Grassley: Looking ahead as Medicare turns 50

Health CareBy Chuck Grassley
United States Senator


Two summers ago, Barbara and I visited the Harry S. Truman Library in Independence, Missouri. It’s also the place where President Lyndon B. Johnson chose to sign Medicare into law 50 years ago on July 30, 1965.  It was a signature moment in our nation’s history that today calls for solutions to help strengthen Medicare for generations yet to come.

At that time in our nation’s history, nearly half of older Americans had no health insurance. In the last five decades, Medicare has provided tens of millions of Americans and individuals with disabilities access to health care. It has arguably contributed to increased life expectancy, improved the quality of life for aging Americans and secured peace of mind for people worried about medical expenses in retirement.  As the baby boom population reaches Medicare eligibility, the program’s already broad impact on the nation’s health care delivery system and the taxpaying public will become even more significant.

Medicare flexes enormous influence in local economies and shapes how medicine is delivered and paid for by older Americans and people with permanent disabilities. Throughout its first 40 years, Medicare established itself as the primary insurer for hospital coverage (Part A) and physician coverage (Part B) for older Americans. As then-chairman of the Senate Finance Committee, I shepherded through Congress the most significant reform to Medicare since its enactment. This bipartisan, bicameral effort helped secure the first-ever voluntary prescription drug benefit through Medicare (Part D). Since 2006, Medicare recipients may obtain pharmaceutical coverage through this program.

Today Medicare serves nearly 54 million Americans.  An entitlement program that administers health care insurance for that many people has its share of challenges. For starters, it’s burdened by the infamous complexity and unaccountability that afflicts so many government-run programs. Keeping intact the fiscal integrity of the program will become even more important to help ensure the sustainability of the program for our children and grandchildren. That’s why I work to strengthen whistleblower protections laws that have proven instrumental to expose wrongdoing. And I keep close tabs on federal agencies tasked with rooting out health care fraud so that Medicare dollars are spent as intended.

The 114th Congress took decisive bipartisan steps earlier this year to fix a flaw that contributed to huge uncertainty for patients and doctors for the last 17 years.  The Medicare Access and Chip Reauthorization Act improved the reimbursement formula that adversely affected health care providers serving Medicare patients.  Medicare doesn’t do a whole lot of good if a sick patient doesn’t have a doctor or health care provider to visit.

Looking ahead, Medicare needs to strengthen its ability to secure access to affordable care. Federal lawmakers must ask probing questions that demand fiscal accountability. I have worked to secure stronger transparency laws that give policymakers and the public the opportunity to check out Medicare payment data to make sure Medicare dollars aren’t squandered.

Medicare spending consumes nearly 14 percent of the federal budget, accounting for about a fifth of the health care spending in the United States. In Iowa, it leaves a big footprint across the network of hospitals and health care providers that serves 531,209 Iowans and spends $4.3 billion per year in the state.

And yet, a number of U.S. hospitals struggle to keep their doors open, especially those serving people who live and work in rural America.

This summer I introduced the Rural Emergency Acute Care Hospital Act (REACH) to address a rising concern that acute health care services in rural areas are at risk.  Supporters of the Affordable Care Act lamented the coverage gap between the insured and the uninsured in America. Notably, since passage of the Affordable Care Act, 55 rural hospitals have closed.

There’s arguably a growing divide between rural providers and those whose revenues are stocked with a healthier payment stream divided among private payers, government payers and self-payers.

As an outspoken champion for rural health care, I have long worked to help make sure Medicare supports the financial viability of rural providers. Americans living in rural areas deserve timely access to health care services.  The REACH Act would create new flexibility and change the Medicare payment structure so that reimbursements for rural emergency health care services aren’t tied to inpatient volume.  Basically, it would give a boost to freestanding 24-hour emergency medical care departments in our rural communities to help keep life-saving medical facilities open for business, around-the-clock, close to home.  Individual states would apply for certification to participate. It also would add incentives to encourage emergency medical professionals to practice in rural areas.

Medicare has made its mark in America these last 50 years. Making sure Medicare continues working to keep health care services open in rural communities is a signature issue that I will continue to endorse for my home state of Iowa.