Few issues hit so many voters so close to home. Access to quality, affordable health care is one of them. And for the swelling population of Medicare beneficiaries, the taxpayer-financed health insurance program plays a central role in how, when, where and from whom they receive basic medical attention and emergency health care services.
But if you’re a Medicare recipient living in Iowa, I’m sorry to say you’re getting the short end of the stick. That’s because Iowa gets shortchanged by a complex federal formula that determines how health care providers and health plans get reimbursed by Medicare for their services. And because so many Iowa hospitals, health clinics and doctor’s offices operate on razor-thin operating margins, the low Medicare reimbursements affect the delivery and availability of services available to the entire community.
Plus, the unfair federal formula also makes it harder to recruit and retain health care professionals to Iowa. Why would a newly minted physical therapist, nurse practitioner or family physician choose to open up shop or join a clinic in Iowa if they can get paid a lot more for the same work in another state?
For years I have been fighting the system in Washington to fix the unfair federal formulas. Unfortunately, it’s not an easy fix. That’s because money doesn’t grow on trees and lawmakers representing areas with generous Medicare payments aren’t willing to see their slice of the pie pared down to accommodate states like Iowa that are delivering health care for less.
Although it’s an uphill battle, my efforts have caught fire at the grassroots and in Washington. Along with other members of Congress from Iowa and Iowa health care providers, business and community leaders, journalists, and opinion makers have jumped on the bandwagon to help fix the inequity. The drumbeat is getting louder and louder. I’ve worked hard to gain more momentum by building a coalition with lawmakers from other states facing the same problem.
It all boils down to an issue of fairness. Every American taxpayer pays the same Medicare tax rate, whether you live in Iowa or Florida. But the Medicare health benefits and choices available to seniors can differ greatly from state to state, no thanks to a flawed payment system.
In May I introduced a comprehensive plan to address the unfair treatment by the Medicare program to Iowa hospitals, doctors, nurses, home health care providers, and other medical professionals. I called it the IOWA bill, "Improving Our Well-being Act."
After a relentless effort to build consensus among my colleagues in the Senate, I won an important step forward in these waning days of the 107th Congress. On Oct. 1, the chairman of the Finance Committee and I took the extraordinary step of introducing a bipartisan Medicare package under special Senate rules, putting the bill directly on the Senate calendar in two days.
The bill contains almost every provision of my IOWA bill, including reducing a payment inequity that hurts Iowa physicians; a sharp five percent increase in payments for 75 Iowa hospitals which operate on low profit margins with their Medicare patients; a base payment boost to put all Iowa hospitals on equal footing with their urban counterparts; a protected funding stream for outpatient services provided by rural hospitals and better protection for 40 small-town hospitals which qualify as a Critical Access Hospital; an extension of the 10 percent payment boost for home health care services provided in rural areas; an improvement of the hospital wage index that currently pulls down Iowa’s reimbursements; and improving an existing program which offers a 10 percent bonus to physicians serving patients in medically underserved rural areas.
The bottom line of my proposal is simple. Under my bill, Iowa stands to gain from a tremendous infusion of cash from Medicare over the next 10 years. If signed into law yet this year, my bill would pump well over $700 million into the Iowa’s health care sector in the next decade, including payments for Medicaid and other social service block grants. It would represent a historic shift in the way Iowa gets treated by a key federal program. And it would provide a tremendous boost to hospitals, clinics and doctor’s offices struggling to keep their doors open and recruit highly-qualified medical professionals to good-paying jobs in Iowa.
As far as I’m concerned, this is one squeaky wheel that must get fixed. One way or another, Iowa and other states that practice cost-effective, quality health care should not go one more day getting penalized for efficiency. The clock is ticking. Congress has just a few days remaining on the calendar to get the job done.
I’ve leaned on Majority Leader Tom Daschle, the Democrat from South Dakota who sets the agenda and order of business in the U.S. Senate, to expedite action on my bipartisan Medicare payment bill. He represents a small, rural state and ought to understand the ripple effect felt by entire communities due to the flawed Medicare payment structure. Whether or not the Senate takes action on my proposal is up to him.
This is an important opportunity to fix shortcomings in Medicare that shortchange Iowa and a handful of other states. Let’s hope he sees fit to keep this bill from joining what is turning out to be a long legislative casualty list from this congressional session.