July 26, 2002
Thank you, Chancellor Shore, for that kind introduction. I appreciate
the University of Colorado Health Sciences Center hosting us here
today. You and your staff have done a tremendous job of helping
organize this summit and I thank you so very much.
Governor Beasley, guests and friends of rural
America, I want to thank you all for coming here today as we discuss
one of the Administration's top priorities: improving access to
health care and social services for rural Americans.
I especially want to thank my good friend and
fellow Wisconsinite Tim Size, Executive Director, of the Rural Wisconsin
Health Cooperative. Thank you Tim for coming over and thank you
for all of your work in Wisconsin.
I also want to say hello to Jeff Staser who is
a member of the Denali Commission in Alaska. Thank you for coming
down to the tropics to join us today. As you know I'm going to be
getting a taste of rural America - Alaska style - next week. I'm
looking forward to traveling around the state with Senator Stevens
and Senator Murkowski to see how HHS can help improve health care
and social services to the people of rural Alaska.
As most of you know, I grew up in rural America,
in a town called Elroy, Wisconsin, population 1500. My dad owned
the local general store, so we knew everyone and every one knew
us. You know, Elroy is so small you can call someone, get a wrong
number and still talk for a half hour.
So when we talk about problems and challenges
facing rural communities, I know firsthand what they look like from
the perspective of rural Wisconsin.
There is no "one-size-fits-all" answer
to the problems faced by rural America. Solutions that work in Elroy,
Wisconsin, may not work in Elba, Alabama. Solutions that work for
a New England fishing village may not work in a small Colorado community.
And I am proud to say I work for a man, President
Bush, who is committed to ensuring that families in rural America
have access to the same quality of care as everyone else in the
While nearly one quarter of our nation's population
lives in the rural and outlying communities in this country, almost
all of our nation's health care and social services continue to
be found in the major population centers - sometimes hours away
from the people who need them.
One year and one day ago, I launched my initiative
on rural health. After talking with people all across America, I
realized we had to have a special focus on rural towns and communities.
We had to change the way we thought about rural communities- we
could no longer just think of them as "small cities."
Rural communities have unique challenges that bring with them unique
So, what has a year and a day of a rural initiative
meant for my department? Very simply, a great deal.
During the past year, we have begun to make dramatic
changes in the way we provide medical care in rural areas.
As many of you know from your participation in
the "open door forums", the Centers for Medicare &
Medicaid services (CMS) is sponsoring rural listening sessions.
And not only is my CMS Chief Tom Scully listening to your concerns,
but he has also made policy changes based on your input.
On that note, I understand there are a lot of
people in this room who are very concerned about CMS's hospital
wage index and how it affects small rural hospitals. I assure you
we are working to make this system as fair and equitable as possible.
In the near future, we will be able to share with you more details
on what we have planned.
In addition, many of my agencies at HHS have developed
agency-wide rural workgroups to look more closely at their programs,
identifying ways to better meet the unique needs of rural America.
And although I'm very pleased with the strides
we have made in the first year - we must do more to solve the challenges
of providing health and social services to rural communities. And
As part of my initiative, I wanted to look at
the long-term global changes we could make as a department. So I
created a department-wide rural task force. I challenged this new
task force to determine the barriers rural communities face in trying
to gain access to health and social service programs and to make
recommendations on how we, as one department, can do a better job.
As a result, over 100 dedicated employees throughout
HHS worked together to build a department that better serves rural
Today, I am proud to announce our next bold steps
in improving health and social services to rural Americans and to
release my rural task force report.
First, I am announcing $46 million in funding,
from three separate grants, to improve the services HHS provides
to rural communities. We are releasing $23 million dollars through
the Medicare Rural Hospital Flexibility Grant program. This program
focuses on our smallest, most rural hospitals. The money will help
rural health care providers receive more adequate reimbursement
from Medicare when they serve our nation's senior citizens.
Our second grant series will award $15 million
in new grants to improve the quality of care in over 1,000 small
rural and frontier hospitals across the country. These funds will
provide hospitals with fewer than 50 beds with resources to meet
the challenges of improving performance and complying with the Health
Insurance Portability and Accountability Act of 1996.
And our third series of grants, totaling $8 million,
is going directly to our 50 state Offices of Rural Health. These
are the people who work in each of the states helping rural and
frontier communities with technical assistance. They coordinate
statewide rural health activities and have worked to recruit and
retain health care providers.
I am also pleased to release my HHS rural task
force report. The report lays out a series of barriers and challenges
facing rural America and provides specific action steps we can take
as a department to improve our service.
One of the things the Rural Task Force highlights
is the fact that HHS has about 225 different programs that offer
grants to organizations in rural communities. Now, that's a lot
of different places for a small hospital or service organization
in rural west Texas to go looking for some help.
So I am directing each of my ten regional representatives
to work out a plan, tailor-made to their region to make HHS easier
to understand and more accessible to small organizations.
And I am also creating a single point of entry
at HHS to give rural communities one focal point to receive information
and technical assistance on HHS grants. No longer will you have
to go wading through the alphabet soup of acronyms of our department-
through HRSA, and FDA, NIH, and IHS. You can go to one
Government should not be a hindrance to providing
service to rural Americans: we should make it easier. And by cutting
down on excess paperwork, health care and social service providers
can spend more time with the people who need their help.
I am also directing the budget officers at HHS
to ensure that our annual budget process includes a specific focus
on serving rural America. I want my agencies to look at ways we
can specifically help rural Americans by providing funding and additional
programs to rural hospitals and service providers.
The report also points out the need to link health
and social service issues. In many communities in America, health
care and social services account for as much as 25 percent of that
With that type of impact, we need to focus our
efforts on issues that link the two areas. In response, I am increasing
the number of people on my National Advisory Committee on Rural
Health and amending its charter to focus on both health and social
I appreciate the work of the committee and the
strength of Governor Beasley's leadership. Governor, I know you
and your committee can meet this challenge and I look forward to
And we are going to develop a new approach to
better determine HHS's investments in specific communities and populations
including using geographic information systems to identify communities
with unmet needs.
This geographic information system will provide
invaluable information as we continue to expand the numbers of community
health centers across the country. President Bush has made expanding
these community-based centers a key element of his plan to increase
medical access for the nation's most medically underserved individuals.
Over the next five years, President Bush wants
to increase the number of health centers by 1,200, eventually doubling
the number of people these centers serve to more than 20 million.
For fiscal year 2003, the President's budget calls
for $1.5 billion for health centers. That's a $114 million increase
and would provide care to a million additional patients next year.
And finally, to continue the best possible service
to rural Americans, I am directing the Rural Task Force to permanently
continue their effort and follow up on the steps I've outlined today.
The task force will evaluate our proposal and communicate with all
of you as to how we can improve our services.
You folks in this audience and up here on stage
with me are on the frontlines strengthening our health care safety
net and social service delivery system. We, in Washington, can't
help the people of this great nation without your expertise, commitment,
and hard work.
And so my friends, today marks the beginning of
a new era at the Department of Health and Human Services. An era
filled with a strong relationship between HHS, rural communities
and health and social service providers.
Let us continue to stretch out our hands of compassion
and build and lift each other up with hope for a better tomorrow.
Together we can all make a difference in the lives of millions of
people living in rural America - now, and for generations to come.