Hospitals in Iowa, especially in small towns and rural areas, are watching eagerly as Congress considers adding a prescription drug benefit to the federal Medicare program. Greg Miner is C-E-O at the Loring Hospital in Sac City and he says Medicare is unfair to Iowa healthcare providers. He calls it a “flawed system” that doesn’t reward states where care costs are low and quality is high. Miner says it was a terrible disappointment when a proposal to make Medicare reimbursement rates more fair was removed from the president’s economic-stimulus bill approved last month. For years he says hospitals tried to “be at the table” and were close when they were shot down, as Miner says it was a “pretty major blow” to see the Medicare proposal not survive in the bill. He says reform would have meant 400-thousand dollars just to his hospital. The rate at which Medicare pays Iowa hospitals and doctors for healthcare is the nation’s lowest, and Miner says it’s not fair. Iowa has some of the lowest cost healthcare in the nation, he admits, but provides some of the very high-quality care and every time a patient comes into one of the state’s hospitals, they lose money. In small hometowns many patients are elderly and under-insured, Miner says 78-percent of patients who come in the door are on Medicare or the low-income Medicaid program, as he explains in Sac County there’s little industry so many don’t have private health insurance. Miner says a prescription drug benefit is different than readjusting Medicare reimbursement rates, but would be another way to help Iowa healthcare providers reclaim some of their losses in treating low-income patients.