This is a proposed political ad for our upcoming election to be paid for by a proposed political action committee named Pre-Existing Conditions Political Action Committee (PEC PAC).
PEC PAC commercial — Take One. Continue reading
Category Archives: rural health care
Health Reform and Primum Non Nocere
Following the admonition to “First do no harm,” I will refrain from sharing a post I wrote before the presidential election that would not promote a productive conversation regarding the future of health reform. Instead, I will share some immediate thoughts regarding the future President Donald Trump.
Health Reform and “Under Duress”
I was quoted in the Des Moines Register on Friday, November 27, regarding the Medical Assistance Advisory Council (MAAC) meeting that I attended on Wednesday, November 25. The topic is familiar in this blog: Medicaid managed care. The federally mandated council advises the state of Iowa on Medicaid issues and is one of the major overseers of the upcoming Medicaid managed-care “modernization” that is currently scheduled to begin on January 1, 2016 — four short weeks from today. The approximately 30 other members of the council and I spent two hours raising questions and concerns with the Iowa Department of Human Services and representatives from the four managed-care organizations (MCOs) that will divide 550,000 Medicaid patients and more than $3.5 billion in state and federal monies.
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, 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 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.
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.”
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.