In 1993, during the Clintons’ attempts to create health reform, the Iowa Academy of Family Physicians came forward with the Principles of Health Reform (present in archives), which I helped to write. Number one and the most important principle was that individuals should have the peace of mind of knowing they and their families have access to affordable, comprehensive health care.

Failing in that effort in the early 1990s to achieve broad health reform, as Senator Tom Harkin would tell you, Congress and individuals throughout the country sought to make incremental improvements in the system. One of the major efforts was made in the area of children’s health care. During that time, the Healthy and Well Kids in Iowa (HAWK-I) program was conceived, developed, legislated, and passed into law. Working on that effort, I wrote a piece published by The Des Moines Register (present in archives) that described a child arriving at school with a cut held together with rags and electrical tape because of the family’s inability to afford health care. I would submit that that parent did not have peace of mind regarding his or her child’s health.

As a parent and now a grandparent, I understand the angst when one is concerned with the health of a child or grandchild. One of my most poignant moments as a physician was when a 90-some-year-old patient of mine expressed concern over her 70-year-old daughter, whom I had also taken care of. Her daughter had been dealing with serious medical issues and eventually was transferred to University of Iowa Hospitals for ultimate resolution of her problems. The mother remarked to me, “My baby was really sick then.”

Pete Damiano, a professor in the College of Dentistry and the director of health-policy research at the University of Iowa’s Public Policy Center, has extensively researched the effects of HAWK-I and has clearly shown that HAWK-I has significantly improved the parents’ peace of mind regarding their children’s ability to receive good health care when needed.

I hope that the effects of the ACA will someday be similarly researched by Dr. Damiano and that he will ask and find out that the ACA has improved the peace of mind of those individuals able to access the health system in new and improved ways.

It is with this lens of the individual’s peace of mind that I shall look at the effect of the ACA’s various parts, be it the Exchanges (Marketplaces), Medicaid expansion, health-care access and outcomes, private insurance options, etc.

This emphasis on peace of mind has limitations, as many undoubtedly have already thought of while reading this entry.

Two countervailing demands referenced by those Iowa Principles of Health Reform were the need to be cost-conscious and patient responsibilities. While having these elements in mind, I shall continue to use peace of mind as a reference point for our future discussions.

Unfortunately, the collective peace of mind is not being improved by the chaotic, confusing, and stuttering run up to January 1, when the ACA’s key provisions start. Despite this run up, January 1 will come, and the new system will unfold.

If the insurance marketplaces work, if insurance offerings are affordable and available, if the health-care system provides quality and efficient care, if patients become active team members in an effort to improve their health, we shall have a better system, and, I believe, we will begin to accomplish that first principle of health reform.