Making health care accessible, affordable, and portable

We are offering a set of bold, state-based initiatives to make health care more accessible, affordable, and portable.

Health care reform solutions need not come from Washington, DC. In fact, the best reforms are often those developed closest to the people. Iowans do not need to wait for national politicians to act. Instead, they can join with us in pursuit of a set of common sense Iowa Health Care Initiatives and solve Iowa problems with Iowa solutions.

ACCESSIBILITY

Patients Right to Know Act

As with any product or service, the more information consumers can access to compare the costs and quality of that product or service, the lower the cost and the higher the quality of the products and services they ultimately consume.

Consumers have been slow to embrace market practices to the delivery of health services and, as a result, costs may remain high and quality is often unknown.

We believe the information age provides a tremendous opportunity to dramatically improve access to tools that compare cost and quality in the delivery of health care services on-line. We will propose legislation to establish a statewide information hub that brings together both cost and outcome quality data in a searchable format for online consumers.

Cost and quality transparency will empower consumers to make better health care decisions in a way that maximizes quality while minimizing cost.

Low-Cost Catastrophic Health Plans for those Under 30

Iowans age 18-30 are known as the “Invincibles” as they often believe, given their relative youth and good health, health insurance is a product they do not need. As a result, when they do have to seek medical treatment it is often for a serious condition and very expensive.

In fact, there are 106,000 Iowans in this age group who do not have health insurance and account for roughly half of all the uninsured in the entire state. We will propose legislation that will encourage the development of low cost catastrophic insurance products that will provide base care for younger Iowans and limit the amount of uncompensated care that results when uninsured young Iowans need medical treatment.

AFFORDABILITY

Medical Malpractice Reform

No serious attempt at reducing rising health care and insurance costs can move forward without an honest attempt to address the issue of medical malpractice and tort reform.

We have continually championed the need to pass legislation that raises the burden of proof on medical malpractice claims and places reasonable limits on payment for damages.

Expand Health Insurance Tax Deductibility to Individuals and Small Business

Current law allows large employers the opportunity to deduct health care costs “above the line” – meaning a straight dollar for dollar reduction in their taxable income equal to the employer share of health insurance costs and provides a tremendous incentive to provide health insurance to their employees.

Thus, it should be no surprise an independent study shows 94% of employers who have 50 or more employees provide health insurance, whereas 36% of employers who have 10 or fewer employees offer health benefits.

With a significant portion of our population now working for small businesses or for themselves, we believe such above the line deductions for health insurance costs should be extended to all businesses and individuals, be they subchapter S corporations, limited liability companies, partnerships or sole proprietors.

Some estimates suggest an above the line deduction for health insurance costs may provide a 30% savings on such costs and provide a significant incentive to offer health insurance benefits to their employees. It’s simple: if it’s good enough for Wall Street, it should be good enough for Main Street.

Prevention Credits: Putting a Premium on Wellness

Prevention programs that encourage long-term commitment to wellness practices are proven to reduce demand for expensive health services and contain future growth in health care spending. However, our current system chooses to focus on imposing penalties on those who practice less healthy lifestyles (smoking, poor food choices, lack of regular exercise) through higher insurance rates rather than rewarding good health practices with lower rates.

These “prevention credits” will allow an average Iowa family to save upwards of 15% on their health insurance premium or $1,635 on an average family policy. According to the United States Department of Health and Human Services there is a return on investment of up to $4.91 for every dollar spent on wellness. This shift in policy will save Iowa families real money while reducing the long term cost of health care in the state.

We propose legislation to require insurers to offer “prevention credits” to individuals and businesses that can be used to reduce health insurance rates for those individuals and businesses that demonstrate, through measurable periodic screening practices, a commitment to wellness and prevention.

This “carrot instead of the stick” approach to prevention and wellness should encourage more Iowans and their employers to actively pursue the promised savings through participation in health and wellness practices that reduce health costs in the long term.

PORTABILITY

No Pre-Existing Exclusions when Changing Plans with the same Insurance Provider

Nothing strikes fear in the hearts of those seeking continuation of health care coverage than the words “pre-existing conditions”. We propose legislation that prohibits the denial of coverage or the imposition of coverage riders due to pre-existing conditions when an insured Iowan moves from one plan to another plan offered by the same insurance company.

The simple act of moving from Plan A to Plan B (for whatever reason) within the same insurance company should not provide an opportunity to base coverage exclusions as if the employee were accessing coverage with that company for the first time. If the company assumed the risk 20 years ago, it should continue to assume the risk without further exclusions.

