This week State Senator Matt McCoy, Representative John Forbes and former Senator Jack Hatch presented a “Public Option” to replace Iowa’s Obamacare Exchange. Earlier this year, the three major insurance carriers that sell coverage on the Iowa Exchange – Wellmark, Medica and Aetna – announced they wouldn’t participate in 2018. The withdrawal of these three insurance carriers leaves 72,000 Iowans without any insurance options for next year. With this looming insurance crisis these three Democrats decided they weren’t going to allow vulnerable Iowans to lose their coverage without a fight.

Compare that to the near silence from Iowa Republicans, including then-Governor Branstad and Lt. Governor Reynolds. In a May 4th article in the Des Moines Register, all the Iowa Republicans quoted including Governor Branstad, Senator Grassley and Senator Ernst said it was up to the U. S. House and Senate to fix the Iowa problem. They totally refused to address the specific Iowa Insurance Exchange crisis.

The initial reaction from Iowa’s Insurance Commissioner, Doug Ommen, was similar. He said his hands were tied unless Congress acts. “This is a federally created situation, and we need a federally created solution,” he said.

McCoy, Forbes and Hatch decided that they couldn’t wait for the feds to make a decision. This Iowa Healthcare crisis required an Iowa solution, and they began to research options. They called for a public forum on May 22nd and invited Iowa Insurance Commissioner Ommen. That pubic meeting generated a number of suggestions and possible solutions from Ommen, the Democrats and the public. It’s important to note that these three Democrats called for a bipartisan meeting with the Branstad-appointed Insurance Commissioner in an effort to seek common ground with Republicans. Compare the Iowa Democrats bipartisan public approach to the U.S. Senate Republicans’ secret healthcare meetings. The Senate Republicans have excluded not only Democrats but all the healthcare stakeholders involved.

Following the May 22nd Iowa meeting, Insurance Commissioner Ommen went to Washington and met with Trump’s Health Care Administrator. He returned to Iowa with a stop-gap plan that would offer continuing coverage on the Exchange. Ommen went from saying in May that his hands were tied to a meeting in June that created an Iowa Heathcare plan. We must assume the pressure from these three Iowa Democrats helped motivate him to search for a solution.

Following Ommen’s release of his stop-gap plan, these three Democrats along with other Democratic legislators met and thoroughly examined the Ommen proposal. After several conferences they designed their own “Public Option” alternative.

The public meeting this week was called by McCoy, Forbes and Hatch to examine Commissioner Ommen’s plan, present their Democratic plan and get more public input on both. Ommen was invited but declined to attend the second public meeting.

The Democrats’ “Public Option” solution they are proposing would utilize Medicaid as the vehicle to get the 72,000 Iowans insured for 2018 and beyond. The most appealing piece of the Democratic plan is the reliance on Iowa’s proven history with Medicaid.

Prior to Branstad’s disastrous Medicaid privatization, Iowa’s government-run Medicaid program was the envy of the nation. It had low overhead, provided quality care and was less costly. The Democrats plan would eliminate the failed Branstad/Reynolds Medicaid privatization, return Medicaid to state-run control and simply allow the 72,000 individuals and families to buy into Medicaid at affordable rates. The state-run Medicaid program would reduce costs by taking the profit out of the privatized system and use it to lower premiums and or deductibles.

The Democrats acknowledged and thanked Ommen for his stop-gap proposal, but pointed out the serious flaws in his plan. It would clearly result in higher premiums. Medica stated this week that if they re-enter the exchange under the Ommen plan they will raise their premiums by 43%. The Ommen plan would offer $80 million in taxpayer funded reinsurance for high risk customers. This is a huge profit boosting gift to Wellmark in order to lure them back to the Exchange. Wellmark has said they would re-enter the market based on Ommen’s proposal getting implemented quickly.

Iowans have real world experience comparing private and public insurance options. Iowa’s public Medicaid was working extremely well prior to Branstad/Reynolds blowing it up with their catastrophic private alternative. McCoy, Forbes and Hatch are proposing that Iowa return to a proven, economical and quality public Medicaid option. Other insurance companies could compete, and we can have a verifiable test between the public and private choices.

This battle is just beginning and it will be a fight. Private insurers won’t easily give up their control, or their profits and it will require all Democrats to unite behind the “Public Option.” These three Iowa Democrats will need the public’s support to make this work.

by Rick Smith

Posted 6/23/17