Several months ago in this space, I discussed my concerns about a Trump presidency regarding the Latin phrase “primum non nocere,” which means “first do no harm.” Now, at the end of the 2018 Iowa Legislative session, I revisit this phrase to discuss my concerns about the results that this Republican-dominated Legislature and the Republican governor have created or are creating.

Given a budget deficit that required cuts for the current fiscal year and a poor farm economy that may worsen, the Republicans have announced the “largest”-ever tax cut for Iowans. This will surely lead to even less money for government services in years to come. For health care specifically, Republicans have ignored and continued a flawed, private, for-profit, Medicaid managed-care system, as well as passed a new law allowing associations to create health plans that will discriminate against people with existing health-care conditions. This plan, which was pushed by the Farm Bureau and Blue Cross and Blue Shield’s Wellmark, will undermine the insurance market and destroy vital aspects of the vision and gains of the Affordable Care Act (ACA). The plans to be offered will not include ACA-mandated health-care requirements, such as maternity care and mental-health care.

Health care in Iowa will suffer because of these developments.

On Tuesday night next week, I will attend a fundraiser for Dr. Andy McGuire, who is a Democratic candidate for governor. She is making health care a major focus of her campaign. On Thursday, I will attend a federally mandated Medical Assistance Advisory Council (MAAC) meeting, which has the responsibility to critique this Iowa version of Medicaid.

I know examples of patients not receiving services and of some health-care entities that are owed millions of dollars by these private, for-profit, managed-care companies.

I fear that 2018 will go down as a watershed year for health care in Iowa. I hope that the fall elections will be a referendum on what kind of health care we Iowans want for ourselves and our families and that 2019 will undo some of the damage that is being perpetrated upon Iowans this year.