It is with sadness that I acknowledge the takeover of the cooperative health-insurance company, CoOportunity Health, by the Iowa insurance commissioner. I have touted CoOportunity Health many times in this blog, and I have strongly felt it was a critical part of the current health-reform efforts in Iowa. My sadness is even greater for the 100,000 individuals who had insurance with CoOportunity Health. These individuals’ confidence and coverage are jeopardized because of this action. The health and peace of mind of friends, family, and patients who I know are insured by CoOportunity Health are a major concern for me at this time.
Category Archives: access & costs
Health Reform and Drugs, Drugs, Drugs
The good news. On Wednesday, November 19, CoOportunity Health, the Iowa-Nebraska health-care-cooperative insurance entity that I have touted in several blog posts, insured its 100,000th person for health-care coverage. As I have said before, its projection for the end of this year, its first year of operation, was 15,000 policyholders.
The bad news. CoOportunity Health announced that next year, 2015, it would not participate in the Iowa Medicaid expansion for individuals whose incomes were between 100 to 133 percent of the federal poverty level (FPL). CoOportunity Health simply could not sustain the financial losses for this group of 11,000 Iowans. From my non-insurance and non-actuarial level of understanding, the major issues were 1) the federal government being unwilling to allow for a separate, more accurate actuarial premium amount for this population of newly insured individuals and instead requiring this population to be part of the entire population’s actuarial projection of CoOportunity Health’s premium holders, and 2) the high cost of drugs for treatment of diseases such as Hepatitis C and HIV. For now, this group of individuals will be part of the Medicaid program instead of utilizing the Exchange and being part of the private insurance system.
In this post I’ll discuss several incidents of how the high cost of medicines has negatively affected my patients and the health-care system. The question is: Can health reform, or for that matter the health-care system, survive the upward trajectory of the price of medications?
Health Reform and a Governor Hatch Administration
One of my proudest moments, which was photographed — the photo is displayed in my office at the clinic — is the 1998 signing ceremony for the Healthy and Well Kids in Iowa (HAWK-I) program. I stood with representatives of several medical societies and an Iowa family that included a mom and three daughters while Governor Branstad signed into law a program that helped to make Iowa a leader in the nation in the percentage of insured children.
I worked long and hard with Democratic legislators, Republican Representative Brad Hansen, who also is in photo, and Republican Senator Nancy Boettger to create a program made possible by federal funding that created a public-private system to insure children. For my efforts, in 1999 I received a national Public Health Award from the American Academy of Family Physicians. During the negotiations for the HAWK-I bill, I clearly remember that then-Governor Branstad did not want a quasi-independent board to supervise the program. He stated that in his administration he did not want to add “silos” that prevented him from overseeing the actions of state government.
Fast forward to 2013-2014.
Health Reform and Reminiscences of Hospice Patients
This blog is dedicated to a good friend and patient of mine who died last month in hospice. I had taken care of her for 15 years. We had many remarkable and enjoyable conversations regarding her growing up in a home where her father was a physician. She thought very highly of her father and the profession of medicine. She knew the value of good medical care and how much it means to all of us, even physicians and their families. She had seen the human side of medicine in its effects on her father and her family.
Health Reform, Celebrating, and Parenthood
Celebrate! I celebrate the birth of my granddaughter and the birth and growth of CoOportunity Health. This week, as I drove with my wife and my 2-and-a-half-year-old grandson across the city of Des Moines so we all could meet my newborn granddaughter, I pondered the emotions involved with parenthood: the pride that — even as a grandparent, with only a small part in the creation of this tiny, new life — is still an overwhelming emotion, responsibility, joy, and sincere thanks. Each of these emotions fill a parent, grandparent, or godparent. At the baby’s birth on Tuesday evening, May 27, I was so moved and will continue to be throughout this beautiful child’s life into her adulthood.
Health Reform and “Reprehensible”
Words, at one time or another, have a profound impact on us. As I have watched some of the television commercials currently running and that will, undoubtedly, continue to run, paid for by out-of-state entities, falsely describing the Affordable Care Act (ACA), most often referred to as Obamacare, one word came to mind: reprehensible. Reprehensible is an adjective that declares something morally wrong, evil or disgraceful. My wife added that it seems also to imply the term dastardly. Both words are consistent in describing these too-often-seen commercials.
These commercials imply that the ACA has exorbitantly raised insurance premiums for individuals and denied others the opportunity to renew their insurance policies from last year. This is simply not true when applied to the effects of the ACA in Iowa.
Being Thankful this Health-Reform Season
Jim is a 56-year-old man with diabetes who has been my patient for several years; he is a subcontractor in the construction field in a county seat. (I changed his name and those of others whose examples I cite in this blog.) He is divorced with grown children and is devoted to his grandson. He has been uninsured for years due to his medical problems. Starting January 1, he will have health insurance through the Exchange, which allows people to explore subsidies and to compare and sign up for plans. An insurance agent who would not have had any options to offer my patient last year drove to Jim’s home twice from metropolitan Des Moines to set him up with his new policy.
Welcome to Health Reform in the Heartland
“USA, USA, USA,” cheered the crowd anticipating the upcoming fireworks off Arnolds Park on West Okoboji Lake at twilight on this Fourth of July — thousands of people on land and hundreds in boats on the bay, all celebrating the birth of the land of freedom and opportunity. It is with this sense of freedom (specifically the freedom of speech, which the Des Moines Register reported the same day to be one of our most-cherished freedoms), and it is with this sense of opportunity for the future that I start this blog dedicated to the improvement of health care in Iowa.
During the next 18 months, guest bloggers and I will describe, evaluate, discuss, criticize, highlight, dissect, potentially improve, and — hopefully at some point — complement the effects of the Affordable Care Act (ACA) on the residents of this great state. We will dig into topics of health-care costs (our biggest problem), health-care access, Exchanges (now called Marketplaces), Medicaid expansion, Medicare, competition in the private insurance market, health-care labor needs, independent physician associations, preventive health care and early detection, coordination of care (our greatest opportunity), government vs. for-profit vs. not-for-profit health care, rural health care, and, most importantly, the value and ultimate economic wisdom of ensuring that individuals have health care coverage (to me, the essence of living in a land dedicated to freedom and opportunity).
As someone who has, for more than 25 years, been active in health-policy issues here and nationally, I have witnessed and been a part of many efforts to improve health care; I have met Iowans and others outside of Iowa who have shared with me their wisdom and visions of how health care could be made better; and, finally, I have spent untold hours considering — as a family physician, geriatrician, and hospice director who has had more than 100,000 patient-doctor interactions — how these theoretical ideas can affect real patients’ lives.
For better or worse, I share some of this with you in this blog. For the better, I will ask some of these wiser individuals whom I have met to guest blog about their own really fine thoughts and ideas.
This blog will end on December 31, 2014, with a summary of how the Affordable Care Act has fared in Iowa. The next 18 months will be a watershed for health care. Iowa, as always, will be a microcosm for this unfolding of the future of health care. That said, let us get started.