:

* With about 26 percent of Medicare recipients from rural America, this legislation would require that at least 5 of MedPAC's 17 board members adequately represent rural patients.

* With about 20 percent of Medicaid recipients from rural America, this legislation would require that at least 4 of MACPAC's 17 board members adequately represent rural patients.

Rep. Walden:"Rural America continues to confront challenges posed by shortages of health care providers and barriers to health care access," said Rep. Walden, who received NRHA's 2010 Legislative Award. "Because of these unique challenges, rural Americans and rural Oregonians deserve a voice on the boards empowered with making the major policy decisions that affect how they get health care."

Rep. Thompson:"Rural Americans deserve advocates who know the needs of rural patients. Unfortunately, many of MedPAC and MACPAC's board members do not have experience delivering health care in rural areas. It's time to take action to ensure rural families in California and across the country have a voice at the table to ensure their unique health care challenges are being addressed."

Rep. McMorris Rodgers: "Rural Communities in Eastern Washington are faced with unique needs, particularly as it relates to accessing quality health care. Too often, rural communities have been left out of the decisions that impact them. The bill that we are introducing today would ensure that rural communities are represented in the health care debate and their needs addressed."

Rep. Ross: "We're facing a major crisis in rural health care as small town hospitals and rural doctors are closing their doors across America," said Ross. "Rural Americans are having to travel farther and pay more for health care and we deserve advocates on these advisories boards who understand the complexities and challenges of rural health care, particularly in the areas of access and affordability. This commonsense bill ensures that the membership of these boards is proportionate to the people they serve."

Rep. Matheson: "For far too long, the voices of rural Utahns have been missing from the discussions that decide federal health care policy. Rural residents face different issues with respect to accessing affordable, quality care and this bill seeks to bring their perspective to the decision-making process."


The American people expect their business be conducted in a transparent way and subject to scrutiny from the press, public, and their elected representatives.

In that spirit, the legislation also calls for greater transparency in how MedPAC and MACPAC operate. The bill would require both boards to:

* Provide on the Internet full and timely public disclosure of its proceedings
* Post on the Internet either audio or video coverage of its proceedings
* Post transcripts of its proceedings online

"This legislation is good public policy, and certainly good for rural America," NRHA CEO Alan Morgan said.

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