Healthy Opportunities for Iowa

Introduction

In November 2005, I released Leading Iowa Forward, my Plan to build on Iowa’s traditional strengths in agriculture, manufacturing and education to create good jobs with good benefits in every corner of the state. Leading Iowa Forward set forth my fundamental belief that the single best thing we can do to make sure that all Iowans have the things I believe in – a high quality of life, the opportunity to earn a decent living, affordable health care coverage, the ability to make ends meet and still have time to spend with their kids and the promise of a dignified retirement – is to ensure a thriving economy here in Iowa, with industries that pay good wages and provide good benefits.

My Health Care Plan: Quality, Affordable Insurance for All Iowans

Nobody needs to tell Iowans about the importance of affordable, quality health care for living life to its fullest potential. Unfortunately, many Iowans currently do not have the opportunity to access the care they need, when they need it. Over 300,000 hard-working Iowans currently cannot afford health insurance for themselves or their children. Currently, 58,000 children in Iowa lack health insurance – we must do better than that.

Even when they have health insurance, many Iowa families and seniors are being squeezed by skyrocketing health care and pharmaceutical costs. Health insurance simply isn't enough to guarantee health care affordability anymore. Families are burdened by increasing deductibles and co-pays, and Iowa's seniors in particular are still paying too much for prescription drugs, because the new Medicare drug benefit does not do enough to control prescription drug costs.

As Governor, I will work every day to help provide affordable, quality health care for every Iowan. I believe that good health is a good investment for Iowa: school performance improves when children have health insurance, the workforce is healthier and more productive, and reducing the burden of illness and medical costs gives more people the opportunity to make the most of their lives. I will not stop until we make the right investments to benefit the good health of every Iowan – because we all deserve to look forward to the healthiest future possible.

My Healthy Opportunities Plan for Every Iowan to work towards obtaining affordable, quality health care, includes the following components:

• Launching an Insure Iowa initiative that allows Iowans to buy into the same health plan our elected officials enjoy, starting with small businesses and independent workers.
• Insuring all of Iowa's children by making sure all those eligible for Medicaid and Hawk-I are enrolled
• Extending Hawk-I to cover parents as well as children up to 200% of the Federal Poverty Level, for those without employer-provided coverage.
• Allowing all Iowa parents to buy Hawk-I coverage for their kids, with a sliding premium based on income.
• Focusing on senior citizen wellness, including assisting Iowa's seniors with their prescription drug costs through innovative cost-lowering arrangements and assistance to complement Medicare drug coverage.
• Reducing our health care costs by keeping Iowa healthy so that less medical care is needed in the first place.
• Ensuring quality health care so that harmful, expensive medical errors are avoided.

Part I - INSURE IOWA: AFFORDABLE, QUALITY HEALTH CARE FOR EVERY IOWAN

Too many Iowans currently do not have the opportunity to access the health care they need, when they need it, because they lack health insurance. Groups that often have the hardest time obtaining health insurance include small business employees, independent workers, and those between coverage such as recent retirees, young adults, and the temporarily unemployed.

As Governor, I will make it a priority to make sure that nobody in Iowa has to forgo the opportunity to purchase affordable, quality health care coverage for themselves and their families due to cost. My first step to extending affordable health care coverage to every Iowan will be to launch an Insure Iowa initiative that allows Iowans to buy into the same health plan our elected officials and state employees enjoy. We will start by allowing small businesses and independent workers to purchase this coverage, and later will open the plan to those Iowans temporarily between insurance coverage, such as the temporarily unemployed, young adults, and recent retirees. In its final stage, Insure Iowa will be open to all Iowa individuals and businesses that wish to buy this coverage for themselves or their employees.

Insure Iowa: Why Now?

