Reality had a message for the Republicans when it came to their oath to “Repeal & Replace Obamacare.” For the past seven years, Republicans all promised to repeal it, then they promised to repeal and replace it, and by the end of 2016 they promised to “rip it out by its roots.” This was, of course, bluster and nonsense designed for a campaign audience. In reality, the Republicans had no sustainable plan and wasted their time rushing a terrible piece of legislation through several committees in President Trump’s first 65 days.
Good legislation takes time, hard work and compromise before a bill passes. It took President Obama and the Democratic Congress 18 months to develop, negotiate and pass the Affordable Care Act bill with participation from providers, patients, business and industry and local and state elected officials.
I know this because I was there. The White House asked me to chair the “Task Force of State Legislators for Health Care Reform” in 2009. The ACA took an incredible amount of time and resources at all levels of government.
It’s a good thing for Iowa that the Republican’s attempt to take over health care failed. The Des Moines Register editorial stated, “Their plan would lead to more uninsured Americans (Iowans), higher health care premiums, more unplanned pregnancies, health providers not compensated for treating the uninsured and Americans (Iowans) dying for lack of care. Pretty much like the days before Obamacare. Perhaps worse.”
Iowa can manage our own health care
But do Iowans have to wait for a dysfunctional Congress to solve it? No, we did it before Obamacare and we can do it again. In 2008, we created a new health care system. In a bi-partisan manner, Iowa legislators came together and passed legislation that led Iowa to insure the highest percentage of children of any state in the nation, created a patient centered health care system with “medical homes” for all residents, created a centralized data system expanding electronic medical records and expanded prescription drug availability. In 2011, we developed a new mental health system with bi-partisan support and in 2013, we expanded Medicaid. It’s more than possible for Iowa to continue this tradition of bi-partisan legislating if we have progressive and thoughtful leadership.
With the failure of the Republican proposal, Iowa now has an obligation to proceed like we did before. We can lower premiums, provide greater access for all Iowans and improve health care quality. It will take a willingness to solve the problem that Congress and the President have failed to do, but it is possible for every state to take the initiative and develop their own system. Governors of both parties call this “state flexibility.”
This is how we do it.
First, Iowa should abandon Branstad/Reynolds privatization of Medicaid. When Iowa Medicaid Enterprise ran Medicaid, the administrative cost was only 4%, not 12% under Branstad/Reynolds. They predicted that Privatizing would save the state $50 million; instead, it’s costing Iowa taxpayers more than $80 million in additional funds. But worst, thousands of Iowans have not received the quality and accessibility to the care they received before.
Second, create a “Public Option”. We can put competition back into the individual insurance market and lower premiums. The state should allow all Iowans to purchase individual insurance policy coverage directly from the Iowa Exchange and allow any Iowan to purchase directly into Medicaid benefits. This is known as the “Public Option.” If Republicans want competition, then let the Iowa Exchange compete with Wellmark for the non-eligible Medicaid Iowans; then watch as premiums come down.
Third, allow Iowans to purchase their drugs on-line and from Canada. Canadians purchase the same medication as Americans for half the price. The power and the wealth of the pharmaceutical industry have prevented any real change nationally. As a state, we can challenge the status quo and fight for the issue for our citizens.
Reality is intruding on our politics again: 22 million (and 250,000 Iowans) newly insured under Obamacare versus 24 million losing insurance under the Republican plan. What a difference competent leadership makes. Those are promises kept and they are promises worth continuing. Iowa needs leaders to put the health of its citizens first and not default to the special interests of the health insurance industry.
by Jack Hatch
Former state senator, 2014 Democratic gubernatorial candidate and author of No Surrender – A Progressive Agenda for Iowa with the Five Securities.