The Democrat majority party has introduced a bill in the Iowa Legislature designed to make insurance coverage more affordable for Iowa families and small businesses. The legislation is based upon eight recommendations made by a public/private commission that held meetings and public hearings across the state over the past six months. You can access the full committee report at www.legis.state.ia.us/lsadocs/IntReport/2008.
The chief provision of the legislation requires parents to have health care coverage for children under the age of 18 by December 31, 2009. During the course of the public meetings held by the Commission, legislators learned that 97 percent of Iowa’s children are currently covered by health insurance. The remaining three percent amounts to roughly 45,000 children; 26,000 of whom qualify for Medicaid or HAWK-I, but are not enrolled in either program.
In order to administer the mandate, the legislation calls for the formation of a new state agency called the Iowa Health Care Coverage Exchange (the Exchange). Under the proposed bill, the Exchange would attempt to enroll uncovered children who qualify but have not enrolled in the Medicaid or HAWK-I programs. In addition, the Exchange would offer lower-cost health care coverage subsidized at a lower level to Iowa families who earn up to 300 percent of the federal poverty level (this equates to approximately $62,000 for a family of four).
For children who do not qualify for the Medicaid or HAWK-I programs, the Exchange would work with Iowa insurers, operating as a statewide insurance agent to broker the sale of insurance plans to families who meet the financial guidelines. The Exchange and its Board are also charged with setting benchmarks that insurance plans must meet in order to be offered by the Exchange, as well as setting the premiums that can be charged by the participating insurance companies. If a qualifying parent’s child is not covered by insurance, the legislation gives the Exchange the authority to enroll the child and bill the parent.
While the focus of this legislation is to mandate coverage for all children, the Commission’s recommendations call for universal coverage “to ensure that all Iowans have access to private insurance at a pre-determined rate ceiling and without preexisting conditions exclusions.” While the sponsors of the bill acknowledge the current state budget does not allow the legislation to include adults, the bill will have “trigger” language that will allow the program to expand as funds become available.
While the legislation offers guidance on the direction of the plan, it also leaves many unanswered questions and concerns. For instance, although the Medicaid and HAWK-I programs have been in existence for many years, 26,000 children remain uncovered. The legislation does not explain how the Exchange would identify parents that qualify for subsidized health insurance, let alone force them to pay for it. Because the Governor’s proposed budget did not include any kind of funding for the legislation, it is unclear from where appropriations to pay for the bill will come. Finally, it is unclear how many insurance companies will be interested in participating in the program if they are not given any control over premiums in the program.
Other recommendations by the Commission attempt to offer solutions to reduce the high cost of health care. This includes creating a statewide system of electronic health records, developing chronic disease management strategies, strengthening the Certificate of Need process, and supporting efforts to help consumers take more responsibility in the prevention and management of their wellness to avoid health problems. These solutions are more likely to receive bi-partisan support.
While the goal of mandating health insurance for every child in Iowa is a laudable goal, my concern is the state’s increased role in the current proposal. Expanding and mandating subsidized health insurance coverage for all Iowans is not the right direction for our state. Instead, solutions that expand consumers’ role in controlling their own health care costs, as well as providing education and requiring accountability for medical care costs better serves the citizens of Iowa. I look forward to working with the majority party to explore these ideas as the bill moves forward.
There is still time to complete my legislative survey at www.voteboal.com. I appreciate your feedback on these important issues.
E-mail: carmine.boal@legis.state.ia.us
www.voteboal.com
Home Address: 3301 SW Timber Green Road, Ankeny 50023
Home Phone: 964-3335