When I became a Member of Congress, I brought with me perspectives gained while serving as an emergency room physician and as a member of the Army Reserve overseeing a section of a combat support hospital in Iraq. My experience taught me access to health insurance does not always mean access to health care. This is something we know too well in Nevada.
This challenge was underscored on a recent trip to Elko County. During that visit, several community members approached me about the lack of doctors here who accept Medicare. I later read a letter to the editor by Bob Swenson who highlighted his struggle to access care as a new Medicare patient. Bob is a member of the Medicare in Elko Work Group — concerned citizens who are raising awareness and looking for answers.
I understand access to health care, especially through Medicare, can be difficult for communities around Nevada. That is why strengthening Medicare and increasing access to health care services are among my top priorities in Congress. I have advanced legislation to increase the number of physicians in our state, stabilize Medicare’s reimbursement system, and ensure Medicare covers stays at skilled nursing facilities.
There are several reasons why Elko County faces an access to care challenge. While the percentage of residents with health insurance is high, the number of doctors, particularly primary care physicians is low. According to the University of Nevada School of Medicine, our state is severely short on generalists and specialists.
To address this issue, I reached across the aisle and joined my House colleague Rep. Kathy Castor (D-FL), to introduce H.R. 1117, the Creating Access to Residency Education or CARE Act. This bill would establish federal grants for states like Nevada to create new residency programs or increase slots in existing ones. According to the Association of American Medical Colleges, more than half of physicians stay or return to practice in the communities where they completed residencies. More residency slots mean more doctors and better access to care. And because the grants would be administered by the Centers for Medicare & Medicaid Services, a condition of the residencies would be to see Medicare and Medicaid patients.
Of course, Medicare only works if it is on sound fiscal footing. For years, the formula determining reimbursements for physicians treating Medicare patients — the Sustainable Growth Rate (SGR) — contained a flaw that threatened access to Medicare services. The flawed formula called for annual drastic cuts in reimbursement rates for doctors who took Medicare patients. Because the result of such cuts would be physicians reducing or eliminating their Medicare practices, Congress would step in and pass a short-term fixes, known in Washington as the “Doc Fix.” But this problem needed a long-term solution and so I set out to find one.
I joined with Rep. Alyson Schwartz (D-PA) to introduce legislation called the Medicare Physician Payment Innovation Act. Our bill repealed the flawed formula and moved Medicare towards a payment model that rewards the quality of care, not the quantity of care. In early 2015, the House and Senate finally took action on a long-term SGR fix like the one Rep. Schwartz and I developed. The permanent fix strengthens the Medicare reimbursement system so seniors can continue to receive the care they need, while saving taxpayers hundreds of billions of dollars.
Once seniors gain access to care, they should not have to worry about bureaucratic billing technicalities determining whether or not Medicare will reimburse that care. That is why I again took bipartisan action and teamed with Rep. Joe Courtney (D-CT) to introduce H.R. 1571, the Improving Access to Medicare Coverage Act.
Currently, Medicare covers stays at skilled nursing facilities (SNF) if patients have three consecutive days of hospitalization as inpatients, not counting the day of discharge. However, hospitals increasingly care for Medicare beneficiaries on “outpatient observation status.” H.R. 1571 would fix this by allowing observation stays to be counted toward the three-day mandatory inpatient stay for Medicare coverage of SNF services.
Nevada is a great place to work, raise a family, and retire. I’m running for U.S. Senate because I believe together we can build a stronger Nevada. A big part of that is improving access to and delivery of health care. If elected, I pledge to continue working on this issue until Nevada and Elko County are considered some of the best places in the country for access to quality health care, especially for Medicare patients.