Health care reform now a year old: What's the impact been on Iowa?

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The health-care reform law will turn a year old Wednesday.

If there’s a party, expect a lot of arguing.

Polls say the public is deeply divided over the law, and the courts and Congress have thrown a blanket of doubt over its prospects for a long life.

Meanwhile, Iowa’s top political leaders are taking — not surprisingly — strikingly different views on how the law’s early provisions have affected the state.

Most of the health reform law’s major pieces won’t take effect until 2014.

That’s when the insurance exchanges — marketplaces where people will be able to buy small group and individual policies — will begin operating.

But in the past year, a handful of provisions have rolled out.

Among the most prominent:

  • Prohibitions against denying children insurance coverage because of pre-existing conditions (that will be the case for all people in 2014).
  • Restrictions on the ability of insurance companies to limit annual payments for essential benefits.
  • Tax credits for small businesses.
  • The ability of parents to keep kids on their policies until they reach the age of 26.

Also, a high-risk insurance pool has opened its doors, and Medicare has been picking up more of the cost of prescription drugs.

All of these are being felt and appreciated, U.S. Sen. Tom Harkin, D-Iowa, said.

“Most of the things that have rolled out early, especially consumer protection provisions, have been widely accepted,” Harkin said last week.

Sen. Chuck Grassley, R-Iowa, who voted against the law, agrees the early measures have had an effect on the public. But they’re not as advertised, he said.

Grassley blames premium increases on the new law, says he’s heard of troubles getting coverage in Oklahoma and worries people who have been told they’ll be able to keep the coverage they have may find otherwise.

He also questions how much benefit seniors are getting from the prescription drug provision, given it requires a senior to buy brand-name drugs to get reimbursed, rather than cheaper generics.

“All the promises that were made about how this bill was so great are ringing hollow for more and more Americans every day,” he said.

Margaret Tweet, a Rock Island woman who supports the new law, said the $250 rebate check she got last year helped defray some of the cost of the medications she takes for a liver condition.

“It was a real bonus to get that,” she said.

And this year, the law will give her a 50 percent discount on brand name drugs when she reaches the coverage gap in Medicare’s prescription drug program.

Tweet isn’t sure whether she’ll be able to benefit from that yet, however, because the drug she takes now is a generic, which wouldn’t qualify.

But she added the generic isn’t that much cheaper than the brand name drug, so she might switch.

One early provision of the law, an insurance pool for people who can’t get coverage elsewhere, has drawn fewer than 150 applications. Officials had once thought they would have to cap it at 1,000 enrollees.

The pool provides cheaper coverage for people who were denied it before, but the relative lack of use is puzzling.

Cecil Bykerk, executive director of the plan called HIPIowa, said the cost may still be too high. Also, political turmoil may be part of the cause, he said.

“There’s a lot of concern health care may be on its way out,” Bykerk said.

Since the law was signed, states such as Iowa have begun preparing behind the scenes to set up the exchanges to meet the legally mandated start date of Jan. 1, 2014. Iowa got a $1 million grant to begin the work.

Even though the start date is nearly three years away, there still is some urgency. The federal government must approve the design of the exchanges Jan. 1, 2013, and they must be ready to accept applications three months before going online.

In Iowa, the state Department of Public Health, the insurance division and the human services department formed a working group last year to make plans.

In a letter to the Obama administration last month, Public Health Director Marianette Miller-Meeks wrote the state had made “significant progress” utilizing the grant it got. And, she said, “at this time, we are committed to continuing our examination of how Iowa will structure such a health benefits exchange to best meet the needs of Iowans.”

Tim Albrecht, a spokesman for Gov. Terry Branstad, said the governor had instructed state agencies to prepare for the law’s implementation, even though he thinks it will be overturned by the courts.

“We don’t want to be caught flat-footed,” he said.

Branstad has been critical of the law and worries what effect it will have on the state’s Medicaid budget. Backers of the law, including Harkin, say federal reimbursement for additional state costs will cushion most of the blow, although that is in dispute.

Branstad has joined other GOP governors in demanding changes to the law.

Earlier this year, he joined other Republican governors in a letter warning they might not take part in the exchanges without substantial changes to the law.

President Barack Obama gave ground last month by lending his support to the idea of letting states opt out of the law early if they met certain conditions, but Republican governors, including Branstad, said the offer didn’t go far enough.

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