Here is what Republicans will do if Iowa voters give us the opportunity.

Paitent’s Right to Know Act
Iowa Republicans propose legislation to establish a statewide information hub that brings together both cost and outcome quality data in a searchable format for online consumers. Cost and quality transparency will empower consumers to make better health care decisions in a way that maximizes quality while minimizing cost.

Low Cost Catastrophic Plans for Those Under 30
There are 106,000 Iowans in this age group who do not have health insurance and account for roughly half of all the uninsured in the entire state. Iowa Republicans propose legislation that will encourage the development of low cost catastrophic insurance products that will provide base care for younger Iowans and limit the amount of uncompensated care that results when uninsured young Iowans need medical treatment.

Medical Malpractice Reform
No serious attempt at reducing rising health care and insurance costs can move forward without an honest attempt to address the issue of medical malpractice and tort reform. Iowa Republicans have continually championed the need to pass legislation that raises the burden of proof on medical malpractice claims and places reasonable limits on payment for damages.

Expand Health Insurance Tax Deductibility to Individuals and Small Business
With a significant portion of our population now working for small businesses or forth themselves, Iowa Republicans believe all businesses and individuals, be they subchapter S corporations, limited liability companies, partnerships or sole proprietors should have the opportunity to deduct health care costs.

Prevention Credits: Putting a Premium on Wellness
Iowa Republicans propose legislation to require insurers to offer “prevention credits” to individuals and businesses that can be used to reduce health insurance rates for those individuals and businesses that demonstrate, through measurable periodic screening practices, a commitment to wellness and prevention.

No Pre-Existing Exclusions when Changing Plans with the same Insurance Provider
Iowa Republicans propose legislation that prohibits the denial of coverage or the imposition of coverage riders due to pre-existing conditions when an insured Iowan moves from one plan to another plan offered by the same insurance company.

With the discussion over rising insurance premiums, Iowans expect their legislators to save them money. Iowans might be surprised that the majority party is, in fact, looking for ways to increase the demands on health insurers. All that means is one thing – even higher premiums in the future.

Currently, there are five different bills in the Legislature that would implement new requirements on health insurance plans. They are :

House File 234 – Mental Health Parity
The bill would require Iowa-regulated health insurance plans to offer the same level of coverage for mental health and substance abuse as the plan does for physical health issues. What is covered is based on the Diagnostic and Statistical Manual of Mental Disorders, which is used as the guidebook for psychiatric diagnoses. This book is being revised to add new recognized conditions. If House File 234 is adopted, this could require insurance plans to cover apathy disorder, internet addition, and gambling addiction.

House File 2329 – Mandated Coverage of Medication Therapy Management
The bill would require state-regulated insurance plans to pay pharmacists for counseling customers on the proper use of the prescriptions they receive and to also pay pharmacists for overseeing the different prescriptions of a customer.

House File 2404 – Mandated Coverage of Audiology Services
The bill would require Iowa-regulated plans to cover audiology exams, hearing aids and ear molds for children under the age of 18. Currently, the state has a program that provides hearing services to children without audiology coverage through the Dept. of Public Health for around $230,000 per year. The imposition of a mandate could increase the premium payments for state employee insurance plans by $600,000.

House File 2410 – Substitution of Anti-Epileptic Drugs
The bill would require a pharmacist to provide notice to a patient and their health care provider of the intent to substitute a different drug for what the provider prescribed when that drug is used for the treatment of epileptic seizures. Under Iowa law, a pharmacist has the authority to substitute an equivalent drug when it is cheaper for the patient. This bill would place another bureaucratic process on the pharmacist for this one type of drugs. It has the potential to raise the cost of health insurance by requiring the use of more expensive medications.

Senate File 2349 – Mandated Coverage of Autism Services
The bill would require public employee health plans to provide coverage for services to person with autism. This would the be first step towards a full mandate on all insurance plans regulated by the state.

While each of these bills address legitimate health concerns, the fact remains that requiring health plans to add this coverage means additional costs. And additional costs to insurance companies turn into higher insurance premiums for Iowans.

What Iowans need for the Legislature to focus on are ideas that can really lower costs. House Republicans have offered a number of ideas, including allowing insurance companies to sell mandate-free policies, offer basic health plans for young adults, and breaks for Iowans who undertake wellness efforts to reduce their need for health care services. Will Democrats join in fighting growing health care costs, or will they continue to pile on Iowans’ insurance bills?

Senate Democrats came forward with their proposal for health care reform during the 2010 legislative session. Unlike health care reform bills from previous years, SF 2092 just deals with a few issues. But like the other ideas, the initial proposal will cost the taxpayers a lot of money.

