Washington Week: Student Voices (O)

U.S. may copy Iowa health care
By Adam Sullivan
The Daily Iowan, U. Iowa
December 15, 2008

National leaders may look to Iowa as a model for restructuring the country's ailing health-care system, local experts said.

State lawmakers passed a handful of landmark health-care legislation in last year's session. For instance, the Legislature OK'd a measure that will expand health-care coverage to almost all of the state's children by 2011.

"I think we're one of the leading states in looking at health-care reform," said Sen. Joe Bolkcom, D-Iowa City. "The legislation we passed this year is very progressive in that regard."

He predicts national leaders will look to several states' policies when drafting a national health-care reform plan.

"The states are really the places where experimentation is happening," said Bolkcom, who serves on the Iowa Senate's health and human-services subcommittee. "Federal reform will likely be based on the best practices."

Iowa has the second best health-care system in the nation, according to a report by the Commonwealth Fund - a nonprofit foundation aimed at expanding health-care coverage. More than 90 percent of Iowans have some form of health-care coverage.

But there are still holes to patch in Iowa's system: For one, the state has nearly 300,000 uninsured citizens, Bolkcom said. And paying to those holes, especially with the current economic climate, will be a challenge, experts said.

Iowa Gov. Chet Culver announced last week that the state budget would be trimmed by approximately $40 million. Officials said they're hopeful those cuts won't threaten the health-care progress they've made.

Bolkcom said there are two key issues posing a challenge to state health coverage. The first is maintaining the $25 million set aside to insure Iowa children, and the other is sufficiently funding Medicaid.

And budget constraints on the national level are likely to be just as tight.

"Obviously, [lawmakers are] going to be very tentative of moving toward any sort of benefit expansion that doesn't have some sort of cost savings associated with it," said Brian Kaskie, a UI associate professor of health policy. "How we're going to achieve this is by cutting back or improving efficiencies on other things."

Not paying to fix the U.S. health-care system could prove to be even costlier, however.

Health-care costs, which Kaskie said are already too inflated, will continue to rise if unchecked.

"Providers are going to continue to claim their costs are going up," he said. "The cycle will go on."

Bolkcom is cautiously optimistic that, despite economic strains, federal lawmakers will be able to expand health coverage.

"We need a federal health-care solution," he said. "The Obama administration has its hands full dealing with this dire economic downturn - all projections indicate he has a very rough year ahead. But there is some opportunity, hopefully, to rally people around progressive health-care strategies."

And officials are confident Iowa has a system that the new administration can call on for inspiration.

"The president-elect is sending a pretty strong message that health-care reform will be first on his agenda," said Christopher Atchison, an associate dean in the UI College of Public Health. "It's our hope that Iowa's legislation represents a wonderful state-based model that the nation should look at … as something that could give some guidance."

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