Former Des Moines Register investigative reporter Tom Witosky dissects a letter he received from the Republican who represents Iowa’s third Congressional district. -promoted by desmoinesdem

Congressman David Young has scheduled a town hall meeting for today at Living History Farms. Clearly, one of the topics to be discussed will be the Affordable Health Care Act and what the Republican majority intends to do to it.

As fate would have it, I received a lengthy response from Congressman Young about my concerns about the Republican plans on Tuesday.

First some background. Up until I became eligible for Medicare almost a year ago, my wife and I purchased our health insurance on the federal exchange.

Our experience was good. We kept our doctors, the level of deduction was acceptable (stay healthy and you don’t need to worry about it) and the premium cost was acceptable. We received no subsidy. Especially important is the ACA requiring coverage of all purchasers with a pre-existing condition. My wife, who is still purchasing her health insurance on the exchange, has one that insurance companies commonly declined to cover or placed limits on.

I provide this background because Young’s letter to me outlines a position that attempted to persuade me major problems exist within the ACA that apparently deserve radical change.

Here are parts of his letter dated Feb. 21. I am also going to add several comments designed to help in the questioning of Young.

“No honest debate about our healthcare law – some refer to it as the Affordable Care Act (ACA) and some as Obamacare – can take place without the acknowledgment that this law has definitely helped people. And, no honest debate can take place without the acknowledgment that this law has definitely hurt people as well. We need a healthcare law that works for all Iowans, the facts are that the current healthcare law works for some but it does not work for others.”

“There’s no doubt the ACA has increased the number of Americans covered by health insurance regardless of income level or employment status. And there are many who have benefited because of a long-held bipartisan principle, included in the ACA, that no one should be denied access to affordable healthcare because of a pre-existing condition.”

“However, too many have been hurt by the law including millions of patients who lost their healthcare coverage and access to the healthcare they were promised they could keep. Costs have significantly gone up for millions – not down – in premiums, costs, costs, and deductibles. And the federal government will spend trillions of hard-earned tax dollars when our nation is already swimming in debt. These are our neighbors, family members, and friends. That’s not reform – that is hurting some to help others – that is just wrong and we must do better.”

“Unfortunately, the situation is only going to get worse if we pretend that the law is working for everyone. And, it doesn’t matter what we call it – repeal, fix, reform, replace, or redo. The reality is the current law and system is failing and is expected to worsen. Solutions must be offered to fix it. In fact, in the first years since it was signed into law, several provisions have already failed, and President Obama himself signed multiple pieces of legislation repealing portions of the law.”

Young’s comments, while seemingly fair, amount to the same Republican rhetoric heard during every campaign since the passage of the legislation.

What Young tries to do here is provide an alternate reality that the ACA forced people off health insurance. What the ACA did was require some people to change physicians while also receiving broader coverage. That change while making it inconvenient for those having to find new physicians was no different than what many employers have required of their employees in their offering of employer-backed insurance. The mandate in the ACA was that everyone has insurance coverage. As a result, the only individuals not covered by health insurance are those individuals who chose not to purchase it and pay a fine.

Young also insists that requiring coverage of those with pre-existing conditions is a “long-held bipartisan tradition.” If that is so, why did it take the passage of the ACA in 2010 to impose that requirement on insurance carriers?

On the issue of health care spending increases, a recent report by the Urban Institute suggests that the ACA has actually acted to limit the rise in health care spending by a small percentage.

But more importantly, there is an inconsistency in Young’s position that the ACA is a major driver of health care spending increases. The vast majority of Americans are covered by employer-provided health insurance, not through individual policies. It seems a little far-fetched to believe the ACA, which helps to provide coverage to less than 40 million Americans, is responsible for health care spending increases when overall spending has doubled in the last decade for users largely protected by employer-provided health insurance.

“I have always believed patients with pre-existing conditions must have the ability to find safe, secure, and stable coverage. Denying any patient access to healthcare is not the Iowa way and this provision and concept is one part of the ACA that is good and is right.”

This is the most critical question for Iowans in their 50’s and early 60’s and one that Young clearly equivocates. Access to health care for those with pre-existing conditions is not coverage as provided by the ACA. Young needs to answer this question on this issue. Will you be voting in favor of creating high-risk pools for those with pre-existing conditions even though many health industry experts contend it only will limit access to those with the money to afford the increased premium costs? What mechanism will be established by Congress to fund high-risk pools, if it intends to provide access to those individuals in this manner?

“Among other common sense solutions, I’m pursuing fixes to our healthcare law including enacting legislation that;
– maintains the right for portability of benefits for employees,
– provides for complete transparency of insurance and healthcare pricing to patients,
– protects current policy allowing children and young adults to remain on their parent’s healthcare policy until they turn 26 years old,
– protects policy that prohibits insurance companies from limiting (capping) yearly or lifetime coverage expenses for essential health benefits,
– provides the right to Iowans and all Americans to purchase health insurance across state lines,
– expands the convenience of Health Saving Accounts (HSAs).”

While most of the bullet points are obvious, Young’s assertion that insurance companies should continue to be required to eliminate caps on coverage is vague. What does he mean by “essential health benefits?” Would that cover, for example, hip replacements, bypass surgery, cancer treatments?

He should also be required to provide answers to the following questions.

What assurances will a purchaser of health insurance from a company regulated in another state have that the company is adequately capitalized to pay for the coverage offered? If a purchaser is defrauded by an out of state provider, what recourse would the victim have?

How does a Health Spending Account help an individual or family now receiving a subsidy under the ACA?

Republican leadership is toying with health insurance of 240,000 Iowans in this debate and has provided no specific plans other than “government bad, cut costs.”

Young says he is committed to fixing healthcare so that it works for all patients – not just some. He needs to be asked just what does that mean.

Tom Witosky retired from the Des Moines Register in 2012 after a 33-year career as an investigative reporter specializing in politics, business and sports. He is also the co-author of Equal Before the Law: How Iowa Led America to Marriage Equality.