Health Reform, Celebrating, and Parenthood

Celebrate! I celebrate the birth of my granddaughter and the birth and growth of CoOportunity Health. This week, as I drove with my wife and my two and a half-year-old grandson across the city of Des Moines so we all could meet my new-born granddaughter, I pondered the emotions involved with parenthood. The pride for which even as a grandparent, with only a small part in the creation of this tiny, new life, is still an overwhelming emotion; responsibility, joy and sincere thanks. Each of these emotions fill a parent, grandparent, or godparent. At the baby’s birth on Tuesday evening, May 27, I was so moved and will continue to be throughout this beautiful child’s life into her adulthood.

In a similar fashion, we can have such feelings about the programs that we either help to start or to maintain in our professional lives. In one of my proudest moments, I was called by the former president of the Iowa Senate, the godfather of HAWK-l(Healthy and Well Kids in Iowa), which is the Children’s Health Insurance Program(CHIP) for Iowa. I too, have been called a godfather of the health care cooperative insurance movement in Iowa, which led to the eventual creation of CoOportunity Health,a new insurance entity that was started in Iowa and will serve both Iowa and Nebraska by virtue of the Affordable Care Act(ACA).

I lobbied for a health care cooperative insurance option when the ACA was being written and initially was part of a group of individuals brought together in Iowa to evaluate this option in Iowa; served nationally on the Consumer Operated and Oriented Plan(CO-OP) Advisory Board which submitted rule recommendations for this program to the U.S. Department of Health and Human Services, and when that Advisory Board was disbanded, was asked to serve on the Quality Assurance Committee for CoOportunity Health, on which I still serve.

It would take two or three rather long blog entries to fully explain the Consumer Operated and Oriented Plan(CO-OP) option found in section 1322 of the ACA. I will summarize very briefly. Senator Kent Conrad of North Dakota, with help from Senator Grassley’s office, helped to write this section,which following the rural tradition of electric co-ops, grain co-ops, and credit unions, sought to establish health care insurance cooperatives like Group Health in Seattle or Health Partners in Minneapolis, by offering federal monies as loans for insurance entity start-ups.The purpose was to provide insurance competition in states which lacked such competition. These start-ups had several requirements to meet, including 1) nonprofit status, 2) no ownership involvement by current insurance companies, 3) boards of directors that ultimately must include greater than fifty percent of premium owners, 4) a care coordination element to these entities’ relationships with providers, 5) be rural-focused, 6) no federal resources for advertising, and finally,7) significantly oriented to selling policies to individuals and small businesses on the health insurance exchanges. The goal was to be consumer-oriented, affordable, and creative in an effort to develop a totally new kind of insurance model. The goal was to push the proverbial envelope as it had not been pushed before.

This proposal was opposed by current insurance companies at the time of the creation of the ACA and subsequently, some of its funding was removed due to their lobbying efforts. Nevertheless, more than twenty-some health care insurance       CO-OPs were funded throughout the nation. In Iowa, Dave Lyons, Steve Ringlee, and Cliff Gold formed the nucleus of a highly qualified, motivated, and competent team that conceived of and created an insurance entity that would serve both Iowa and Nebraska called CoOportuniy Health. They applied and received two CO-OP loans for CoOportunity Health. One loan for reserves to be paid back in 15 years, and one loan for start-up costs. The CoOportunity Health infrastructure was rented from Health Partners of Minneapolis, the largest health care co-op in the nation with high ratings in quality and patient satisfaction. In the first selection of plans process, CoOportunity Health was the only multi-state CO-OP to receive loan monies and it received the second highest amount of combined loan monies–more than 110 million dollars. Starting in the October, 2013, CoOportunity Health sold policies on the Exchange in Iowa and Nebraska, as well as off the Exchange, directly to individuals and to small businesses. They sold policies through insurance agents, direct to consumers via the Internet, and as part of the Iowa Health and Wellness Medicaid Expansion Program, sold policies to the State of Iowa.

Just as with my new granddaughter, I am proud to report CoOportunity Health has exceeded all expectations. By the end of the enrollment period, this brand new insurance entity had over 73,000 members, far exceeding anyone’s estimates. Equally important, the percentage of young subscribers was high, making continued viability more likely. At a meeting of the nation’s CO-OPs prior to the end of the enrollment period, CoOportunity Health and the New York CO-OP, were the only CO-OPs to exceed 50,000 premium holders. The next largest was in the 20,000 range, and the third largest was 11,000. In Nebraska, due to better pricing of its insurance policies, CoOportunity Health is now the leading insurer of individuals in rural areas. CoOportunity Health is, indeed, pushing the envelope with creative ways to interact with consumers and providers, including helping independent rural family physician groups to survive by promoting associations. These efforts, and related directly to these efforts, allowed these associations not only to work with CoOportunity Health but also apply and become part of a Medicare Shared Savings Program. Speaking of proud moments, and more important, speaking to the essence of this entire effort, I am overjoyed when I am able to see my patients in the clinic who were uninsured and now have CoOportunity Health insurance. This access to health care is improving their lives and sometimes saving their lives. Finally, I believe it is because of this increased competition by CoOportunity Health and Coventry on the Exchange that led Wellmark (Blue Cross Blue Shield) in Iowa not to raise their premiums for individuals for 2014, thus proving the wisdom of Senator Conrad, who believed improved insurance competition would help consumers.

My granddaughter is beautiful, or as her two and a half-year old brother says, “she’s cute,” and was a strong 8 lbs 4 oz at birth.CoOportunity Health, after 5 months, is 73,000 members strong with projected annual gross receipts of over 200 million dollars. I celebrate both these two new creations and look forward to watching both grow and prosper. Additionally, I look forward to being a positive influence on their trajectory of both their futures.

Finally, a word about parenthood. One of my mentors for my public policy work has always been Senator Chuck Grassley. With the health care cooperative insurance concept, I remember a long talk I had with Senator Grassley the August before the ACA was enacted. He talked positively about the idea as he reflected on his interaction with rural co-ops on his farm. He told me how his Senate Finance Committee had heard testimony that to survive such an insurance co-op needed to have at least 26,000 members. I know for a fact that his aide offered valuable advice in the writing of this section of the ACA . He and Senator Tom Harkin nominated me for the CO-OP Advisory Board on which I served. I used Senator Grassley’s thoughts when I participated in the work of the Advisory Board. For whatever credit that I am given regarding the health care cooperative movement in Iowa, I can truly point to the efforts of Senator Grassley, who had a significant role in that work. If not a godparent, Senator Grassley was, in my eyes, a wise uncle offering sage advice.

Post-script: My interest in public policy dates back to my childhood when I saw my father involved in local and state efforts to improve the lives of Iowans. It may be genetic. My great, great, great-grandfather was a member of the first ever Canadian Parliament. Both my children–my two daughters–share this interest with varying areas of focus. I fondly remember when my elder daughter, while in Washington, DC lobbying with me, expressed awe while looking out her hotel room window at night at the lighted Washington Monument. Similarly, hours after this same daughter delivered my granddaughter at Mercy Hospital in Des Moines, I noticed out the window of their birthing room, the Iowa State Capitol, in all its grandeur. My granddaughter may just be part of the 8th generation to carry on our long family tradition of public policy advocacy.