Guest Columnists

GOP plan cuts access to health care for many

An exam room at the Iowa City Free Medical Clinic Thursday, Oct. 15, 2009 in Iowa City. (Matt Nelson/The Gazette)
An exam room at the Iowa City Free Medical Clinic Thursday, Oct. 15, 2009 in Iowa City. (Matt Nelson/The Gazette)

I am not one of Rep. Rod Blum’s constituents, but as the medical director of the Iowa City Free Medical and Dental Clinic for the past 10 years, I have cared for many of his constituents as patients.

I have gotten to know these people and their health struggles. Since the implementation of the Affordable Care Act, or ACA, I have seen a significant decrease in the number of people who have had to travel from Rep. Blum’s district (and others) to my own in order to obtain health care and I take issue with many of his statements in his recent editorial in The Gazette (“AHCA is good for Iowans,” May 22).

Rep. Blum’s claims that “Obamacare is collapsing in Iowa” are not entirely truthful. Insurers are withdrawing from the market because they are unable to make enough profits. That is a major flaw with both the ACA and the AHCA (American Health Care Act) — providing health care through funding health insurance companies. However, under the AHCA these problems will, in effect, be worse. Insurance companies charge premiums to make a profit — meaning the a big chunk of money they receive go to the salaries of CEOs and nice buildings — instead of providing health CARE to the people of Iowa. The minimum requirements for essential health benefits are being removed as a way of making insurance policies more competitive, not improving health. But the effect of that change is to provide less coverage for people’s medical problems for the same or greater premium costs. Despite all the insurance companies claims of losses, the top five managed to post profits of more than $65 billion with their CEOs each making more than $10 million a year.

Although patients are not excluded under the AHCA because of a pre-existing condition, no safeguards ensure that the cost of premiums will not cause those both with and without pre-existing conditions to be unable to obtain health care again. The AHCA does not prevent insurance companies from raising premiums overall. Again, many of my patients before the ACA were both denied coverage because of pre-existing conditions or charged much higher premiums, making them unaffordable.

His statement that “That’s called free choice, not losing your insurance” in response to the estimate of 24 million Americans losing their coverage by 2020 is wrong. I have had many discussions with my patients about obtaining insurance. It is not that they were “choosing” not to have health insurance — it is that they were “choosing” to eat, have a bare minimum of shelter and clothe their children. All of my patients wanted health care. It was not a realistic “choice” to be paying more than half their income for health insurance. His statement that Medicaid “should only help those who truly can’t help themselves” is demeaning and shows he does not know these people. I do. I have cared for them for years. The majority of them were and are hardworking people but working in low-paying jobs. The current AHCA tax breaks will not benefit those at the lower and middle income brackets as much as it will help the very wealthy.

Blum’s statement that Medicaid will not be cut also is effectively false. Section 121 of the AHCA provides for spending caps for each state beginning in fiscal year 2020. Iowa is having difficulty providing Medicaid services under its privatized plans. Services will either need to be decreased or the number of patients covered will need to be decreased. Section 111 also allows states to lower, from 133 percent to 100 percent of the official poverty line, eligibility for Medicaid for children age 6 to 19.

Rep. Blum also fails to point out that another reason for higher than anticipated costs is that patients now able to afford insurance enter the health care system with more costly, more difficult to control medical problems and complications. I have had many patients whose diabetes, for example, could have been better treated early with access to medications and insulin. This access could have prevented the more costly long-term complications of heart attack and stroke, kidney failure, vision loss and loss of extremities. I have seen patients now being able to get these necessary preventive services, but it will take years before the financial benefits are realized because the United States has ignored the problem of lack of health care for so long.


Health insurance is not like other insurance. You don’t want to ever have to collect on your life, house, or car insurance because that would be mean that a disaster befell you. But everyone should “collect” on their health insurance by seeing a health care provider both to maintain their health and to treat any illness that come up. To provide true health care in the U.S. we need a single-payer system. The current insurance-based health care delivery system has clearly demonstrated that competition does not improve quality of health. In fact, the U.S. lags behind all other developed countries that have universal health care in most health outcomes.

Rep. Blum, the AHCA is not a move in the right direction for the people in Iowa. It is a move away from providing health care for Iowans and toward giving even more resources and power to insurance companies and their profits.

• Cecilia Norris is medical director at the Iowa City Free Medical Clinic



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