Iowa congressmen take steps to overhaul medicare reimbursements

Members of Iowa’s congressional delegation are working to ensure that the much-anticipated overhaul of the nation’s health care system does not leave out important changes to the formulas that determine federal Medicare reimbursement rates from state to state. Under the current system, doctors in some states, including Iowa, are paid less by Medicare for performing the same procedures as doctors in other states.

On a conference call with reporters on Thursday, U.S. Rep. Bruce Braley (D-Waterloo) ticked off a massive list of meetings and discussions that have been held in Washington to ensure that “meaningful reform” of reimbursement rates does not get lost in the back-and-forths between Republicans and Democrats, between the House and the Senate, and between legislators and the White House.

“Even though there is a short window of time before the mark-up begins (on the health care reform bill), there has been a tremendous amount of activity on this subject,” Braley said.

One of the discussions held Wednesday in Washington included Braley and U.S. Reps. Leonard Boswell and Dave Loebsack, Iowa’s two other congressional Democrats. Braley said the three lawmakers have drafted a plan to tackle the problem together.

But they may face an uphill battle. Because members of the U.S. House are elected according to population, and because the existing reimbursement rates tend to benefit more densely populated parts of the country, the push to reform that part of the health care system could prove difficult.

U.S. Rep. Bruce Braley

“Being outnumbered has been a problem for a long time,” Braley said in response to a question from the Iowa Independent. “If you look at how long Iowa senators and representatives have been trying to change this dynamic, you know it is not because of lack of trying that this system has been allowed to exist. But this is also a game-changing opportunity — a once in a lifetime opportunity — to change the way we provide health care and how we expand the availability of health care coverage to the nearly 50 million Americans without it. That’s why we are working so hard to build coalitions.

“In order to get these bills passed out of each committee of jurisdiction, there is going to be a minimal amount of votes required to pass. And if we can bring enough leverage to the table to insist upon more meaningful reform, I think that we have an opportunity to shape these bills when they come out of each of these committees — that includes Energy and Commerce, Ways and Means, and Education and Labor,” Braley said, adding: “Even if we are not successful in that setting, the continued pushing of this issue within the caucus has certainly caught the attention of leadership, and bringing about a full and informed debate on this subject for the first time in a long time.”

Boswell, who was elected to Congress in 1996, is also acutely aware of the difficulty of changing the current Medicare reimbursement regime, which seems to value quantity of services more than quality.

“For years now, through the Clinton, Bush and Obama administrations, I have taken my concerns for Medicare to our nation’s leaders,” Boswell said. “The opportunity to reform health care is before us, but this bill must include improved payments for hospitals and providers. Congress should not mass a bill that will simply perpetuate the problems our nation is attempting to remedy.”

U.S. Rep. Leonard Boswell

Both Boswell and Braley said that changing the existing formula would not only give rural states like Iowa a fairer shake, but that it would help to eliminate wasteful spending and incentivize higher-quality, more efficient care nationwide.

“We have a once in a lifetime opportunity to transform our health care system by rewarding providers who consistently achieve good outcomes at a reasonable cost … to change the flawed reimbursement formulas that penalize doctors and hospitals in states like Iowa, who consistently rank at the top in quality of care and at the bottom in Medicare reimbursement rates,” Boswell said.

Braley said he shares that sentiment and sees some hope for a solution soon. “I think we are making some progress in highlighting an issue that has too long promoted waste in the system and led to less-than-desirable outcomes,” he said. “I believe we are going to have a very full and frank discussion about how we bring about meaningful health care reform and also how we change the way we pay for it.”