Grassley's health care proposal is focused on Iowa and other states where cost-efficient, high-quality health care is the norm. The legislation ? the Improving Our Well-being Act, or IOWA ? represents a continued effort by Grassley to ensure access to Medicare services and other health care services for Iowans. Last year, Grassley also gave his backing to legislation to update Medicare payments to physicians in the short-term and order a study on replacing the existing physician payment formula used by Medicare in the long-term.
Grassley said his IOWA legislation addresses key problem areas identified by Iowa hospitals and other components of the health care infrastructure in Iowa. He introduced it today to affect the health care debate still to come this year in the Senate. It primarily makes changes for Iowa with regard to the Medicare program, but it also improves Medicaid payments for hospitals in states such as Iowa and improves access to dental services for Iowa children.
On the whole in the traditional Medicare program, Iowa health care providers receive less Medicare money per beneficiary than providers in other states. The regional variation in spending stems in part from regional differences in utilization and medical practice, in access to providers, and in health status of beneficiaries. Medicare payment rules account for some of the disparity, as well, and Grassley has focused over the years in ferreting out the flaws that unfairly disadvantage cost-effective and smaller, rural providers.
The legislation introduced by Grassley today has provisions that would significantly help every Iowa hospital, both rural and urban. It focuses for the first time on hospital outpatient payments, which are the biggest problem for Iowa hospitals. It rectifies inequities in both Medicare and Medicaid hospital payment, in a targeted way. It makes incremental improvements to the Critical Access Hospital program. And, it addresses Iowa's major problems in the areas of children's dental health.
"I'm using the best ideas I've received from Iowa providers. My focus is on access to care for Iowans, but if Iowa providers aren't adequately funded, then Iowans won't have that access. I'll continue using the leadership position I have on the Finance Committee to insist that any health care bill that moves this year has a substantial component for states like Iowa that provide low-cost, high-quality health care," Grassley said. "Anyone who wants something done on Medicare will have to deal with me on this issue, period."
Discrepancies in Medicare payments for Iowa first became apparent with the rise of Medicare managed care plans in the early 1990s. In many parts of the country these plans were providing much richer benefits than traditional fee-for-service Medicare, including prescription drugs. Iowans didn't have the same choices as people living in Florida.
In 1995, when Congress first passed the Balanced Budget Act, though it was vetoed and not enacted until 1997, Grassley won congressional approval for two important changes, despite stiff opposition from high reimbursement states such as New York and Florida. His initiatives raised the payment floor for Iowa and other rural states raised to $350 per capita per month. At that time, 98 of Iowa's 99 counties were well below that amount. He also won support for a payment blend that compressed Medicare payment disparities across the states. Grassley also succeeded in getting Medicare payment increases in both rural and small urban areas in 1999 and 2000.
"Obviously we're still not where we want to be. That's because most managed care plans still haven't been willing to offer their products to Medicare beneficiaries in Iowa. I'll continue to fight to make more choices available to people in Iowa, but right now the focus needs to be on correcting discrepancies in the traditional Medicare fee-for-service program," Grassley said. " Iowans pay the same payroll and income taxes and premiums for Medicare as other Americans. They deserve the same access to Medicare services."
Grassley is the top Republican on the Senate Committee on Finance, which is responsible for all Medicare legislation. A detailed summary of Grassley's IOWA bill follows.