Grassley visits Floyd County Medical Center

By Travis Fischer, tkfischer@charlescitypress.com

Sen. Charles Grassley (R-IA) visited Charles City on Thursday, March 20, as part of his regular tour of the state when Congress is out of session.

Grassley’s visit took him to the Floyd County Medical Center, where he was given a tour of the hospital to see both its recent additions and in-progress renovations.

“This program has really advanced,” said Grassley, complimenting the hospital’s successful maternity program and new MRI equipment. “It’s a lot bigger and it’s a real powerhouse in this area of Iowa.”

Though on a break from Washington, D.C., right now, Grassley is currently working on extending the Tax Cuts and Jobs Act. While the 2017 law permanently cut the corporate tax rate, the individual tax cuts are set to expire at the end of the year.

“For the average family in Iowa, that’d be about a $1,600 tax increase,” said Grassley.

Grassley is also working on the new Farm Bill. The House of Representatives agreed on a bill last year and Grassley presumes a similar bill will be presented this year. While the house bill is bi-partisan, each party in the Senate has drafted its own framework.

“I presume that now with the Republicans being in control of congress, we’re going to be working off the House bi-partisan bill and the Senate Republican framework,” he said.

The Farm Bill framework focuses on increased price protection for farmers to reflect inflation, more money for exports and ag research, and putting a cap on what a single family farm can receive from the farm program.

“So we target it toward medium and small farmers, as opposed to a mega-farmer being subsidized to buy more land and pay higher cash rent,” said Grassley.

After touring the hospital, Grassley met with hospital staff for a Q&A session.

Health care was naturally the dominating topic, beginning with a discussion about the nationwide nursing shortage and what the federal government can do to address it.

Staff at FCMC told Grassley that they have difficulty transferring patients to other hospitals because while those hospitals may have beds for incoming patients, they may not have nurses to staff them.

“The real problem is if you’re a professor of nursing you get less money than if you’re actually practicing nursing,” said Grassley. “So getting the dollars up to pay nurses isn’t something that the federal government sets salaries for people and things like that so that’s the problem we’re dealing with.”

In lieu of being able to recruit nurses for full-time positions, Grassley was told that the hospital is reliant on “locums” to fill its vacancies. Short for “locum tenens,” a Latin term for a placeholder, “locums” are temporary nurses that take short-term contracts, often for higher pay and flexibility than full-time nurses.

While a popular option for nurses seeking experience and opportunities to travel, they are an expensive alternative for hospitals in need of filling long-term full-time jobs.

A suggestion offered to Grassley was federal funding to support programs that provide scholarships or maternity leave benefits to incentivize nurses to take on full-time positions.

One avenue Grassley brought up to help alleviate the nursing shortage was immigration through H1B programs.

“There’s limits on the number of people that can come in under that program, and limits on what can come in from specific countries, but if they meet our credential requirements they can come in,” said Grassley.

Bringing on international nurses is something that FCMC has explored, but Grassley was told that the cost of getting nurses through such programs is also a costly endeavor, and he was asked if the federal government would look at subsidizing that expense to help address the shortage.

“I think with what you see going on in Washington now, trying to deal with a $36 trillion debt and cutting down on the expenses we have, I think it’s not an environment that I can give you a positive answer for,” said Grassley. “But that doesn’t mean that there’s not going to be more money spent someplace that it isn’t being spent now. But it may be taken away from someplace else.”

Grassley noted that a reduction in those fees would actually reduce money coming into the federal government and that some are suggesting that, due to inflation, those fees should be increased.

When asked about the exact cost of bringing over an international nurse, he was shocked to find that it can cost as much as $39,000 in administrative costs per nurse.

“Are you sure you can’t find a cheaper place?” asked Grassley. “I’ll betcha half of that is going to some expensive lawyer.”

It was explained that the amount comes from a private firm that specializes specifically in bringing in nurses through the immigration system.

“I just can’t believe that it costs $39,000 for one person,” said Grassley. “Maybe I have a responsibility of looking into that.”

Moving away from nurses, discussion turned to pharmaceuticals where the 340B program was a topic Grassley anticipated talking about as it’s frequently brought up by pharmacies.

The 340B program requires drug manufacturers to offer discounts on drugs to certain entities, including rural health care providers. However, instead of offering savings upfront, pharmaceutical companies use rebate systems, forcing hospitals to first pay the full cost of the drug before getting the money back. At FCMC, the program amounts to about $250,000 a month.

Grassley said that while Congress has a few bills addressing the 340B program, the current state of it is dependent on the courts. Both the Biden administration and the previous Trump administration attempted to regulate the program, resulting in three lawsuits from pharmaceutical companies that may reach the Supreme Court.

“That still doesn’t mean Congress can’t step in and maybe maintain the program,” said Grassley.

Another federal program discussed was Medicare Replacement Plans, private alternatives to Medicare that were criticized for being difficult for people to understand what is and isn’t covered or that require pre-approval compared to the regular Medicare program.

Grassley said that President Biden signed an executive order to go into effect next year that would cut down on the number of pre-approvals by half, though there is a question of whether that order would be rescinded by President Trump.

“There’s already regulations that were issued under Biden that I don’t think Trump is going to mess with. Although he’s trying to undo, through executive orders, just exactly the opposite,” said Grassley. “Biden went in and did a whole bunch of what I call crazy things and Trump’s trying to undo it, but I don’t think this would fall in this category.”

Grassley said that he thinks the regulations currently in place will stay, but agreed that the pre-approval process needs reform.

“Some of this pre-approval stuff is ridiculous,” said Grassley.

Finishing up the session, Grassley was asked to keep an eye on the USDA which, along with working with the agriculture industry, is a valued partner with the hospital. The current administration’s management of the USDA program prompted concerns about its reliability in fulfilling its contracts in the future.

“Remember that every president comes in and delays things from going into effect for 90 days to review,” said Grassley. “I just think it’s a little more aggressive this time than previous presidents, but they’ve already reversed themselves on some decisions they’ve made because they’ve realized this wasn’t the right decision.”