A Who Knew What Mystery

Culver said he found out about the initial findings Sept. 15, while traveling in eastern Iowa with Tramontina.
“Culver pledges to work with film companies to sort out tax credits”
- Thomas Beaumont Des Moines Register 9/21/09

When information was first brought to my attention last week about Iowa’s film tax credit program, I was troubled.
“An outraged Culver: Iowans will not be taken for suckers”
- Jason Clayworth Des Moines Register 9/22/09

Tramontina submitted a request for proposals Aug. 10 to find an accounting firm to review operations and expenditures of the Iowa Film Office, which is part of economic development department.

He hired the Clifton Gunderson firm of West Des Moines on Aug. 19.
“Film tax errors seen as early as July”
- Lee Rood Des Moines Register 9/23/09

On Tuesday, Governor Chet Culver in Cedar Rapids said at least three times he learned of the tax credit fiasco either "last Tuesday" or "last week". When I asked him to clarify later on during his news conference, he said he had heard about possible problems before then and that's why he said he directed his legal counsel to push for the audit/review/investigation (whatever the proper term would be here) that now-former Iowa Dept of Economic Director Mike Tramontina discussed in a memo last Wednesday.
“Iowa Lawmaker Says Legislators Knew of Film Issues Early Summer”
- Dave Price “Price of Politics” 9/24/09


SEPT. 15: Gov. Chet Culver first hears of problems with the film tax credit, he says. He asks Tramontina for a summary by the end of the next day.
“Miller: Official's assertion on film credits 'mistaken'”
- Lee Rood Des Moines Register 9/25/09

Phil Roeder, spokesman for Culver, said Tramontina raised concerns about the purchase of the automobiles in August, but nobody brought up the depth of the program’s problems until September.
“Lawmaker said he had concerns about film tax credit program months ago”
- Charlotte Eby Waterloo Cedar Falls Courier 10/6/09

"It is critical that the Department of Economic Development immediately prevent additional spending for this program," Sen. Bill Dotzler, D-Waterloo, wrote to Mike Tramontina, the department's director, on Aug. 6. Dotzler send copies of his letter to the governor's office, state auditor and attorney general.
“Records show Culver's office was notified about film office trouble in August”
- Lee Rood Des Moines Register 11/7/2009

The question the Governor now needs to answer is what did he know and when did he know it? Governor Culver clearly stated that he did not learn of the problems at the Iowa Film Office until September 15th from former IDED Director Mike Tramontina. Yet both his spokesperson and the Governor himself stated that they knew of the irregularities in August. In fact the Governor went on to claim that he pushed for the audit put out for an RFP by Tramontina on the 10th of August. So Governor what did you know and when did you know it?

Restoring the Fiscal Balance: Iowa Family Budget Initiatives

We have real solutions to help solve Iowa’s budget crisis and protect the very family budgets that will be at risk if bold action is not taken quickly.

Constitutional Limit on State Spending
We will propose and support an amendment to the Iowa Constitution to limit state spending to no more than 99% of state revenue. The current budget limitation law doesn’t work and, just last year, the legislature authorized nearly 70 loopholes in the current law to allow their outrageous spending increases.

Only an amendment to the Iowa Constitution is immune from legislative loopholes. Limiting spending to 99% of revenue ensures a balanced budget and the annual deposit of money into a rainy day fund. In the meantime, we pledge to pass NO budgets that exceed the 99% limit.

Iowa families must live within their means--Iowa state government should be no different.

Supermajority Vote to Approve New State Debt
This year the Governor signed and a majority of the legislature passed legislation that puts Iowa taxpayers on the hook for a $1.7 billion debt. The average Iowa family’s share of that debt is more than $2,000.

This debt was passed with support form only one party and was done despite statewide polling that showed 70% of Iowans opposed this additional debt. Iowans need greater protection from runaway state debt and these decisions should require more than a simple majority vote—especially when the repayment of the debt may extend for more than two decades and impact taxpayers too young to vote or not even yet born.

We propose requiring a 2/3 supermajority vote of both houses of the Legislature to authorize new state borrowing. Never again should one party have the sole authority to create these long-term debt burdens.

At the local level a 60% vote of the people is required to adopt new debt to ensure there is widespread community support for the projects to be funded. At the state level a 2/3 supermajority vote of the Legislature will help guarantee the same kind of broad support for similar state efforts.

We support pay-as-you-go budgets as the best method for funding state programs. However, if borrowing is occasionally necessary to meet critical needs, we want to ensure the support for that borrowing extends beyond the short term political objectives of any one party and meets the needs of a broad spectrum of Iowans. A 2/3 supermajority vote helps accomplish that goal.