Almost 11 percent of Iowans - about 300,000 people - have no health insurance. Of these, 19% are children. This is not only a moral issue – taking care of the health care needs of our working families and their children is also an economic issue for Iowa. The simple fact is that Iowa cannot hope to have a maximally productive workforce, run a maximally efficient health care system, or lower health care costs for insured families given the high number of uninsured Iowans. When too many Iowans lack adequate insurance coverage, the cost of care goes up for everybody - and the high cost of care reduces access to health care for the insured and uninsured alike. We must break this costly cycle in Iowa by increasing access to affordable, quality health insurance and taking other measures to reduce costs in our health care system.

Here are some facts on what the lack of quality, affordable health care coverage means to Iowa:

• High Costs of Health Care are Hurting Iowa Families: A 2005 Department of Public Health survey found that both insured and uninsured Iowans are facing serious challenges due to increasing health care costs. For example, uninsured, and increasingly insured, Iowans are less likely to access necessary medical care when they need it, leading to the development of more severe and expensive illnesses, overuse of emergency rooms, decreased productivity, and even premature death. Iowans are also cutting back on the level of health insurance they carry and taking on more debt to pay for medical care. Iowa families should not have to worry that a health problem will turn into a financial disaster, or even a financial strain on their household budgets- yet that is exactly what is happening.
  
  
• Insurance Availability Affects Iowans' Major Life Decisions: The Department of Public Health survey found that Iowans are making important life decisions based on whether or not they can obtain health insurance - including such decisions as when to start a family, when to enter or exit the workforce, and whether to invest or save. Lack of insurance availability may even make some Iowans less likely to start a new business.
  
  
• Most Uninsured Iowans Work: The reasons for lack of insurance in Iowa mirror those in the United States as a whole. Nearly 76% of Iowa's uninsured belong to families with at least one full-time worker, yet 65% are low-income. Most uninsured Iowans are not offered benefits through their jobs or cannot afford employer-sponsored or individual health coverage.
  
  
• Uncompensated Care Burdens Hospitals: Hospitals treat some patients even if they lack health insurance. Iowa hospitals provided over $402 million in such uncompensated care in 2004, representing 8% of patient revenue. The amount of uncompensated care provided by Iowa hospitals has grown 46% in the past four years, while revenue has grown only 22%.
  
  
• The Hidden Costs of Too Many Uninsured: Hospitals must still keep the lights on, and in order to provide care to the uninsured as well as pay the bills, some uncompensated care costs get shifted to privately insured Iowans, adding an estimated $518 to Iowa family health insurance policies in 2005. By 2010, this "hidden" cost of caring for the uninsured will cost every Iowa family an additional $921 in insurance costs every year. Insuring Iowans up-front could save Iowa families hundreds of dollars a year, while keeping more people out of the hospital.
  
  
• Employers Burdened: Iowa businesses have had to absorb an increase in premiums of at least 58% since 1999, and on average, costs have increased almost 16% per year since 2001. As a result, fewer businesses are offering insurance to their workers and some are beginning to require higher employee contributions. As a result of increased costs, some employees may be unable to purchase insurance. This is one example of the vicious cycle in which higher premiums reduce insurance coverage, and reduced insurance coverage increases premiums. We must stop this cycle in Iowa by lowering costs and increasing insurance coverage.
  
  
• Drag on Iowa's Economy: High health care costs, due in part to the shifting of charity care costs to the private insurance market, are creating a huge drag on Iowa's economy: according to a University of Iowa estimate, Iowa loses at least half a billion dollars a year because Iowa businesses are hiring less, spending less on taxable equipment and investments, and experiencing lower profits due to the increased cost of health care. Iowa also loses an estimated $60 million in tax revenue due to the impact of the high costs of care on small businesses.

Clearly, Iowa cannot afford to continue with the status quo. As Governor, I will work tirelessly with all sectors of the Iowa community to ensure that we expand access to affordable, quality health care to Iowans in every corner of the state.

