A report to Congress by the Medicare Payment Advisory Committee puts Iowa at the very bottom in the rate at which hospitals are paid back by Medicare for the costs of treating patients. Scott McIntyre, spokesman with the Iowa Hospital Association, says the ranking is based on the state’s Medicare Operating Margin. He says Iowa has the highest percentage in the country of people over 86, so there are a lot of senior citizens on Medicare. McIntyre says Iowa hospitals have to deal with getting back less than their cost for treating Medicare patients. McIntyre points out current labor shortages already are forcing many healthcare providers to offer higher salaries for nurses to get the staff they need. McIntyre says the state is being penalized for holding down the cost of healthcare and for honestly reporting its costs to federal officials who calculate how the state will be paid for providing healthcare to Medicare clients. McIntyre says the formula hasn’t kept up with rising costs, and while Iowa was honest about reporting the cost of healthcare, he says some other states inflated their reports so they get higher payment from the federal government. McIntyre says hospitals are hoping the state’s congressional delegation can work for changes in the way Medicare operates, and get back the state’s fair share of tax money for healthcare.