For Immediate Release
January 27, 2009

  

     GRASSLEY:  Good morning, everybody.  I want to talk about a

health care issue for rural America.  Obviously, in rural America, we

have unique challenges when it comes to health care.  Rural hospitals

are part of the backbone of the rural health care system, and rural

communities and, often, Medicare, doesn't recognize their unique

situation and vital role. 

     Hospitals in our rural communities not only are often sole

provides of health care, but they're also major employers in the area,

oftentimes.  And these county hospitals are the biggest employer in

the county.  These are jobs for spouses of farmers and second incomes

for farmers themselves. 

 

     When I became chairman of the Finance Committee way back in 2001,

I made it a priority to work to ensure quality, affordable, accessible

health care to rural residents.  Since then, we've continued to build

on what I did in 2001.  Late yesterday, I introduced legislation to

help improve and protect access to hospitals in rural America. 

 

     The bill improves payment formulas for rural doctors, improves

real ambulance payments, and continues support for rural hospitals.

The bill also works to protect access for rural residents and home

medical equipment and supplies to continue to lend support to critical

assets of hospitals, and I guess, lastly but probably not everything

that's in the bill, it would provide additional authority for

physician's assistants who provide valuable services, particularly,

extending it -- to extended care and to hospice services. 

 

     The policy changes in the bill go directly to these special

challenges that I often talk about facing health care in rural

America.  The bill recognizes the high quality of health care

delivered by rural providers, embraces common-sense solutions, and

seeks equitable treatment for payment systems. 

 

     If I could quantify what a good job we do in rural America, I

don't know what Medicare costs.  Let's say, $400 billion, maybe $500

billion?  Let's say that if you take the United States from Wisconsin,

Lake Michigan, over to Idaho and from Kansas up to Canada, if you take

that part of the country, including Iowa, and they practice medicine

in the entire United States like we do in those states, we would

reduce health care costs for Medicare by one-third. 

 

     So you can see we do such a good job and efficiently that you can

understand why Medicare can be done in a better way and the practice

of medicine can be done in a better way if they follow the model that

we have. 

 

     Dan, Successful Farming?

 

     Tom Rider?

 

     QUESTION:  Good morning, Senator. 

 

     Senator, I was wondering if you could talk about what crop

insurance changes that you're looking for for Iowa. 

 

     GRASSLEY:  Well, what we're trying to do is not really changing

the law, it's getting people to consider what we have intended in the

law that we have and the extent to which preventive planning was not,

I think, done in a common-sense way -- very arbitrarily and hurt some

farmers in a very unusual year. 

 

     And Senator Harkin and I are trying to get rationale.  And I

don't know whether, at this point, we're suggesting changes, but we

need to know why they arrived at it the way they did. 

 

     This is an opportunity for us just to review policies in light of

the flooding.  And if we hadn't had the flooding, we probably wouldn't

be writing the letter we had. 

 

     Tom Steever?

 

     Dan Skelton?

 

     Tom Steever?

 

     QUESTION:  Yes.  I see that Secretary Vilsack has put actively

engaged in farming -- but that issue back on the table again.  What do

you expect to happen from that and how do you feel about that in the

first place? 

 

     GRASSLEY:  Well, obviously, I'm very thankful to Governor Vilsack

doing that.  And I think it gives us another opportunity to continue

dialogue, maybe not to get exactly what we want, but I think a

quantifiable measure of what being actively engaged in farming is.

And that quantifiable measure would be a very major victory for us. 

 

     But right now, you know, I wouldn't expect Governor Vilsack to

necessarily tell me right now what he wants to do.  He needs time to

understand the issue.  But a new -- a new administration and is a new

secretary of agriculture gives us a chance to maybe do better than we

did with the most recent rules that came out. 

 

 

     QUESTION:  Thank you. 

 

     GRASSLEY:  Dan Skelton?

 

     QUESTION:  Good morning, Senator.  Two questions for you. 

 

     First, on your opening statement about rural health care, the

Obama administration wants to make a move toward electronic

recordkeeping.  Do you support that? 

 

     GRASSLEY:  The answer is I've supported it for a long period of

time.  But let me tell you why we haven't done much in that area and

why, probably, it's a little more difficult to respond to for rural

America and that's directly related to the fact that we have a lot of

sole practitioners and they're probably a little older in rural

America.  And it takes some investment and maybe people that are older

in rural America without quantity of people to serve, it's a

tremendous overhead. 

 

     So we have kind of restrained ourselves over a period of years

while still developing the concept of not forcing it on doctors.  And

I wouldn't say that President Obama's going to force it on to doctors,

but through the stimulus package, we will have medical information

technology promoted through a $20 billion that would help incentivize

doctors to use it. 

 

     Now, we still have a problem beyond just getting the hardware out

there and getting people committed to using it.  You've got several

different approaches.  And we've got make sure that one system can

talk to the other system.  And I'm not sure that that's finalized yet

because it wouldn't do Dr. Brown in New Hartford any good to have it

if Chuck Grassley went to Dr. Brown, but let's say I was wintering in

Florida and I go to Dr. Smith in Florida and I say, well, I got my

records with Dr. Brown, just get into your computer and find out what

he has prescribed for me.  And Dr. Smith's system didn't talk to Dr.

Brown's. 

 

     So that's -- that's a major problem that we have to work on

without mandating a specific system. 