Insure Iowa: Buying In to the State Employees’ Health Plan

Iowa's elected officials are ordinary citizens - ordinary citizens lucky enough to have access to affordable health care. The state employee health benefit plans are examples of the kind of high quality medical plans to which all Iowans should have access. For seven years I have served on the committee that oversees those state benefit plans. I have been directly involved in the selection of the medical providers who serve Iowa’s state employees. I have chaired the committee through tight budgets and in a time of rapidly increasing health care costs. I understand the challenges inherent in selecting and administering employee benefit plans.

The Iowans who put us into office deserve no less than their elected officials enjoy. As Governor, I will open Iowa's health plan for state employees and elected officials to all Iowans who wish to purchase this insurance. This plan, Iowa’s State Employee Health Benefits Plan, currently offers a range of options for health coverage, with 8 health plans to choose from – more than are offered by many private employers. As more Iowans purchase Insure Iowa coverage, more health plans will be allowed to compete to join the pool of available plans.

We will implement the Insure Iowa plan in three phases, so that at the end of each phase, we can ensure we are making maximum progress in covering uninsured Iowans:

• In the first phase, the plan will be open to small businesses and independent workers.
  
  
• In the second phase, we will open the plan to Iowans currently in between insurance coverage, such as the recently retired, young adults, and the temporarily unemployed.
  
  
• In the third phase, the pool will be open to all other Iowans who wish to join.

We know that simply making health insurance available does not mean every Iowan will be able to buy it - the insurance has to be affordable as well as available. That is why I will set aside $20 million in the first year to provide premium assistance to small businesses and uninsured, low-income Iowans who would like to buy into the pool but cannot afford it on their own.

The State of Iowa’s employees have negotiated for and secured a strong package of benefits that forms the basis of the Insure Iowa proposal. The integrity of their health care plans should not be compromised when uninsured Iowans are granted access to them. Further, state employee health care premiums should not suffer because the risk pool has changed with the addition of the uninsured. Therefore, my plan will call for state employee health premiums to be held harmless against undue increases in premiums that stem from the growth of the Insure Iowa program and the addition of the program’s enrollees to the state employee benefits plan. The nature and scope of all coverages offered under Insure Iowa ultimately would be determined by the State Insurance Commissioner and would follow parameters established in any enabling legislation.

Insure Iowa: Phase I

While eventually all Iowans will be able to buy insurance through the Insure Iowa plan, we will focus our initial efforts on those Iowans most impacted by the cost of health insurance. Specifically, only 27% of Iowa small businesses with less than 10 employees, and 69% of businesses with 10-24 employees, currently offer health insurance to their workers - compared to over 86% of businesses with 25-99 workers, and close to 100% of businesses with more than 100 workers.

Therefore, in Phase I of the Insure Iowa plan, independent workers and small businesses with less than 25 employees will be given the opportunity to purchase insurance through the Insure Iowa plan. A percentage of the total premium will be subsidized on a sliding scale basis based on the size of the business and the average cost of health plans offered through the State Employee Health Benefit. Priority for premium subsidies will be given to the smallest businesses (with less than 10 employees). The actual subsidy level will be determined by the State Insurance Commissioner and will be based on funding levels approved by the State Legislature. However, an illustration of how the subsidy levels would work is provided follows:

* Maximum subsidy is based on the percentage of the average premium for SEHBP plans. For example, if the average family health plan premium through SEHBP is $1,050, the maximum subsidy for a self-employed individual would be $315 using this example. The subsidy would remain at $315 if a higher-cost plan were chosen, but would still be 30% of the premium for any lower-priced plan, so the employer would not get to keep the difference by choosing a lower-priced plan.

