Category Archives: Medicaid expansion

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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Health Reform and the Economy

My premise for this blog is that the basic tenets of health-care reform found in the Affordable Care Act (ACA) are sound. I have for years advocated for universal coverage, an individual mandate, care coordination as a way to improve the quality and cost of health care, an employer mandate (as limited by the ACA), improved private-insurance competition, Medicaid expansion for adults below the poverty level, and improved insurance regulation. I will not categorically support every action found in the 2,000 pages of the law, but, by and large, I think it provides a framework that can produce positive, significant change and that, over time, can be improved as necessary.

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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.