Category Archives: ACA

Health Reform and Continuity of Care

In the chaos of health-care efforts both nationally and in Iowa, today I seek to go back to two basic beliefs: 1) the hope of future generations to learn from past generations’ mistakes and 2) the value of continuity of care for primary health care and, ultimately, health care in general.

The U.S. Senate is now debating a tax-cut bill that includes eliminating the Affordable Care Act (ACA) individual mandate for health-care coverage — a basic tenet for true health-care reform — and, in Iowa, the for-profit, managed-care Medicaid fiasco now has one managed-care organization (MCO) leaving the state and another MCO not able to take new patients. These actions leave the state with only one MCO left to serve Medicaid patients. Given these realities, I shift gears by presenting to you a guest blogger.

She is a third-year medical student who recently spent a month with me in my clinic. She plans to be a pediatrician. I choose not to provide her name. Although she would allow it, I am not sure her medical school would.

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Health Reform and Why Words Should Matter

Ah, words! Especially to writers, they are more precious than jewels, as essential as air, and powerful enough to create entire worlds. We chase them, massage or mince them, we roll them around in our mouths, savoring every delicious subtlety. Mostly, we love them.

~Tammy Letherer

Ms. Letherer wrote these words on a blog entry titled Why Words Matter (In and Out of the Locker Room), on October 16, 2016.  In that post, she discussed her unhappiness with Donald Trump’s language regarding women.

In Iowa, former U.S. Representative Bruce Braley lost his Senate race with Joni Ernst in large part to an audiotape of his words to political contributors in Texas disparaging our senior senator, Chuck Grassley, describing him as “a farmer from Iowa who never went to law school.”

This year’s health-care debate, centered on the Republicans’ efforts to repeal the Affordable Care Act (ACA), has led to many statements by Republican leaders in Iowa that should come back to haunt them this Halloween season and for seasons to come, as Bruce Braley’s words haunted him.

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Health Reform and Spudnutz

I stood in line at 6:45 Sunday morning to purchase donuts at a very popular local donut shop — Spudnutz — at Lake Okoboji. The line of donut-seekers stretched far out the door. I did not receive donuts until 7:50 a.m. I waited more than an hour for donuts. (Yes, very good donuts). Nine people were working in that donut shop that once housed an auto mechanic shop.

If either the Senate bill or the House bill that was intended to repeal and replace the Affordable Care Act (ACA) became law, I fear none of those nine hardworking people would have health-care coverage in the future. For many of my patients and for, I believe, the employees of Spudnutz, I give thanks for the defeat of the Senate “skinny” repeal legislation.

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Health Reform and Blood Money

In 2003, Iowa used part of its portion of the 1998 Tobacco Settlement monies to help build a new Supreme Court Building. During those years and later, Iowa Republican legislators sought to reduce the funding and scope of the Iowa Tobacco Use Prevention and Control Commission, which was created to use the settlement monies to help Iowans to either quit smoking or not start. I said at that time that using the Tobacco Settlement monies for any use other than health care was wrong. As a former chair of the Tobacco Commission, I viewed this money as blood money because it was being paid out to partially compensate for the death and disease that cigarettes had caused Iowans for many decades.

Similarly, I use the same term, blood money, today regarding the U.S. Republican House and Senate efforts to repeal and replace the Affordable Care Act with a plan that will reduce wealthy individuals’ taxes by more than $600 billion over 10 years by taking a similar amount of money from the Medicaid program and from subsidies used to supplement poor and low-income individuals’ effort to pay for premiums in the individual health-insurance market.

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Health Reform and the Orphan Called the Individual Health-Insurance Market

Last week, the buzz in Washington, D.C., where I heard numerous lectures and personally talked to two U.S. representatives and two U.S. senators, was about impending health-care legislation in the Senate and particularly focused on the imminent crisis in Iowa, where there probably will be no insurers for the individual insurance market in 94 of its 99 counties in 2018.

Seventy thousand Iowans may not have health insurance next year in a state that prides itself as an insurance state. Iowa is the poster child for the deficiencies in the individual insurance market. Across the nation, only a few counties in Tennessee have that known potential for 2018, though several potential fixes are being discussed at the federal and state levels.

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Health Reform and Nick Bath

Nick Bath is the senior health-policy aide to Senator Pat Murray (D) of Washington. I met Nick several times when he was a health-policy aide to now retired Senator Tom Harkin (D) of Iowa.

Nick is a Harvard law graduate and a classical pianist (according to his bio), and he reminds me in both looks and mannerism of British actor Hugh Grant when Grant was a younger man.

Senator Murray is one of the primary health-care advocates and strategists in the Senate. Because of my previous association with Nick and Senator Murray’s important health-care advocacy, I compose the following letter to Nick regarding the current health-care crisis and unknown future of health care, which evolved from the recently failed partisan attempt to repeal and replace the Affordable Care Act (ACA).

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Health Reform and Motive

My dad — whom I admire, respect, and love dearly — for my taste, watches too much Fox News. He criticized the Affordable Care Act (ACA) for years. He talked exclusively about its shortcomings. He talked about the 3,000 pages of the Act that none of the members of Congress had read. After listening to him for a while, I rebutted him on only one point. I said you could never criticize the ACA’s authors’ motive — to improve health-care coverage for Americans. With my comment, he quickly changed the topic of discussion. During many conversations with him over several years, he never changed the topic as quickly as he did that time. My rebuttal hit home. We can argue over method, but it is far more difficult to argue over motive.

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Health Reform and Post-Truth Politics

As a physician, I have a hard time understanding post-truth politics. Wikipedia defines the post-truth culture as “a political culture in which debate is framed largely by appeals to emotion disconnected from the details of policy and by the repeated assertion of talking points to which factual rebuttals are ignored… . (It) differs from traditional contesting. … Falsifying of truth  … (is viewed as) … of secondary importance.”

I live in a world where the absolute values of lab tests — such as INR levels (the international normalized ratio (INR) is calculated from the result of a prothrombin time (PT) test, which is used to help detect and diagnose a bleeding disorder or excessive clotting disorder; the INR is used to monitor how well a blood-thinning medication is working to prevent blood clots), ejection fractions (which measure the percentage of blood leaving the heart each time it contracts), creatinine levels (used to assess kidney function), and hemoglobin levels (hemoglobin is the substance in red blood cells that carries oxygen) — affect function, quality of life, and the potential life or death for my patients. I live in a world where, for my geriatric patients, the commonly accepted truth of gravity plays a huge role in falls. I spend much of my time as a geriatrician trying to prevent falls and treating the outcome of falls. In my 32 years of practice, I have seen how details of policy and falsifying of truth have tangible consequences.

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Health Reform and Pre-Existing Conditions

I was tempted to titled this blog entry Health Reform and “I Won’t Let People Die in the Streets.” I also was tempted to describe the November 8 election as the day health reform died. One retort could be that the Republicans are now in charge of health reform. They need to play offense as opposed to only playing defense. And we should move forward.

For starters, let’s discuss the dual action of repealing the Affordable Care Act (ACA) and maintaining the Republican pledge not have individuals with pre-existing conditions be excluded from health insurance in the post-ACA world.

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