In order to help lower-income workers with the cost of their health care, without rewarding companies that underpay their employees, the Insure Iowa plan will not base the employer premium subsidy on worker income, but will provide low-income workers direct additional assistance with their share of the premiums on a sliding-scale basis up to 200% of the Federal Poverty Level. For example, individuals with incomes below 133% of the Federal Poverty Level will receive full assistance with their share of the premium, as well as the premium for any dependents, with the maximum assistance again being based on the average cost of a family health plan offered through SEHBP. This structure will result in more low-income workers being able to afford employer-based insurance for themselves and their families, reducing their dependence on Medicaid and Hawk-I, and ultimately saving Iowa money. As with the subsidy levels for employers, the State Insurance Commissioner, along with Medicaid and SCHIP officials, will determine the subsidy level. However, an example is provided below to illustrate how the program will work:

* For example, under the Insure Iowa plan, an employee in a company of 8 employees with income less than 133% of Federal Poverty Level would receive a subsidy of 100% of her share of the premium; the amount would depend on the employee share of premium required by her employer, but employers will be ineligible for their share of the subsidy if they charge their low-income employees (<200% FPL) more than a 30% share of the employer/employee premium.

Employers who buy into the plan will have to meet several requirements in order to obtain their share of the subsidy, including:

• Employers who purchase Insure Iowa coverage must offer it to 100% of their employees. This requirement is to prevent employers from offering insurance to only some of their workers, thereby changing the Insure Iowa risk pool.
  
  
• Employers may not have lowered wages in the last year. This requirement is to prevent employers from paying their lowest-wage workers less to allow them to get the full employee subsidy.
  
  
• Employers may not charge their low-income employees (with incomes less than 200% Federal Poverty Level) more than 30% of the total premium. This requirement is to prevent employers from raising the employee share of the premium, thereby dumping extra costs onto Iowa.

In addition to the subsidy, the Insure Iowa plan provides the following benefits to employers who buy into the plan:

• Small businesses and self-employed individuals that currently do not offer insurance, and that buy into the plan during the first year of operation, will receive an enhanced premium subsidy for the first two years they offer the insurance. Businesses that buy into the plan after the first year will receive the basic subsidy level.
  
  
• Small businesses and self-employed individuals who currently do offer insurance will receive the basic subsidy level if they buy into the plan during the first year of operation, and a lower subsidy level if they buy in after the first year. In addition, Iowa will fund the start-up costs of worksite wellness programs for these businesses if they buy in during the first year. Worksite wellness programs, which have been proven to improve workers' health, reduce absenteeism, and increase productivity, can save businesses between $1.80 and $6.15 for every dollar invested in them.
  
  
• Small businesses and self-employed individuals will be able to purchase high-quality, lower-cost insurance than they would be able to find on the small group or individual insurance market, with a reduction in administrative expenses from no longer having to negotiate health benefits for their employees.
  
  
• As more Iowans become insured, all businesses should see a reduction in premiums because they will be subsidizing less care for the uninsured

In order to keep program costs under control, the State Insurance Commissioner will be given the authority to establish limits on the number of employers who can enroll each year, along with a wait list that gives priority to the smallest employers and those not currently offering insurance. The Insurance Commissioner will also be asked to investigate ways to reduce the premiums for health plans offered through Insure Iowa.

Insure Iowa: Phase II - H.E.L.P. for the Temporarily Uninsured

I believe that no matter what we do to increase health insurance coverage, we will not make significant progress as long as others are losing their coverage. That is why, as Governor, I will take steps to ensure that once Iowans have health insurance, they do not lose it. In Phase II of the Insure Iowa initiative, we will make the Insure Iowa plan available to those Iowans in between health insurance coverage: the temporarily unemployed, young adults, and recent retirees not yet eligible for Medicare.

The loss or change of a job should not result in the loss of health insurance coverage; however, unemployment in the U.S. often leads to this very outcome. Currently, the unemployed worker who was a member of a group health plan made up of 20 or more employees is entitled to COBRA benefits under federal law. Under COBRA, the employee or his dependent may purchase coverage identical to the coverage he had with his employer for a period of up to 18 months, at a price of no more than 102 percent of the group plan premium.

