Medicare attempts to “measure” markets and reimburse accordingly. However, Medicare creates markets by historically reimbursing rural communities less than nearby cities or states. Said King, “Although health care providers in Sioux City may never be reimbursed at the same rate as San Francisco, there is absolutely no reason Sioux City should be reimbursed below cities in Nebraska and South Dakota.”

King’s proposal would provide a 5 percent add-on for any state that falls well below the average per beneficiary Medicare payment of their contiguous states. Iowa is reimbursed over ten percent below the average of Illinois, Wisconsin, Minnesota, South Dakota, Nebraska, and Missouri.

King added, “Like all professions, people follow where the money flows.” From a purely economic standpoint, the loss of health care providers and institutions over borders deprives certain communities of jobs and tax base.

“Medicare reimbursements do not only impact seniors. There is a great access problem in towns that used to employ one, maybe two doctors. Now they are without. Many assume that rural areas have never had proper access to health care. In Iowa’s case that’s simply not true. It has dwindled away over time as Medicare reimburses more and more to other states,” King concluded.