The centerpiece of the bill is a major expansion of the IowaCare program. Created in 2005 as a replacement to the State Papers program at the University of Iowa Hospitals and Clinics, IowaCare offers basic care to lower-income Iowans that are not eligible for Medicaid. Services are only available at UIHC and for Polk County residents, at Broadlawns Medical Center.

Under the Senate bill, IowaCare would be dramatically expanded by allowing Iowans earning up to 400 percent of poverty to sign up for what Senate Democrats are calling IowaCare Plus. Iowans earning between 200 and 300 percent would receive premium assistance from the state to pay for the coverage. Those earning between 300 and 400 percent would have to pay the full cost of coverage.

The cost of these changes are something that Senate Democrats don’t really want folks to worry about. Proponents say the bill is dependent on federal funding, but they don’t know how much it could cost. The non-partisan Legislative Services Agency is working on an estimate. Using consultant reports from previous proposals, it is very clear that hundreds of millions of dollars will be needed to subsidize coverage.

To Iowans following the federal health care debate, the Democrat’s plan looks like the Iowa version of the public option.

The bill also represents a major expansion of the services provided by IowaCare. Currently, the program provides a basic level of care. Senate File 92 would add pharmacy and dental coverage to the program. Providing these services to IowaCare Plus means the state would also have to include them in the current IowaCare program. This is expected to significantly increase the cost of the program by hundreds of millions of dollars.

Another portion of the bill creates an Insurance Exchange, which could end up becoming a government-run insurance super agent. The bill would have the state establish an entity to provide insurance information to consumers and “To provide a portal where uninsured Iowans can receive assistance in obtaining health care coverage.”

It is the second part that concerns many insurance agents across Iowa. They view this proposal to as the first step to establishing the state of Iowa as an insurance agent. The goal of the bill’s proponents to create a Massachusetts-like exchange where the state “assists” lower-income Iowans in purchasing health care insurance. For the insurance agents of Iowa, that sounds a lot like what they do. And they also know they would be at an extreme competitive disadvantage if the state were to enter their business.

In an effort to build support for the bill, Senate Democrats claimed that the bill simply implements the recommendations of the Legislative Health Care Coverage Commission. But the Commission’s discussions on IowaCare never discussed turning the program into a Public Option. And there was little direction from the Commission’s work group of how the insurance exchange would work. Commission members who were able to read the bill didn’t see much connection from their recommendations to the Senate Democrats’ wish list.

As part of the Department’s plan to achieve the ten percent reduction in funding, DHS proposed that almost all Medicaid providers have their payment rates reduced. Provider groups like the hospitals, doctors, and nursing homes were among those who would have their rates reduced by 5 percent. Another group of providers including dentists, in-home providers of waiver services, and community mental health centers would have their payments cut by 2.5 percent. The changes would reduce General Fund spending on the program by $16,845,648.

The proposed reductions are scheduled to go into effect on December 1. In order to implement these changes, DHS is asking the Council on Human Services to adopt a package of emergency rules on November 10. Once those are approved, the Department will seek quick approval of the changes to Iowa’s Medicaid plan from the Centers for Medicare and Medicaid Services (CMS).

There is just one problem with the Department’s plan. Iowa law does not give DHS the authority to cut Medicaid rates.

Medicaid payment rates are statutorily set by the Legislature and signed by the Governor within the Health and Human Services Appropriations bill each year. The current Medicaid reimbursement rates were included in section 32 of House File 811. That section maintained the payment rates at the same level they were in 2009. That language was approved by the Legislature, and signed by Governor Culver on May 26.

In conversations with LSA staff, the Department has expressed the belief that the Governor’s executive order gives them the ability to override state laws enacted by the Legislation. This interpretation would appear to dramatically disrupt the balance of power that is the basic tenet of American government. If a Governor had the power to override laws passed by the Legislature and signed by the chief executive, what law would be safe?

DHS staff also claim that Iowa Code section 249A.4 gives the Director of DHS the ability to change the scope and duration of services under Medicaid, which the Department says is what they are doing. But a reading of section 249A.4 (1) shows that this power is granted to the Director within the limitation of available funds. And thanks to the federal stimulus bill, Iowa’s Medicaid program is flush with cash.

LSA projected before the Governor’s cut that there could be over $60 million left over at the end of FY 2010. DHS was so confident of excess funds, they built a FY 2010 Medicaid surplus of $57.5 million into their FY 2011 budget proposal.

Will DHS be allowed to usurp the Legislature’s power to set Medicaid rates? If they do, it won’t be without a fight from providers and legislators.