However, most unemployed workers, having lost their income, cannot afford the price of the premium and do not take advantage of the benefit. Some of those who do not elect COBRA coverage may be able to obtain it through other means, such as a spouse's employee benefit plan, but it is likely that most of those eligible cannot afford the premiums. Not surprisingly, then, many temporarily unemployed people go without insurance until they can obtain a new job with health insurance coverage. Being temporarily uninsured in this way can create many problems. If someone becomes sick or injured during this period, not only will they lack coverage to pay for their treatment, but when it comes time to obtain new insurance, insurance companies may make it more difficult to obtain new insurance or treatment for the condition that arose while the person was uninsured. The Insure Iowa plan will provide more affordable insurance than the temporarily unemployed can generally afford through COBRA, reducing problems resulting from these gaps in coverage.

As Governor, I will propose the creation of a Health Emergency Loan Program (HELP) to assist the temporarily uninsured to buy into the Insure Iowa program. HELP will be a state loan program to allow the temporarily unemployed and young adults to borrow money against their future earnings to either buy health insurance through Insure Iowa or pay for COBRA coverage. Low-interest loans, repayable after the individual finds re-employment, would be made available to individuals unemployed for less than one year, for the specific purpose of paying for their old health coverage under COBRA, purchasing insurance through a spouse's or parent's plan, or buying into the Insure Iowa program.

The HELP program, modeled on a successful similar program in Pennsylvania to help people keep their homes during economic downturns, promises to succeed in helping thousands of Iowans keep their health insurance during periods of unemployment. The Pennsylvania program has had a remarkable repayment rate. With virtually no defaults and the state recouping the loan through payroll deductions once the beneficiary resumes employment, the HELP program can be expected to pay for itself.

Funding Phase I and Phase II of Insure Iowa

We will fund the Insure Iowa Initiative through the following means:

• A set-aside of $20 million in the first year from the general fund
• An increase in the tobacco tax to $1 per pack, which will also decrease the prevalence of smoking among young people, reduce smoking-related health problems, including those caused by second-hand smoke, and cut down on Iowa’s health care costs.
• Savings from a quality assurance initiative to ensure that the State of Iowa pays only for the highest quality care for plan participants;
• Savings from a health promotion and disease management initiative for subscribers to the state employee health plan;
• Savings from a reduction in the state's uncompensated care payments to hospitals.

Savings from a reduction in the Medicaid and Hawk-I rolls due to increased employment-based insurance coverage among low-income Iowans.

Insure Iowa: Phase III

All Iowans will be given the opportunity to purchase Insure Iowa coverage in Phase III of the Insure Iowa initiative. At that time, the State will consider providing subsidies to the low-income workers of companies not previously allowed to buy into Insure Iowa (those with 25 or more employees) to purchase employer-sponsored insurance.

Other Critical Health Insurance Issues for Iowa - Retirement: More Secure With Health Insurance

Iowans who retire before the age of 65 may find themselves temporarily uninsured, because their employers may not offer health benefits for retirees, they are not yet eligible for Medicare, and insurance on the individual market is unaffordable. However, having health insurance coverage is especially critical during the early retirement years. Many chronic diseases, such as high blood pressure and heart disease, may begin to make their appearance around retirement age, and health experts recommend that many people obtain important health checkups, such as cancer screenings, during this time of life.

As Governor, I will also open the Insure Iowa plan to retired Iowans ages 55-64. Employers who currently offer retirement benefits will have the option of purchasing Insure Iowa coverage for their employees, but in order to ensure that they do not "dump" their retirement health coverage onto the State of Iowa, they will be required to offer the plan to all their retirees in this age group and pay the full State share of the premium.

Other Critical Health Insurance Issues for Iowa - Graduation: A Health Hazard?

Young adults (ages 19-29) are also very likely to be uninsured or between insurance: in fact, they are one of the largest and fastest-growing segments of the U.S. population without health insurance. Although they are generally healthy, it is critical for young adults to have health insurance so they can take care of health problems such as diabetes that may cause complications later if untreated. Young adults often become uninsured when they turn 19, because they lose Hawk-I coverage, lose coverage under their parents' policies, or graduate from high school or college.

