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| Wilson Wants Medicare Formula to Treat New Mexicans Fairly |
June 17, 2003 |
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Washington, DC - Today marks the first of three days that Congresswoman Heather Wilson and the House Energy and Commerce Committee will meet to hammer out details of a prescription drug benefit for Medicare.
"Of all the work we do in this committee, this is the most important to more than 240,000 New Mexico seniors," said Wilson, in her opening statement at the hearing. "The need for a prescription drug benefit in Medicare is one of the issues I hear about most often from New Mexicans. Seniors just shouldn`t have to choose between buying groceries and buying medicine."
Sixty-four percent of New Mexico seniors are expected to benefit from the low-income provision in the Bill. Overall the bill includes a $35 monthly premium and a $250 deductible. The federal government would then pick up 80% of drug costs up to $2000.
Medicare was created in 1965, when prescription medication accounted for 1% of total drug expenditures. Today, 38 years later, that figure is closer to 17%. Congress has revisited the issue for the past several years, and the House has twice voted to add a prescription drug benefit to Medicare. President Bush`s attention and recent Senate action give Wilson and hundreds of New Mexico seniors the hope that the benefit will become a reality this year.
Wilson has also launched an effort to include a provision to change the unfair reimbursement to doctors in rural states like New Mexico. Wilson introduced legislation this February that would equalize payments to rural states and states with efficient health care systems.
"We don`t pay into Medicare based on where we live, and we should not be denied access to health care based on where we live. Medicare pays a physician less for their time in Albuquerque than they pay in Dade County, Florida or in Manhattan. That`s wrong and it makes it harder to keep doctors in New Mexico."
Wilson introduced a similar bill last year and was successful in attaching a similar provision to the Prescription Drug bill that passed the House then. She`s hoping to duplicate that effort this year in a prescription drug benefit bill she hopes will become law.
"Thousands of New Mexicans rely on Medicare for their healthcare, and most private insurance companies tie their reimbursement rates to what Medicare will pay. These reimbursement schedules that pay doctors more for the same service in other states is one reason why we are losing doctors from New Mexico."
Medicare has reimbursement schedules for over 7,000 different procedures or services provided by Doctors. Each service is adjusted by a formula that includes a geographic factor in different counties. For all procedures and reimbursements combined, in fiscal year 2000, the Federal government paid $3,726 per enrollee for Medicare in New Mexico. They paid $6,539 per enrollee in Texas, $5,100 in Colorado, and $4,464 in Arizona. Only 5 states or territories were reimbursed less per enrollee than New Mexico -- Puerto Rico, Vermont, Virgin Islands, Iowa, and Maine.
Following are examples of reimbursement rates by locale for certain procedures:
Procedure Hysterectomy Office Visit
Albuquerque $844.16 $57.22
Flagstaff, AZ $889.73 $60.95
Miami, FL $1000.76 $66.23
Denver, CO $873.71 $60.56
New York, NY $1081.96 $75.50
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