Being Thankful for this Health Reform Season

Jim Jones (not his real name) is 56 years old. He is a subcontractor in the construction field in a county seat town. He is divorced, has grown children, and is devoted to his grandson. He has been uninsured for years due to his medical problems. Starting January 1, 2014, Jim will have health insurance purchased through the Exchange.

Last year, an insurance agent had tried to get coverage for Jim but did not have any health care insurance options for him. Recently, the agent twice drove from metropolitan Des Moines to Jim’s home to set-up Jim’s new health care policy.

Bob Smith (not his real name) is a 63 year-old male diabetic with serious liver disease. He has been my patient for several years.  He worked in a supervisory position. This fall he lost his job and his health insurance. My health coach, who is a Certified Application Counselor (CAC), assisted Bob in enrolling for health insurance through the Exchange. Bob’s coverage begins New Year’s Day.

Gloria Conner (not her real name) is a registered nurse with five children. She has no health insurance at her job. She signed-up for Medicaid using information she found on the Exchange.

A close relative of mine, who owns a family business in a county seat city in rural Iowa, was able to find health insurance for himself and his wife at CoOportunity Health. He will save $800 per month on his new insurance.

My niece, who lives in Texas, came home to Iowa for the holidays. She was able, through the Exchange, to find affordable, comprehensive health insurance. She also was helped by my health coach/CAC.

The head of the Colorado Exchange has said that Colorado has found that many, if not most, of their users have needed the face-to-face assistance of a person to sign-up for health coverage on the Colorado Exchange.

I could recount several other patients who will continue to see me for their health care who now have health insurance available to them in the coming year because of the Affordable Care Act (ACA).

The inexcusable delays, problems, and general screw-ups notwithstanding, 1.9 million people will have health insurance coverage in 2014 that they found through the Exchanges in the United States.

For all of this, I am thankful.

What I am not thankful for is the fact that Iowa does not have a state-based independent Exchange that would have enrolled many more thousands of Iowans; that would not have caused the temporary loss of Medicaid to 16,000 Iowans because of a “communication error” between the federal Exchange and Iowa Medicaid, and that would not have continued to support the public perception of a flawed roll out of this critically important project.

Iowa needs a state-based Exchange. The Des Moines Chamber of Commerce says so. John Forsyth, chief executive officer of Wellmark (Blue Cross/Blue Shield) says so. Thousands of Iowans who will not have their health coverage on January 1, 2014 say so.

We have a blueprint for such an Exchange—an Iowa Exchange. Let us use the nonprofit, nongovernmental approach that Colorado has used for their Exchange and utilize the website contractor that the Kentucky Exchange used to design our Iowa website. Both states have far overshadowed Iowa with enrollment numbers.

The Colorado Exchange——has enrolled more than 35,000 people as of December 21, 2013 and estimates approximately 5,000 more enrollees by December 31, 2013. Enrollment at has reached 24,700 enrollments since October 1, 2013. Kentucky expects to have several thousand more people with health care coverage by December 31, 2013.

Colorado’s Exchange is a nonprofit entity. It uses no general state dollars. Start up costs were derived from the conversion of the state’s unused high risk pool monies and federal dollars. The Exchange will be self-sufficient based on a premium fee for policies sold on the Exchange. It has a legislative board of advisors.  Kentucky has the most user-friendly Exchange website this side of the Health Care Sherpa website——which, if you have not checked it out, is amazing. The Health Care Sherpa website will provide you an individual, accurate, and detailed listing of health insurance options, including subsidies anywhere in the United States with only two clicks of your mouse, simply by providing your age, zip code, and income.

If I have an uninsured patient seeing me, I print out the list of health Exchange options as they appear on the Health Care Sherpa website and give it to my patient during their clinic visit with me.

My final thought. If, as I believe, the Iowa legislature will not have the wherewithal to create a state-based Exchange, maybe a nonprofit entity should be formed in Iowa to serve Iowans, and request that the federal government let a contract to that nonprofit entity to run an Iowa Exchange.

As I said in July when I started this blog, we have a lot of work to do to fully actualize the benefits of the ACA. As we enter 2014, that statement has not changed, but for millions of Americans, 2014 will be a better year because of this effort. For that, I am thankful.