Category Archives: Iowa

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.

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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.

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Health Reform and Answers from Iowa Candidates

Over the past months I have been inundated with requests for campaign contributions, and I looked for a way in which to make informed decisions about which candidates to support. In last month’s blog post, I shared two questions I posed to Iowa candidates running for U.S. Congress, the Iowa governorship, and the Iowa Legislature. The questions asked were an effort to engender better knowledge of just two of the complex issues surrounding the Affordable Care Act (ACA). At that time, I said I would make a $1,000 campaign contribution to the candidate who provided the most-specific answers to my questions and allow the responses to be posted on this blog. If I received thoughtful responses from several candidates, the $1000 contribution would be shared.

To date, I have received only one response, that of Senator Jack Hatch, who is running for Iowa governor. I have posted his response below. I sincerely appreciate Senator Hatch’s response. The opportunity for candidates to submit a response to my questions remains open until August 15. S.S. McClure, editor and publisher of McClure’s Magazine, once said, “The vitality of democracy depends on popular knowledge of complex questions.”  I seek candidates’ answers for just two of the many complex questions surrounding the ACA. Please let the candidates you support know about this campaign-contribution opportunity. Help me share “popular knowledge about complex questions.”

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Health Reform and Questions for Iowa Candidates

During the Golden Age of Journalism, S.S. McClure, editor and publisher of McClure’s Magazine, who is credited with developing some of the best journalists of the 19th century, said, “The vitality of democracy depends on popular knowledge of complex questions.”

Complex questions are currently before the public involving health care, and, specifically, the unfolding and future of the Affordable Care Act (ACA) or Obamacare are clearly among the most complex questions our society faces.

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Health Reform and a Modest Proposal: Outsourcing the Federal Exchange

In previous blog posts, I have attempted to highlight the absolutely critical need for a functional, user-friendly Exchange for Iowa as outlined in the blueprint for health reform that the Affordable Care Act (ACA) laid out. Iowa’s failure, at the beginning of the ACA process, to establish an Iowa-exclusive Exchange — an Exchange operated by Iowans for the exclusive enrollment of Iowans — resulted in a hybrid or partnership between the state of Iowa and the federal Exchange (www.healthcare.gov). The results of that partnership have been neither reliably functional nor user-friendly. On Monday, March 31, I met with members of Senator Tom Harkin’s staff in Washington, D.C., and presented to them the following proposal. The proposal is self-explanatory. Since then, there are reports that the state of Iowa has applied for federal resources from the Department of Health and Human Services to plan for a state-managed, state-government-operated Exchange.

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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.

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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.

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Care Coordination (PCMHs) vs. Assumption of Risk (ACOs): Holy Grail of Health Reform?

(Given as testimony on November 19, 2013, to the Iowa Legislature’s Integrated Health Care Models and Multi-Payer Delivery Systems Study Committee)

The Holy Grail of health reform is controlling costs while still providing access and quality. In my mind, the key to finding this Holy Grail is care coordination, forms of which can include patient-centered medical homes (PCMHs) and accountable-care organizations (ACOs). As a former member of the federal Advisory Board for the federal health-care Consumer Operated and Oriented Plan (Co-Op) Program, I helped write recommendations regarding “integrated care,” which was a legal requirement for becoming such a co-op. Our Advisory Board recognized both PCMHs and ACOs as reasonable forms of “integrated care.”

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A Culture of Coverage and Health Reform

(This month’s blog post is the text of an article that I was asked to write for a professional publication.)

As chair of the Iowa Tobacco Use Prevention and Control Commission, I was responsible for helping to guide Iowa’s anti-smoking efforts by following a mission statement created by the Iowa Legislature that read, “to foster a social and legal climate in which tobacco use becomes undesirable and unacceptable.” In this same vein of using legislation to create social change, I will review the actions derived from the Affordable Care Act (ACA), also known as Obamacare, in Iowa. From this family physician’s reading of the ACA, I submit that the underlying social change goal is to create a “culture of coverage,” which  means that, within certain constraints, the citizens of the United States, and residents of Iowa in particular, will have the expectation that they have health coverage and that they will, in part, be responsible for securing that health coverage.

Obviously this 2,000-page law has many more elements, approaches, and objectives, but for me, this “culture of coverage” is the overarching goal. It is with this goal in mind that I discuss what I perceive as the unfolding of the ACA in Iowa.

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Health Reform and the “Facts” Regarding an Iowa Exchange

Two renowned world leaders have offered “facts” in famous quotations that have bearing on the state of an Iowa health-care Exchange.

Prior to the American Revolutionary War, John Adams, one of our most famous patriots, took on the controversial role of defending British soldiers who had fired on a Boston crowd of protesters. In his successful legal defense, he uttered the famous statement, “Facts are stubborn things.”

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