Our family has been able to afford health insurance, and has had continuous coverage since my career in transportation began in 1984. It is a budget priority, regardless of our work situation. With the April 2013 16.3 percent increase from Wellmark Blue Cross and Blue Shield, our health insurance policy payments will comprise one third of our household budget, by far the single highest expense we have. Nonetheless, we have been able to make the payments, even in the toughest of times.
Not so with about 400,000 Iowans who participate in Iowa Medicaid. This number is expected to grow should Iowa opt into the Medicaid expansion proposed under the Affordable Care Act. Here’s a quick look at how health care is provided outside private insurance in Iowa.
Iowa has a four-part plan to help with access to health care. There is Medicaid, hawk-i, IowaCare and Medicare. Eligibility requirements for Medicaid are located here, and the program includes low income, children, the disabled, elderly and other categories of people. Children make up 57 percent of Medicaid participants, and they make up 19 percent of the costs. The hawk-i program is for uninsured children of families whose income exceeds the eligibility requirements for Medicaid. According to the IowaCare web site, “IowaCare is a health care program that provides limited services for people who are not otherwise eligible for Medicaid. The purpose of IowaCare is to provide some health care coverage to people who would otherwise have no coverage.” These programs, and Medicare for people 65 and older, are part of Iowa’s social safety net.
Jennifer Vermeer, Iowa Medicaid director, recently provided an overview of Iowa’s Medicaid system to the Legislative Services Agency. The audio can be heard here. Here and here are recent presentations she gave to the legislature.
There are two points of interest in the current discussion over how lower income people will be treated under the Affordable Care Act. First, our family might become a lower income family, and will potentially need coverage through one of the programs, including Medicare. Second, there will be a cost associated with covering additional people who do not have the means to purchase health insurance. Costs should be studied, and thoroughly vetted, as it will impact us as taxpayers.
I favor further public discussion of the issue, but the discussion has to move beyond whether one is for or against Obamacare. In a letter sent to my state representative, I laid out what I think should happen in the public debate. I am looking forward to seeing how the conversation develops, and whether a conversation develops in lieu of the mutually assured political destruction of launching hyperbolic talking points back and forth across the legislative aisle.