• Twenty percent of full-time college students are uninsured, even though they are more likely than part-time students to be able to keep their parent's coverage after age 19.
• The problems continue after graduation: almost 40% of college graduates and 50% of high school graduates who do not go on to college will be uninsured for a period during the first year after graduation.
• And although, contrary to popular belief, 71% of employed young adults accept insurance coverage when it's offered to them, young adults are less likely to work in jobs that provide health insurance.

All this translates to more than 30% of young adults being uninsured - that's over 128,000 young Iowans ages 19-29, about half of whom are college-age (19-23). That means more than 40% of the uninsured in Iowa are young adults. We must work harder to make sure this group has health insurance – because taking care of health problems early can prevent expensive complications later in life.

Young Iowans will be allowed to buy into the Insure Iowa plan during Phase II of the initiative. In addition, to increase coverage among college-age Iowans, we will also make sure that all insurance plans in the state define dependent coverage as all unmarried dependents under 23, and will provide a financial incentive to Iowa's colleges and universities to require their full and part-time students to have health insurance, and provide plans to both groups. Specifically, only those Iowa colleges and universities that take this step will receive their full share of the $23.5 million in funding I have set aside to boost higher education in Iowa.

Part II - INSURING ALL OF IOWA'S CHILDREN

Enrolling All Eligible Iowa Kids in Medicaid or Hawk-I

Iowa should be a state in which no sick child goes without medical care due to lack of health insurance or ability to pay - yet 57,700 kids in Iowa lack affordable health care coverage. About 35% of these, or 20,240 children, are already eligible for Medicaid, but haven't enrolled. Another 7,760 children are eligible for Hawk-I but not enrolled. Therefore, we will launch an aggressive campaign to make sure all eligible kids are enrolled, and have budgeted for $13 million a year to cover the additional cost of covering them.

We will make sure that health insurance for Iowa kids is a priority by requiring that schools ask parents whether their kids are covered by insurance and give them information on Medicaid, Hawk-I, and Insure Iowa coverage if not. We know that kids who have health insurance improve their school performance, and as parents, we need to make sure our children come to school as prepared to learn as possible. We will help schools by using some of our state Hawk-I outreach funds to give schools the support they need to fulfill this requirement. To ensure that kids are enrolled before they even get to school, we will also work with Iowa's hospitals to make sure that before newborns leave the hospital, they have been signed up for insurance coverage, as well as other kids in the family who may be uninsured.

Allowing All of Iowa’s Kids to Buy-In to Hawk-I

In addition to those eligible for Medicaid or Hawk-I but not yet enrolled, there are 29,700 uninsured children who currently don't have access to insurance from any source. As Governor, I will change this by allowing all parents whose children who are not eligible for Medicaid or Hawk-I, and who cannot obtain dependent coverage through their employers, to purchase affordable insurance for them through the Hawk-I program. Premiums will be based on a sliding scale up to ensure maximum affordability.

In order to ensure that employers don't "dump" existing dependent coverage onto the Hawk-I program, we will require parents to show proof that their employers have not offered dependent coverage for at least 12 months and that the parents have not cancelled dependent coverage within the last 6 months. We will also work to create a "Dependent Care" insurance package through Hawk-I, which will allow employers to offer Hawk-I as an insurance option to their employees, provided they pay the state's share of the premium.

Covering Parents of Hawk-I Kids

It doesn't make sense to have families in Iowa in which only some family members are covered by insurance. If the whole family is insured, everybody is more likely to get the right care at the right time - and healthier parents have more time and energy to take care of their kids. As Governor, I will make sure that parents whose kids are covered by Hawk-I have the opportunity to buy insurance through the program at low premiums. Therefore, parents with incomes up to 200% of Federal Poverty Level, who are not eligible for other programs such as the recent Medicaid expansion and whose employers do not offer insurance, will be able to purchase insurance through the same program their kids have.

