A year ago, the policy wonks in Washington, D.C., said it couldn’t be done. They all but told members of the Greater Des Moines Partnership to give up their crusade for equity in the Medicare reimbursement formula, which shortchanges Iowa hospitals and physicians to the tune of millions of dollars. The predictions were dour: Iowa and other smallstates receiving less than the national average in reimbursement wouldn’t be able to muster enough support in Congress to correct the disparity because they’d be outvoted in the House of Representatives by more populous states. The smart money was on the plan backed by the Bush administration to provide prescription drug coverage for seniors enrolled in Medicare.

Thomas Scully, the director of the Centers for Medicare and Medicaid Services, joked that he couldn’t get up in the morning without someone telling him that the reimbursement formula cheats Iowa. can thank Sen. Charles Grassley, R-Iowa, and other members of the Iowa congressional delegation for that cup of morning cheer.

That reimbursement reform even made it to the Senate floor for debate is a testament to Grassley’s dogged determination. As chairman of the Senate Finance Committee, he shrewdly tucked an equity provision into the economic stimulus bill to test its support in the Senate. He removed the provision only after he brokered a promise from President Bush to support the reform measure, which has strong bipartisan support.

Iowa is lucky to have Grassley in the Senate, luckier still to have him back in the chairman’s seat of the Finance Committee and in a position to influence the Bush administration, which previously hadn’t expressed much interest in correcting the reimbursement disparity.

Grassley is quick to give credit to Iowans themselves, who have framed the Medicare reimbursement issue around an economic development agenda that isn’t limited to health-care interests. There isn’t a major chamber of commerce or business organization in the state that hasn’t included Medicare equity among its legislative priorities. Other rural states have lost money under the formula, which pays hospitals in rural states 1.6 percent less upon the discharge of Medicare patients than hospitals in urban states. But their rallying cry hasn’t been as fierce, or as persistent.

“Without a doubt, Iowa has carried the water on this issue,” Grassley said. “I haven’t heard from many of my colleagues that we need to do something, and it sure doesn’t come with the same drumbeat.”

There’s still water to be carried. It’s up to the Iowa congressional delegation, firmly united behind the need for equity, to usher Medicare reform through the House of Representatives, through the conference committee and, finally, to the president’s desk.