Fewer people in rural areas have drug coverage through private insurance plans or benefits provided by former employers. That's likely due to the large number of independent workers, such as farmers, who comprise the rural populace.
That's just one of several issues facing Congress as it works to include a rural perspective in its Medicare makeover. Nancy Crowfoot reports.
When Catherine and John Cord retired from farming and moved into town, they rented out their land so they would still earn an income from the farm.
They have a private insurance health supplement, which pays most of the physician and hospital costs not covered by Medicare.
Unplanned expenses included the rent at John Cord's nursing home ... and the nearly 15 different medications the couple takes ... which total more than $600 a month.
Catherine Cord, Danbury, Iowa: "We have an income from the farm but, you know, you can only stretch those things so far. We felt that the cost of caring for him at the nursing home we could cover but I just hadn't thought about that much medication. That's where I'd like to see some help."
For help, Cord sought out an Iowa drug discount program that offers a savings on just a couple of the medications she needs.
She also turned to her local pharmacist...
Slug Ed Maier, pharmacist, Mapleton, Iowa: "Do you have particular reason that you would like to have the brand name Cardezem?"
... who reviews the list of medications she and her husband take to see if any adjustments can be made to reduce cost.
In addition to counseling, pharmacist Ed Maier offers Cord, and his other 3,000 senior patients, a 10% discount on their prescriptions. The discount comes at his own expense, even though he feels he cannot recoup the costs as readily as the larger chain pharmacies in urban areas.
Ed Maier, Maier Family Pharmacy: "Because of our volume, are not in a position to negotiate and bargain for the price that we pay for prescriptions whereas some of the larger chains can decrease their costs at least to some degree because of their bargaining power. So that places us at an additional disadvantage."
While both Maier and Cord struggle to contain the rising cost of health care, Congress is trying to work out a compromise on both a Medicare drug benefit program, as well as make some changes to the overall Medicare policy that would help rural America.
Iowa Senator Charles Grassley, chair of the Senate Finance Committee with jurisdiction over the Medicare bill, also sits on the House-Senate conference committee trying to reach an agreement on a voluntary prescription drug program for seniors.
Senator Charles Grassley (R) Iowa: "There's so little difference between the House and Senate on deductibles that it's going to fall in the area of $250 to $275. In regard to premium, approximately $35 a month."
Those numbers add up to an out-of-pocket expense of $670 to $695 annually. On top of that, are various formulas of co-payments based on an individual's annual prescription costs and income.
While specific numbers are still being tossed about in conference committee, Grassley is hopeful it will be close to the senate-passed version, which would cover 50% of a participant's prescriptions up to $3,700. It would cover 85% of the prescription costs for those under 150% of the poverty level and 90% for those under 100% of poverty.
Senator Charles Grassley, (R) Iowa: "And when you get above $5,300 a year there would be a catastrophic provision kick in where the plan would pay most of the cost, if not al the cost, of catastrophic."
The drug benefit offer is expected to cost $400 billion over the next 10 years. Grassley says the money will come from savings found elsewhere in the Medicare program.
Those savings elsewhere may be how Congress also will finance another Medicare upgrade for which Grassley is fighting ... equity in the reimbursement payments for rural health care providers.
Rural hospitals and physicians who practice in the country receive a lower reimbursement rate than their urban counterparts. For example, the urban hospital inpatient reimbursement is 1.6% higher than in rural areas.
The long given reason for the disparity has been that it costs less to deliver health care in rural area.
Grassley is sensitive to the inequity, as his own state of Iowa is dead last -- 50th of the 50 states -- in the amount of dollars reimbursed. He spearheaded the drive in the Senate earlier this year for a $25 (B) billion package to help not only Iowa, but some 30 other states below the national average in reimbursements.
The House also has a version of the bill.
Senator Charles Grassley (R) Iowa: "There's not a lot of ironing out of differences between the House and Senate. The most important key point is whether or not this passes is, will the locomotive of the prescription drug legislation go and if it goes, this issue will go with it. If we don't pass a prescription drug bill, can we pass this bill as well?"
The "question" was to be answered by the conference committee's October 17th deadline. But Grassley says that deadline won't be met. He is, however, confident that a compromise bill will emerge this fall.
Senator Charles Grassley (R) Iowa: "And more important than my saying that is, Senator Frist, our Majority Leader, says he wants to get this done before we go home. And even if I completed a conference committee report it wouldn't necessarily mean it gets passed unless it gets on the Senate agenda.
And I think his statement plus the President wanting it done. So I think the stars are lined up to get it done for sure before we go home in early November."
For Market To Market, I'm Nancy Crowfoot.