Category Archives: ACA

Health Reform and Uber and Food Trucks

Recent economic trends nationally and in Iowa include the proliferation of Uber contract-driver taxi services and owner-operated food trucks. Both of these services rely on individuals starting a small private business in the competitive world of commerce.

My brother, my father, and my grandfather have all been owners of their own small businesses. The gumption and personal sacrifices needed to take on all the requirements necessary to run a successful small business have always humbled me. From advertising and marketing to hiring and personnel management, to municipal, state and federal regulations, to eventual retirement, a small-business person needs to consider every aspect of their business. Despite this, many individuals crave the freedom and independence that running their own businesses or being independent contractors allows. Given the other options of being someone else’s employee in a large business or a government worker, I sympathize with and support individuals who are willing to risk their time, resources, and self in these challenging endeavors.

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Health Reform and “Yuge”

Former Vermont Governor Howard Dean speaking this week at the 2016 Democratic National Convention quoted Donald Trump. According to Governor Dean, Donald Trump said that he’s going to replace the Affordable Care Act (ACA) with “something so much better” — something “‘Yuge,’ no doubt.”

In researching this “something so much better,” I could find only a mismatched set of random ideas such as buying health insurance across state lines, establishing Medicaid block grants for each state to administer, allowing Americans to import medications, eliminating the individual mandate but still preventing insurance companies from excluding patients based on pre-existing conditions, and expanding tax exemptions for corporate health insurance to individuals.

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Health Reform and ACO Incentives – Getting It Right

We need to get this right. As I have said last month, I continue to be dismayed by the evidence that health-care costs are not being controlled. For example, in Minnesota, one of nation’s top health-care managed states, Blue Cross and Blue Shield announced that it would not sell individual insurance policies next year due to concerns over cost. Skyrocketing health-care costs will affect the affordability of private insurance and the existence of public health-care programs such as Medicare, Medicaid, and subsidized insurance sold under the Exchanges.

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Health Reform and Medicare for All … Seniors

One of my favorite movies is White Christmas, which starred Bing Crosby and Rose Mary Clooney. In one scene, Rose Mary Clooney’s character sings a song in a nightclub about her unhappiness with Bing Crosby’s character. She sings, “Love, you didn’t do right by me … you planned romance that just hadn’t a chance, and I am through.”

In a fashion similar to that Irving Berlin song, after years of touting private health insurance by helping to create the Healthy and Well Kids in Iowa (HAWK-I) — Iowa’s CHIP program, and working with CoOportunity Health — Iowa’s health-care co-op that went bankrupt, I have come to the conclusion that the private health-insurance market under the Affordable Care Act (known as the ACA or Obamacare) has not done “right by me.” More importantly, it has not “done right”  the citizens of the country. For reasons that I will clarify later, I now support expanding Medicare to individuals 55 years of age in a graduated, voluntary enrollment process.

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Health Reform and Enhancing Patients’ Lives

Family medicine is creating and maintaining relationships with patients in order to enhance their lives.That is the definition I gave to the University of Iowa’s family-medicine residents at their resident retreat on Saturday. During my talk with this group of young physicians, I described my family-medicine team and how we help our patients to maintain their health, recover, and become healthy from an illness or improve their quality of life if diagnosed with chronic illness or a terminal disease. My team includes a head nurse, two health coaches who share a full-time position, a “roomer” nurse who seats patients in examination rooms and charts their vitals signs, and a “shot” nurse. Together, we are responsible for the family-medicine needs of 2,100 patients. I have described the use and value of health coaches in a previous entry.

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Health Reform and Wrapping Up

I should wrap up this blog with this post. This was to be the last entry. I said at the beginning, two and a half years ago, that I would chronicle the first two years of progress for health-care reform and the Affordable Care Act (ACA) in Iowa. Now, at the end of the second year of the ACA, we are able — to some extent — to count the successes, some sad outcomes, and end the blog.

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Health Reform and the Letter of the “Court”

June 25, 2015, was a banner day for many reasons. The U.S Supreme Court decision in King v. Burwell allowing 6 million Americans (more than 40,000 in Iowa) to maintain federal subsidies to help pay for individual health-insurance premiums that were purchased under the Affordable Care Act (ACA) federal Exchange was uplifting. The decision will allow the ACA to become a permanent part of our lives and our culture. In Iowa, Republican Governor Terry Branstad responded to the decision saying the ACA was “unaffordable” and “unsustainable.” I would respond to his comments here, but Paul Krugman’s commentary in The New York Times published same day as the decision is a far better response than anything I could write.

In concluding his commentary, Krugman wrote, “Put all these things together and what you have is a portrait of policy triumph — a law that, despite everything its opponents have done to undermine it, is achieving its goals, costing less than expected, and making the lives of millions of Americans better and more secure. … And it’s a beautiful thing.”

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Health Reform and Quid Pro Quo

This week, a high-ranking politician left a phone message for me at my clinic. He asked that I call him. The purpose of his call, according to the note from my receptionist, was “politics.” I did return his call and left a message. He called me back while I was out at a movie. Stepping out of the movie to look at my phone, I found that the purpose of his call was direct and to the point: He asked for money for his political campaign fund. Another politician currently running for office has called me at various times during my work hours. He called once just as I prepared to do a knee injection for a patient and again while I was making rounds at the hospital. During each call, this politician asked for campaign money.

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Health Reform and Numbers

60. I start and end this blog post with selected lines from poems. Dylan Thomas began his Poem in October with: It was my thirtieth year to heaven. Today marks my sixtieth year to heaven (I hope), and, instead of Dylan Thomas describing the beauty of Wales in October on his birthday, I am witnessing six months and thirty birthdays later the beauty of Iowa in April. April brings the brightest green grass of the year, the snow-white blossoms of the pear tree in my back yard, and the soon-to-be-red blossoms of my crabapple tree in the front yard. Colors seem to explode from every flower and bush.

Birthdays also mark time in relationship to other events, including the anniversary of the Oklahoma City bombing. Albert Einstein died 60 years ago yesterday. Sixty years ago this month, Churchill left office as the prime minister of Great Britain. The American Revolution started 240 years ago on this date. For me, dates give a sense of one’s location in both the positive and negative swings of history. Correspondingly, numbers can give us perspective and relative significance of the people, events, and details of our lives. Today, I review some numbers that I have heard over the past several months, numbers that cause me to reflect on health reform, both positively and negatively.

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Health Reform and Aligned Incentives

In further discussing the now-dissolved CoOportunity Health, as well as Governor Branstad’s proposed plan to turn over the Iowa Medicaid program to a private managed-care company or set of companies, I was going to title this blog entry Health Reform and the Need for Nonprofit Entities, which may, in the end, be what the readers of the blog may feel is my conclusion. Instead, I chose the current title to reflect a refinement of my views over the years. To understand this refinement, I want to start this post by going back to 1993.

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