Mr. President, I rise to note the introduction of the Medicare Geographic Fair Payment Act of 2000. I’m very pleased to join Senators Domenici and Wyden in this effort. While we share the problem of low payment rates, Iowa is in a different situation from those states. They are concerned about Medicare+Choice plans leaving, but for the most part we in Iowa are still waiting for plans to arrive. There are a number of things that have to fall into place for Medicare+Choice to become a reality in Iowa, but one of them is clearly increasing payment rates. I want to make sure that if Congress provides any relief in Medicare+Choice this year, that low-cost areas are not forgotten. We need to make Medicare+Choice a truly national program.
There are two simple Medicare+Choice payment provisions in the bill. It would raise the minimum payment floor for all counties from the current $415 to $475 in 2001. This would primarily benefit rural and small urban areas, including the vast majority of Iowa. Secondly, it would establish a new minimum payment floor of $525 for all counties in Metropolitan Statistical Areas (MSAs) with populations exceeding 250,000. In Iowa, this would mean a substantial incentive for plans to enter the Des Moines and Quad Cities areas.
As I’ve said so often throughout the five-plus years that I’ve been working on this issue, people in low-cost states like Iowa pay the same payroll taxes as those in high-cost areas. So it’s a matter of simple fairness and equity that all seniors have access to the choices in Medicare, wherever they live. The problem with Medicare+Choice has been that payment rates are based on fee-for-service payment rates in the same county; thus, cost-effective regions like ours are punished. This makes no sense. We took our first step toward breaking that unfortunate link in 1997, and I have high hopes that we will take another big step with this bill in 2000.
We in low-cost regions have to keep the fight for equity going on two fronts: Medicare+ Choice payment, and traditional Medicare payment. The latter is harder for Congress to change, because we have to identify inequities in the various Medicare payment policies and fix them one by one. I thank my colleagues for including in this bill my earlier bill on the hospital wage index, which is one of those flaws in fee-for-service Medicare that cries out to be fixed.
I look forward to the Finance Committee’s Medicare discussions this fall; this is the kind of legislation that merits serious consideration there. Mr. President, I yield the floor.