Invest in solution, not ‘broken system’

By Gov. Terry Branstad

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Imagine a health insurance plan where you pay nothing for your health care and have no incentives to improve your health. Imagine a plan that pays your doctors on quantity of services provided, instead of the quality of services and healthy outcomes.

Imagine this plan has increased the number of people participating by 65 percent over the past decade and increased in cost by 129 percent. Despite serving more and paying more, every single health metric for those on the plan has gotten worse, not better. Imagine a plan whose main financier faces a mountain of debt, spends more than it takes in every year and has not had a budget in four years.

Do you have confidence in this plan? Would you want state leaders to invest money in this plan without demanding improvements to health outcomes?

Unfortunately, this plan is reality and it's called Medicaid. The Senate wants to add 150,000 more Iowans to the program without improvements that our residents deserve. I believe adding 150,000 Iowans to a broken, unsustainable program is the wrong choice for patients, providers and taxpayers.

The feeling is bipartisan. In 2009, President Barack Obama stated: “ ... As we move forward on health care reform, it is not sufficient for us simply to add more people to Medicare or Medicaid to increase the rolls, to increase coverage in the absence of cost controls and reform. … We can't simply put more people into a broken system that doesn't work.”

Medicaid should be a promise of better health for our neediest Iowans. I believe that Iowa, where we enforce the requirement for a balanced budget and have our financial house in order, is a better partner than Washington to keep this promise.

We have seen the federal government fail to keep promises. The Obama administration cut the long-term care entitlement and cut the small business health insurance options featured in the Affordable Care Act. As failed promises turn into larger cuts to care, Medicaid patients could be collateral damage. I do not want that to happen.

I am not simply opposing Medicaid expansion. I want to create an improved health care program for the neediest Iowans, called the Healthy Iowa Plan. True compassion is ensuring our population gets healthier, not simply covering them in an antiquated program like Medicaid. With an Iowa-crafted plan, we can succeed where the federal government failed.

The Healthy Iowa Plan will offer state coverage for every Iowan below the federal poverty level while offering affordable and subsidized private insurance through the exchanges for others. However, I am also committed to a health care system that improves Iowans' health.

The Healthy Iowa Plan offers local health care services to patients. It requires a primary care doctor within 30 minutes or 30 miles for someone on the plan. But most important, the Healthy Iowa Plan focuses on measures that make Iowans healthier, such as health risk assessments, annual physicals and preventive measures. It encourages individual health ownership by asking everyone to contribute a modest amount, but waives contributions for those actively participating in healthy behaviors.

The Healthy Iowa Plan is an Iowa-based solution to our health care challenges. It is a promise to Iowans we can keep today and in the future.

l Terry Branstad is governor of Iowa. Comments: tim.albrecht@iowa.gov