Insurance—Those With and Those Without - Changing Medicare Reimbursement

Medicare reimbursement varies in different parts of the country, despite the fact that everyone pays the same amount to Medicare through taxes. As a result, older

	Medicare fee-for-service only1,8						Medicare health maintenance organization1,9
Characteristic	1989	1995	1998	1999	2000	2001	1989	1995	1998	1999	2000	2001
	Number in millions
Total3	4.5	4.6	4.7	5.1	5.5	5.9	—	—	4.7	5.2	5.0	4.2
	Percent of population
Total, age adjusted3,4	15.7	14.8	14.5	15.8	16.8	17.9	—	—	14.4	16.0	15.2	12.9
Total, crude3	15.4	14.7	14.5	15.8	16.8	17.9	—	—	14.5	16.0	15.2	12.9
Age
65–74 years	13.8	14.4	13.7	15.6	16.4	17.4	—	—	15.3	16.1	15.8	12.8
75 years and over	17.8	15.2	15.4	15.9	17.4	18.4	—	—	13.5	15.9	14.6	13.1
75–84 years	16.2	14.1	14.2	15.2	16.0	17.0	—	—	13.7	16.5	15.5	13.4
85 years and over	24.9	19.2	19.7	18.4	22.7	23.7	—	—	12.8	13.7	11.1	11.9
Sex4
Male	14.9	14.3	13.2	15.4	16.1	17.4	—	—	14.7	16.5	15.6	12.5
Female	16.2	15.0	15.4	16.0	17.4	18.2	—	—	14.2	15.6	15.0	13.3
Race4,5
White only	13.9	13.5	13.3	14.4	15.5	16.5	—	—	14.0	15.8	15.2	13.0
Black or African American only	34.9	29.0	26.7	28.0	29.6	30.5	—	—	17.6	16.5	14.7	11.2
American Indian and Alaska Native only			26.6	39.1		37.9	—	—
Asian only			12.6	22.0	21.4	19.8	—	—	17.0	18.9	16.0	13.4
Native Hawaiian and Other Pacific Islander only	—	—	—				—	—	—
2 or more races	—	—	—	19.1		21.7	—	—	—	21.8	29.8	16.3
Hispanic origin and race4,5
Hispanic or Latino	22.7	23.6	20.6	22.8	20.8	23.9	—	—	24.4	25.7	25.0	20.1
Mexican			21.5	26.3	22.7	29.3	—	—	23.3	26.0	24.5	18.9
Not Hispanic or Latino	15.5	14.3	14.2	15.3	16.6	17.5	—	—	13.9	15.4	14.6	12.5
White only	13.6	12.9	12.9	13.9	15.3	16.1	—	—	13.5	15.2	14.5	12.5
Black or African American only	34.9	29.1	26.7	28.0	29.6	30.5	—	—	17.5	16.5	14.7	11.2
Percent of poverty level4,6
Below 100 percent	26.4	23.4	21.9	24.8	23.6	23.3	—	—	11.0	13.8	14.4	8.6
100–149 percent	20.7	18.6	22.2	23.1	22.0	24.5	—	—	16.6	17.7	17.0	12.5
150–199 percent	13.6	16.8	14.3	17.1	16.6	16.6	—	—	18.6	20.4	16.0	15.0
200 percent or more	11.0	10.8	8.0	10.3	11.4	11.5	—	—	15.2	15.7	16.7	14.5
Geographic region4
Northeast	17.4	15.3	12.3	13.8	17.1	17.6	—	—	12.7	17.5	12.5	13.5
Midwest	13.8	11.0	12.9	11.7	13.5	16.1	—	—	7.7	9.0	8.4	7.5
South	16.6	15.9	17.5	20.3	19.6	19.7	—	—	12.5	12.2	13.2	10.2
West	14.4	17.2	13.7	14.9	15.7	17.3	—	—	28.2	31.0	30.6	23.8
Location of residence4
Within MSA7	15.9	14.9	13.4	14.9	16.4	17.6	—	—	17.7	19.7	18.7	15.8
Outside MSA7	15.5	14.2	18.2	18.7	18.2	19.0	—	—	3.5	3.4	4.4	3.1

adults in some geographic regions have access to a more comprehensive range of services such as prescription drug coverage and coverage for eyeglasses, while those in other areas do not receive these benefits.

Describing this practice as "unfair and outdated," legislators called for more equitable reimbursement formulas in August 2002. U.S. Representative Leonard Boswell, a Democrat from Idaho, and Republican Congressman Tom Osborne from Nebraska introduced bipartisan legislation to ensure that no state receives Medicare reimbursement greater than five percentage points above or below the national average. In 2003 thirty-five states, including Iowa, received less than average reimbursement while states with higher health care costs received above average reimbursement.