Sunset Authorization of Every State Program
During these difficult economic times, every Iowa family has been forced to gather around their kitchen table and examine every aspect of their personal spending. They ask difficult questions and set new spending priorities to ensure their essential needs are met. Unfortunately, this same discussion rarely occurs within state government.

We propose a systematic process wherein EVERY program funded by state government will be sunset (de-authorized) by a date certain unless the Governor and Legislature reauthorize that program. This will force a thorough top-to-bottom review of every existing program funded by state government to determine whether the program is effectively and efficiently meeting the needs for which it was created, or if the need even continues to exist.

Those programs that are no longer relevant or functioning at a high level will be eliminated, reorganized, or the resources diverted to other priorities--just the way Iowa families eliminate spending that no longer meets their personal needs.

Incremental budgeting practices have led to a bloated and expensive state government that is both unsustainable and a drain on Iowa taxpayers. We will streamline state spending and state programs in a way that protects taxpayers from excessive state spending and ensures better delivery of state services to those in need.

A History of Fiscal Mismanagement

In Their Own
Words …………….

… a deepening national recession dealt Iowa a serious financial blow that Culver said has left him with no choice but to make "significant cuts in government spending."
“Budget plan dismays some”
- Jennifer Jacobs and Jason Clayworth Des Moines Register 1/29/09

The new revenue estimates mean the cuts must go deeper. "This is the worst I've ever seen. This is the worst in my 27 years in the Legislature," Senate Majority Leader Michael Gronstal, D-Council Bluffs, said Friday during taping of Iowa Public Television's "Iowa Press."
“More cuts in state jobs, services seen”
- Jason Clayworth Des Moines Register 3/21/09

"If you look at how deep this recession was," Culver said, "I'm encouraged to see some of the trends showing improvement."
“Culver's advisers guardedly upbeat about economic turnaround”
- Jennifer Jacobs Des Moines Register 8/11/09

"In spite of the economic challenges brought on by the world-wide recession, and a projected shortfall for the fiscal year 2011 budget ….” Culver said in a statement.
“Culver dips $45 million from emergency reserves to balance budget”
- Jason Clayworth Des Moines Register 9/26/09

And Their Actions Led to ????????

Iowa legislators, intensely worried early this year about a looming recession and the economic toll of natural disasters, ended the 2009 session by approving the largest budget in the state's history - $6.3 billion.
“Federal stimulus plugs holes, but problems loom for future”
- Jason Clayworth Des Moines Register 4/27/09

That caps off a five-year spending uptick that, in total, increased by 25 percent from $5.02 billion in 2006.
“Federal stimulus plugs holes, but problems loom for future”
- Jason Clayworth Des Moines Register 4/27/09

The state's revenue would have to grow by almost 10 percent in the 2011 fiscal year for the state to avoid future gaps, the Legislative Services Agency estimated about a month ago.
“Federal stimulus plugs holes, but problems loom for future”
- Jason Clayworth Des Moines Register 4/27/09

That means the upcoming budget will be almost $6.3 billion, the largest in the state's history, according to the Legislative Services Agency.
“News Analysis: Session recaps often stretch facts”
- Jason Clayworth Des Moines Register 5/10/09


Iowa families cannot afford Governor Culver and Legislative Democrats Record of Fiscal Mismanagement!

Lights. Camera. Action - but not too much action.

“If you build it, He will come.” The Iowa Legislature, in a bi-partisan fashion in 2007 and in 2009, passed film tax incentives to surpass what other states were offering to lure Hollywood into Iowa. Well, the film industry has arrived in Iowa - and it is big business for the state - bringing in film crews, movie stars and the best of Iowa jobs and opportunities. But wait…..like every good Hollywood movie, there is a plot twist ahead.

Dozens of film advocates and Iowans are now worried that a law change passed by Iowa Democrats capping the tax credits in the closing days of the 2009 session will effectively kill the tax breaks and this new Iowa industry.

Iowa Democrats are proud of their achievements and twittering away on how their insight brought economic development to Iowa. Well, that is nothing more than “Hollywood hype.” Congrats, to the promotions department. But, all the airbrushing and press releases can’t hide the fact that the Democrat’s compulsive spending habits have led to the dismantling of this field of dreams. So, they built it, they came, but the Democrat’s cancelled the game.

All the movie magic in the world can't cover this one up. Democrats are, yet again, trying to have it both ways. They need the economic dollars to balance out their flawed budget but don't want to give too many breaks/incentives. This is one tale that won't end well as Iowa's Hollywood dreams are quickly fading to black.


Click here to watch a video on an awesome opportunity Iowa has with the film industry, but thanks to the Democrats' tax caps, this could be the last pirate ship that sets sail here.