Health care reform debate is low on specifics

The mere mention of health care reform has become divisive, but 10 months after it passed, specific provisions of the Affordable Care Act are still not well known.

“It is so complex,” said Keith Mueller, director of the Rural Policy Research Institute Center for Rural Health Policy Analysis, at the University of Iowa.

Mueller said little of the 967-page document is simple, so it's easy for opponents to distort pieces for political purposes.

“It is frustrating to those of us who devote time to analyzing it,” he said. “The discourse isn't about what's really in there.”

A congressional repeal vote scheduled for last week was postponed.

U.S. Rep. Steve King, R-Iowa, predicted the repeal would pass in the House and Senate. King said the law, which he refers to as “ObamaCare,” is unconstitutional because it requires people to buy health insurance.

If the law is not repealed, King said he will work to ensure funding is shut off so it cannot be implemented or enforced.

Sen. Chuck Grassley, R-Iowa, also plans to vote to repeal the law.

In an e-mail, Grassley said he opposes several components, including “the way the bill will drive up health insurance premiums even more than premiums are increasing already.”

He also opposes an item that gives five rural states, but not Iowa, better Medicare payments.

Grassley supports portions, including requiring insurance plans to provide coverage regardless of pre-existing conditions, not allowing plans to charge higher premiums to the sick and a provision he wrote to fight Medicare fraud.

U.S. Rep. Dave Loebsack, D-Iowa, said an amendment he offered in light of the repeal vote points to benefits Iowans would miss if the law is repealed. The amendment would preserve free preventive care for seniors on Medicare and Americans on private health insurance.

“The more preventive care we have, the more significant reductions we'll see in chronic diseases,” Loebsack said.

Loebsack also co-sponsored amendments to preserve provisions that prohibit insurance companies from denying coverage to people with pre-existing conditions; allow young adults to stay on their parents' health insurance until age 26; extend the solvency of Medicare by 12 years; close the prescription drug doughnut hole for seniors; and maintain tax cuts to small businesses to provide employee health insurance.

“If we repeal this law, lock, stock and barrel, all of those things will go away,” he said.

Dr. Peter Damiano, director of the UI Public Policy Center, said many people are unaware that the law has little effect on employer-based insurance, which covers about 75 percent of Iowans and Americans in general. That means most rules pertain to individual policyholders and small businesses.

One of his biggest questions is the cost.

“With 24 million Americans added to the rolls, how do you do it so it doesn't cost a fortune?” he said.

Damiano believes employers will continue to offer health insurance, even when provisions of the law are in place.

“Businesses currently offer it, not because they have to, but for recruitment and retention of employees,” he said. “That's not going to change.”

John Monaghan, president of Group Benefits Design Corp. of Waterloo, said businesses are struggling to interpret the law. Many are moving to incentive-based wellness programs that reward employees for healthy lifestyle changes.

“I think a lot of it is because of health care reform - to take control of their costs,” he said. “No matter what happens with health reform, having a healthy work force benefits everyone.”