Although some members of the U.S. House have voiced firm opposition to the long-awaited initial health care reform bill presented this week by U.S. Sen. Max Baucus (D-Montana), chairman of the Senate Finance Committee, U.S. Rep. Bruce Braley (D-Iowa) isn’t necessarily among them. The process is not a sprint, he reminded reporters on his Thursday morning conference call, but more of a marathon in which the finish line must remain the top priority.

“I’m not at all happy with some of the things that were left out of the Senate [Finance Committee] bill, but the reality is that this is not the final Senate bill. It is the chairman’s mark,” Braley said. “It was the product of work by six senators and, in the end, we’re not sure how much the Republican senators contributed to this chairman’s mark since none of them support [it].”

Braley indicated that one of the things that pleased him about the Finance Committee’s initial effort is that it included an extension of a 2003 Medicare reimbursement reform measure intended to better balance payments made to physicians in different geographic regions. Braley noted with disappointment, however, that he has seen nothing within the bill to address overall Medicare reimbursement disparities that leave smaller and more rural states like Iowa receiving significantly lower rates.

“We are working with key senators … to make sure that [Medicare reimbursement disparity reform] language winds up in the Senate bill as well as our value-based reimbursement model that was included in the House bill, based upon legislation that [Wisconsin Congressman] Ron Kind and I had introduced,” he said.

Medicare is the single largest payer for health care in Iowa, and Iowans, just like Americans throughout the nation, pay equal premiums to support the program. Yet the reimbursement distribution formulas contain substantial geographic disparity in patient services and payment levels. It’s an economic disparity that not only impacts Medicare beneficiaries and the medical providers that serve them, but everyday Iowans who often pay higher insurance premiums so that private companies operating in the state can counter Medicare’s shortfalls. In addition, the lower reimbursement rate has also been linked to the overall lack of access to basic and specialized care in less populated states like Iowa.

The Baucus bill will need to gain full Finance Committee approval before it comes before the Senate as a whole, a process that most anticipate will be completed next week. Once the full committee submits its work, senators will weigh the provisions of that bill with one introduced in July by the Health, Education, Labor and Pensions Committee as well as consider additional amendments for items that might not currently be contained in either bill. Only when that process is complete will the Senate have a final health care reform bill, which will ultimately have to be merged with the bill that is passed by the U.S. House.

Braley contends that he is closely monitoring the situation in the Senate, but that his primary concern for now is helping to give the House bill a final polish before it is presented on the floor, which should happen at some point before Columbus Day.

“Our goal is to get the bill passed, to get the Senate to take action so that we can get to conference committee in a timely fashion and, hopefully, get a bill passed and on the President’s desk before the end of the year,” he said. “So, even though I have very serious concerns about some aspects of the Senate bill, this is a long and difficult process, and I think that everyone needs to negotiate and work on this bill in good faith so that it is in the best shape possible when it reaches the President’s desk.”