Landmark legislation not complete

Welcome back to Iowa, President Barack Obama. Your appearance today at the University of Iowa is fitting. After all, the UI also was where you outlined your health care reform ideas May 29, 2007, during your campaign. Now you return to discuss the landmark reform legislation you signed into law Tuesday.

We must say that the process Congress used to advance these reforms didn't always sit well with us. We dislike parts of this massive, complicated bill that even medical and business experts haven't fully analyzed for impact on consumers, providers and insurers.

Nonetheless, Mr. President, your persistence and fierce advocacy clearly helped resurrect the bill when it teetered on the edge of survival. That was impressive.

Much of the legislation doesn't kick in until 2014, but it did accomplish several vital steps we support. Later this year, insurers will no longer be allowed to deny coverage for children with pre-existing medical conditions; adults will be phased in by 2014. And also starting this year, there will be no lifetime coverage limits for adults or children. Those changes are simply the right thing to do.

It also provides some temporary tax credits for companies to help them provide insurance for employees and protect jobs. They vary quite a bit but provide meaningful assistance to the smallest companies, less as the company size increases.

Medicare reimbursement rates to Iowa, unfairly low for decades, will increase. And there's more incentive for prevention practices toward reducing chronic illness.

The most controversial feature? Mandating that everyone must have insurance or pay a penalty that will rise to nearly $700 for individuals and $2,000 for families by 2016. That provision's constitutionality is being challenged; legal experts are divided on whether the Supreme Court would uphold it. Yes, the larger the pool of insured, the more the cost is spread out, but we're not convinced a mandate is the right way to do that.

The soaring cost of health care remains the biggest headache, and we are skeptical of this legislation's ability to do much about it. As for impact on our debt-ridden federal government, the Congressional Budget Office figures the legislation will cost $938 billion and reduce the federal budget deficit by

$143 billion over 10 years - but it requires tax increases and cuts in Medicare to do that.

So, Mr. President, we hope your speech today is more than a political celebration. Acknowledge that this legislation is not complete and may never be. It needs ongoing objective analysis and adjustments. And your leadership must inspire a more bipartisan collaboration going forward.