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 SEPARATE  STATEMENT  OF  COMMISSIONER  KATHLEEN  Q.  ABERNATHY 
 Re:  Rural  Health  Care  Support  Mechanism,  Report  and  Order,  Order  on  Reconsideration,  and  Further  Notice  of  Proposed  Rulemaking,  WC  Docket  No.  02- 
 60  (adopted  November  13,  2003) 
 I  am  extremely  pleased  to  support  this  Order  and  its  significant  improvements  to  the  rural  health  care  support  mechanism.  While  the  universal  service  programs  overall 
 have  successfully  delivered  benefits  to  consumers  living  in  high-  cost  areas,  to  patrons  of  schools  and  libraries,  and  to  persons  of  limited  means,  there  is  no  question  that  the  rural 
 health  care  mechanism  has  been  underutilized.  I  am  confident  that  today’s  action  will  more  faithfully  deliver  on  Congress’s  promise  to  lower  telecommunications  costs  for 
 health  care  providers  serving  rural  communities. 
 In  turn,  our  action  should  make  telemedicine  available  for  many  consumers  for  whom  visits  to  specialists  otherwise  would  cause  great  hardships.  We  often  talk  about 
 the  benefits  of  broadband  services,  but  telemedicine  may  be  the  most  important  application  of  them  all.  Telemedicine  has  the  potential  to  make  it  irrelevant  whether  a 
 patient  lives  in  a  downtown  urban  area  or  on  a  mountaintop.  I  have  seen  demonstrations  of  how  telemedicine  connects  patients  in  remote  areas  of  Alaska  to  hospitals  and  clinics 
 hundreds  of  miles  away,  often  preventing  the  ordeal  (and  immense  cost)  of  air  transport.  I  was  also  privileged  to  have  the  opportunity  last  week  to  visit  the  University  of 
 Virginia’s  exemplary  telemedicine  program,  which  serves  consumers  throughout  the  Appalachian  region  of  the  state.  It  was  truly  heartwarming  to  hear  testimonials  from 
 patients  whose  lives  have  been  improved  by  the  availability  of  high-  speed  telecommunications  links  throughout  rural  Virginia.  And  it  was  awe-  inspiring  to  listen  to 
 a  patient’s  heartbeat  or  view  a  cardiac  ultrasound  in  perfect  fidelity  and  clarity  from  hundreds  of  miles  away.  Dr.  Karen  Rheuban  and  her  colleagues  have  done  an  amazing 
 job  at  UVA,  and  I  hope  other  states  and  institutions  follow  their  example. 
 I  also  hope  that  we  will  find  ways  in  the  further  rulemaking  to  fund  mobile  clinics,  such  as  the  satellite-  enabled  mammography  van  that  Healthcare  Anywhere 
 proposes  to  use  to  serve  women  on  tribal  lands  in  North  and  South  Dakota.  Such  innovative  ideas  not  only  would  bring  critical  health  care  services  to  underserved 
 communities,  but  also  might  lower  health  care  costs  by  making  preventive  care  more  widespread. 


 Finally,  while  I  fully  support  taking  steps  that  are  likely  to  drive  up  the  demand  for  universal  service  funding,  I  am  confident  that  our  rules  will  continue  to  ensure  that 
 funding  needs  are  met  without  waste,  fraud,  or  abuse.  For  example,  although  we  have  expanded  the  program  to  provide  discounts  on  Internet  access  for  the  first  time,  we  have 
 set  the  initial  discount  rate  for  Internet  access  at  a  modest  25  percent  to  prevent  excessive  fund  growth  and  to  ensure  that  providers  have  adequate  incentives  to  avoid  overpayment. 
 In  time,  we  may  decide  that  additional  funding  is  warranted,  but  we  must  balance  the  tremendous  benefits  of  telemedicine  against  the  significant  burdens  that  are  being  placed 
 on  consumers  to  fund  our  various  universal  service  support  mechanisms.  At  this  point,  the  balance  clearly  tilts  in  favor  of  expanding  the  program,  because  it  has  barely  begun  to 
 fulfill  Congress’s  mandate  to  establish  an  effective  rural  health  care  support  mechanism. 
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