Lawmakers need to step up for Medicare, rural health care

Just last month, two of Iowa's four mental health institutions closed due to budgetary constraints. Iowans are constantly reminded of how hard it can be to find accessible health care - especially in a rural area.

Mental health practitioners are hardly the only care providers at risk of shuttering due to funding cuts. Some in Washington, D.C. are threatening to cut reimbursement rates under Medicare Part B, which covers medications that can only be administered by a physician, such as intravenous chemotherapy drugs. Under the Part B program, doctors buy the medications for these services directly, bill Medicare for the costs after they administer them to patients, and are then reimbursed. That's right: Some in Washington are trying to find budget cuts in cancer care.

This is why it's so important for Iowa to have lawmakers who are willing to stand up for crucial health services - lawmakers like Senator Chuck Grassley, who in more than three decades in the Senate has established a record second to none in support of access to care for those who need it most. Senator Grassley's colleagues in Washington should follow his example.

Part B has been the subject of much debate lately. With Senator Grassley's backing, Congress recently passed a law known as the 'permanent doc fix,” which put Part B on a stronger financial footing by making sure doctors are reimbursed at fair rates for most services. But physician-administered drugs are still under some debate.

For years, Part B reimbursed doctors for the average sales price (ASP) of these drugs plus 6 percent – 'ASP+6 percent” for short. Although this reimbursement rate is typically lower than what private insurers usually pay, the additional 6 percent was intended to make sure providers at least broke even on other costs, such as shipping, storage, and administration of the medications.

One problem with the reimbursement rate of ASP+6 percent is that not all doctors pay exactly the average price. Also, rural clinics face much higher shipping costs. In some cases, doctors must pay more than the average price and the ASP+6 percent payment has not been enough to cover all of their costs.

Now doctors no longer get the full 6 percent - and some in Washington would like to cut the reimbursement rate even further. In 2013, sequestration cut the effective reimbursement rate to ASP+4.3 percent. In many cases, that's not enough to break even.

Almost immediately, cancer clinics across the country began turning away thousands of current Medicare patients. 'It's a choice between seeing these patients and staying in business,” one oncology executive said.

According to the Community Oncology Alliance (COA), in Iowa alone, two clinics have already closed and another has started sending Medicare patients elsewhere. Furthermore, according to a survey conducted by COA on the impact of sequestration on community cancer care, 49 percent are refusing to treat Medicare patients because they can no longer afford to.

Some lawmakers in the House have been trying to exempt cancer drugs from sequestration, but their efforts have been frustrated by others who seem intent on making matters worse.

The White House is trying to cut the reimbursement rate for Part B drugs all the way to ASP+3 percent. Instead of forcing rural clinics to bear the full brunt of the reduction, the proposal would shift costs onto drug companies by requiring 'rebates” to practices whose costs exceed ASP+3 percent. But this is hardly a solution, as doctors would continue to suffer under inadequate reimbursement.

It's hard to believe that cancer care at struggling clinics is a prime target for budget cuts. But it's true. Fortunately, Iowans can count on lawmakers like Senator Grassley to stand up to those who threaten Medicare reimbursement rates for Part B drugs.

' Dwight Baldwin, of Kellog, is president of the Iowa State Grange. Comments: 2606 Hwy 224 North, Kellogg, Iowa 50135