To: Kenneth E. Phillipps who wrote (495855 ) 11/20/2003 9:38:32 AM From: JakeStraw Respond to of 769670 Senators tout bill's benefits for rural areas By JANE NORMAN Register Washington Bureau 11/20/2003 Washington, D.C. - Senators who back the Medicare prescription drug bill launched a hard sell Wednesday on its rural health provisions, saying it's the best chance small-town America will ever have to catch up with the federal money going to urban areas. "This is the best thing rural America has ever seen when it comes to improving Medicare equity," said Finance Committee Chairman Charles Grassley, R-Ia. A vote is expected in the Senate before Thanksgiving, and in the House as soon as Friday. Calculations of Iowa's share of the rural money have soared upward. Congressional aides over the weekend had estimated Iowa would get from $300 million to $329 million over 10 years, but by Wednesday, the estimate was $438 million. Aides said the difference is in higher physician payments. Earlier estimates were figured using numbers provided by the Iowa Medical Society, which used a model different from that used by the American Medical Association. The national organization's model now is considered the most accurate predictor of future payments, aides said. Sen. Max Baucus of Montana, the top Democrat on the committee, said, "This is the last chance for rural America to get significant increases in payments for doctors and hospitals and seniors." Sen. Craig Thomas, R-Wyo., noted that every state has at least some rural areas, even those states dominated by cities. Of the $400 billion in the bill, which would extend prescription drug benefits to seniors for the first time, $25 billion over 10 years would be spent to increase Medicare payments to rural doctors and hospitals. The senators handed out a state-by-state list of how much each state would receive from the $25 billion. However, $10 billion included for rural health would reverse a planned cut in all Medicare physician fees. The 4.5 percent cut was supposed to begin in the 2004 budget year. Aides said rural doctors insisted that reversal was needed as much as the increased payments specific to rural areas, and it was also needed politically to gain support for the package. The biggest winner in rural health appeared to be the president's home state of Texas, which would pick up $1.9 billion. Close behind is Florida, home to many retirees, at $1.8 billion. California and New York each would receive about $1.2 billion. For hospitals overall, the largest sum, $6.8 billion, would be spent on eliminating the disparity in funding between large urban hospitals and rural and small urban hospitals, beginning in April 2004. Iowa gains $163 million from that provision. Grassley said senators pushed to have rural money included after it was dropped from the tax-cut bill earlier this year and in the face of opposition from House members representing urban areas. He said the way the complex Medicare reimbursement formula is computed has been "held hostage for too long by powerful chairmen from big cities." dmregister.com