As with the Hawk-I expansion for kids, we will make sure employers do not dump coverage for low-income parents by requiring proof that employers have not offered insurance for at least 12 months and parents have not cancelled coverage in the last 6 months. However, those parents who do have access to employer-sponsored coverage, but cannot afford it, will receive premium assistance to purchase that insurance instead of Hawk-I. Employers will also be allowed to purchase Hawk-I coverage for their employees, provided they pay the state's full share of the premium.

* Employers must buy into the plan in the first year to obtain the “basic” subsidy level; a reduced subsidy level will apply after the first year.

** Employers must buy into the plan in the first year to obtain the “enhanced” subsidy level; the “basic” subsidy level will apply after the first year.

Part III - FOCUSING ON SENIOR WELLNESS

Iowa has the 5th highest percentage of citizens aged 65 and older, and the 2nd highest percentage of citizens aged 85 and older, in the United States. As Governor, I will work towards an Iowa in which our seniors live healthy, active lives for as long as possible, and do not have to worry about the burden of excessive health care costs, freeing them to spend more of their time enjoying their retirement, friends, and family.

Pharmaceutical Assistance for Seniors

Rising prescription drug costs go hand-in-hand with the rise in overall health care costs. Total retail sales for drug prescriptions in Iowa totaled more than $1.96 billion in 2004. Iowa's seniors are especially vulnerable to this increase in costs, and the new Medicare prescription drug law is confusing and difficult to navigate. Furthermore, while many states have already acted in response to the new Medicare law to determine how their state laws can best help seniors, Iowa has not yet passed any laws to coordinate with the Medicare drug law. As Governor, I intend to help the Medicare law work for Iowans and take other steps to reduce the escalating prices of prescription drugs for Iowa seniors. We will initiate these programs and others to reach those goals.

• 24-Hour Hotline to Assist Iowa Seniors With Questions About Medicare Part D Program: I will launch a hotline available 24 hours a day for use by seniors who have difficulty understanding the provisions of the federal Medicare Part D prescription drug benefit. The program has resulted in confusion about which plans are best for which seniors. It has further complicated an already intimidating health care administrative process for many seniors.
  
  
• Senior Prescription Drug Information Program: I will start a public-private effort, including funds from Iowa's insurance companies and pharmacies, to help seniors get access to the information they need to choose the best drug plan for them. As part of this effort, we will look for ways to streamline information sources, provide training to volunteers and professionals who assist seniors, and improve Internet access for seniors through our schools, libraries, and other public places.
  
  
• Medicare Part D Supplemental Coverage Plan: This plan would provide supplemental or “gap” coverage to Medicare recipients, particularly low-income recipients and those with the highest drug costs, to help with co-pays and deductibles. The new federal Medicare program does not provide the kind of comprehensive coverage Iowa’s seniors need. We need to make sure that none of our seniors fall through the cracks of the program, and I have set aside $15 million in my budget for this assistance.
  
  
• Evidence-based drug purchasing: Iowa’s health care dollars should pay for prescription drugs that have been proven the most effective – which may often differ from the latest, most expensive version of a particular drug. Therefore, as Governor, I will ask Iowa’s Quality Purchasing Initiative (see below) to review information from projects such as the Drug Effectiveness Review Project, a multi-state effort to review the evidence on the safety and effectiveness of various classes of prescription drugs, and incorporate this information into decisions about which drugs to purchase through all State programs, including Medicare prescription drug assistance programs, Medicaid, Hawk-I, and the Insure Iowa initiative. As opportunities arise, I will also make sure that Iowa participates in these types of multi-state quality improvement efforts, so that Iowa can be sure to incorporate the best evidence into its health care purchasing decisions. In this way, we can reduce trial-and-error prescribing and cut down on our state’s prescription drug costs.
  