 

     QUESTION:  On the ag front, back to Secretary Vilsack's press

conference yesterday.  He talked about wanting to modernize the food

safety system.  Do you see a change in the (inaudible) approach

coming? 

 

     GRASSLEY:  Well, if he's going to look at it and he feels that

there's a problem, I would suggest there's going to be some changes.

But I haven't talked to him about it, so all I can say is that a new

secretary that has responsibility to make sure that the food I eat is

safe, I would expect him, if he thinks there's problems, to review.

And, you know, with salmonella and all, that sort of stuff, it's quite

obvious that things need to be looked at. 

 

     Go ahead. 

 

     QUESTION:  (Inaudible). 

 

     GRASSLEY:  Yes.  Chris Clayton?

 

     QUESTION:  No questions today, Senator. 

 

     GRASSLEY:  Gary in Arkansas? 

 

     QUESTION:  Senator, tell us about wind energy and your amendments

for the economic stimulus package.  Can you make the credit permanent?

 

     GRASSLEY:  Well, I might have a difficult time making it

permanent.  I think we've got a fair chance of making it longer than

what they have in the bill.  All of those things are very necessary,

but, you know, we're also trying to deal with the fact that there

doesn't seem to be a lot of capital available even with the credit. 

 

     So the industry is slowly shutting down, and solar is probably

shutting down faster than wind.  And so we've got to have some way of

getting it.  So we're talking about some grants or the federal

government purchasing credits through a bank that we would set up.

Because even if we extended it and made it permanent, it wouldn't be

-- it wouldn't revitalize the industry, which is down now because of

the recession we're in or maybe not because of the recession, but

because of a recession caused by the credit crunch.  So the credit

crunch is the problem. 

 

     QUESTION:  OK.  Thanks. 

 

     GRASSLEY:  Philip, Des Moines Register?

 

     QUESTION:  Yes, Senator.  Boy, I'd like to find out a little more

about your -- follow up on that idea. 

 

     I also wanted to ask you another question about the stimulus.

With the increase in food stamp that in this bill, what's going to

happen to that after that increase?  Is that increase going to

essentially be a permanent level for the program?  And if so, where is

that money going to come from after the post-stimulus? 

 

     GRASSLEY:  Well, all I can tell you is what I feel. 

 

     QUESTION:  Uh-huh. 

 

     GRASSLEY:  And what I suspect.  First of all, let's get back to a

purpose of a stimulus.  Spend money in the next two years in a massive

amount to get money to revitalize the economy.  So money for food

stamps would be a good way of doing that. 

     But I'm urging my Republican caucus -- and I made this remark at

a couple of meetings yesterday -- that we've got to make sure that we

get something in the bill that these things aren't going to be in

baseline. 

 

     So to answer your question, I'm fearful it could get into the

baseline.  It would up the level of expenditures for food stamps.  And

I'm not saying that that's wrong per se, but it's wrong to do it

through a stimulus package.  That should be done through the annual

appropriation bill. 

 

     And you will find other senators like Cochran making that point

not so much on food stamps but on a lot of other programs where

there's a suspicion that it gets into the baseline and becomes a

higher level of expenditure.  And it's -- we're not going argue should

there be more money spent on these programs for the next ten years; it

just shouldn't be done through the instigation and the lack of

consideration that the stimulus is getting. 

 

     And when I say "lack of consideration," it's not getting the

consideration that it ought to because we've got to get something

passed quickly or there's not much point in passing it.  So those

things ought to be well thought out in committees of jurisdiction, not

through a stimulus package. 

 

     QUESTION:  Aside from it being in the baseline, regardless of

whether it's putting it in the baseline or not, how would you

politically reduce spending on food stamps?  Isn't that politically

going to be...

 

     GRASSLEY:  Yes.  Yes.  And that's...

 

     QUESTION:  And isn't that money going to have to come from post-

stimulus -- come from some other programs? 

 

     GRASSLEY:  Of course, it's going to have to or else -- there's

two places for money.  One is borrow, and so you increase the debt or

you increase taxes.  Or you can -- I guess, like you said, you can

take it from some other program. 

 

     Now, you're going to have to do one of those three things or all

of those three things.  And that's what shouldn't happen because of a

stimulus bill.  And maybe should happen if there's a need to do it

through the regular process. 

 

     OK.  I've gone through the entire list.  Anybody want to jump in?

 

     QUESTION:  Senator, can I follow up on the idea that you talked

about with the federal government purchasing credits on the wind --

back on the wind energy.  You talked about dealing with the investment

-- lack of investment in wind right now. 

 

 

     GRASSLEY:  Well, it's -- let me tell you what normally would

happen if we didn't have a credit crunch.  These companies get these

credits.  They go to a bank, borrow money on these credits, and

somebody that's paying taxes gets the benefit of those credits.  So,

in a sense, they're selling credit and passing on credit to somebody

else to raise money to do the construction that they have to do.

Well, the credit is frozen up.  So what do you do? 

 

     So the federal government is going to set up a bank to do what

the private banks aren't doing for a short period of time of to get it

back on track, to maintain the jobs that are going to be lost.  Like,

for instance, you know in Cedar Rapids, that component of

manufacturing there -- I forget the name of it. 

 

     But, anyway, they just laid off, I think, 90 employees, as an

example.  And I said it was worse in solar than it is in wind at this

point as well. 

 

     OK.  Anybody else want to jump in?  OK.  Thank you all very much.