  
• Enforcing ethical drug marketing practices: Drug companies spent $22 billion on direct marketing to doctors in 2003 - that's about $25,000 per physician per year. Research has shown that this direct marketing, which includes gifts and meals given to doctors, makes doctors more likely to prescribe the expensive medications the drug companies are selling. In some cases, these expensive new drugs are prescribed instead of cheaper drugs that have been shown to be equally effective, and even safer, for patients. We cannot hope to control drug prices in Iowa if doctors prescribe expensive medications based on sales pitches from drug companies, rather than drugs that are proven to be cheaper and as effective. Therefore, as Governor, I will require drug companies that sell their products in Iowa to disclose the nature, value, and purpose of gifts to doctors worth over $25. Companies that refuse will be fined, and the funds will be used to provide lower-cost drugs to Iowa seniors.

Long-Term Care

Iowans value their independence, and as Governor, I will take steps to help more Iowans be independent as they age. Therefore, I will take steps to help Iowa seniors live at home for as long as possible. For example, I will work with lenders and senior agencies to help seniors obtain low-cost home improvement loans to retrofit their homes with features that make it easier to live in their own homes if mobility declines. I will also work to give Iowans better access to home-based long-term care services and reward employers who provide extra leave time to their employees to care for aging parents. I will make sure Iowans have the information they need to understand their options for long-term care and help them prepare for the possibility that they will need long-term care.

For those Iowans who can no longer live at home and must receive nursing home care, I will also work until all Iowa nursing homes provide the high quality, safe care that Iowa seniors deserve. Because Medicaid pays for most long-term care, I will especially focus on giving nursing homes incentives to improve their quality by tying the level of Medicaid funding to the quality of nursing homes.

Iowa Senior Wellness Initiative

To help increase the proportion of Iowa seniors living healthy, active lifestyles, I will launch an Iowa Senior Wellness Initiative, a major public health initiative aimed at providing seniors and their families with the information and resources they need to stay healthy and prevent cancer and other chronic diseases. I will ask Iowa's Department of Elder Affairs to convene a group of relevant organizations, such as Iowa's AARP, senior centers, and health care providers, to design a program that will have a major impact on improving senior health in Iowa. For example, the program could include an 800 number and website, and be staffed by a mix of trained professionals and senior "Healthy Peer" volunteers who will provide wellness advice and direct seniors to resources they need to stay healthy. Other components of the initiative could include:

• Assistance with transportation to medical appointments.
  
  
• A secure, password-only website where seniors and their families can create a one-stop personalized wellness and medical plan including wellness goals, medical appointments, reminders, and medical bill tracking.
  
  
• Public health campaigns for seniors, including smoking cessation, weight loss, blood pressure screens, and flu shots.
  
  
• Funding for more senior centers to obtain automated external defibrillators to help save seniors' lives.

Iowa Pre-Medicare Initiative

If Iowans are going to live longer, healthier, and more active lives, they must engage in healthy habits starting as early as possible. Therefore, the Iowa Senior Wellness Initiative will include a component for Iowans aged 50-64, called the Iowa Pre-Medicare Initiative. I will work with key players - including employers, insurance companies, health care providers, the Department of Public Health, and community organizations - to make strategic changes focused on reducing the number of Iowans who enter Medicare with chronic diseases. Because this initiative should ultimately save the Medicare program money, I will also work with Federal partners and ask for Federal funding to help us launch this initiative.

The Iowa pre-Medicare initiative will make strategic changes at all levels to help future senior populations in Iowa be as healthy and active as possible. For example, we will:

• Work with employers to create wellness programs for recent retirees;
  
  
• Get employers, insurers, and health care providers to talk to each other and implement standards for quality health care in this population;
  
  
• Create a clearinghouse to help Iowa communities apply for active living grant funding to plan communities around the needs of the senior citizens of today and tomorrow;
  
  
• Prioritize Iowa public health efforts to focus on those most likely to prevent the top causes of illness, disability, and death in Iowa.

Iowa Governor's Physical Activity Challenge

As part of the Iowa Senior Wellness Initiative, I will launch the Iowa Governor's Challenge, a physical activity program based on the President's Physical Fitness Challenge, in collaboration with the Department of Elder Affairs, Department of Public Health, senior centers, faith-based organizations, and organizations such as the AARP. We will build on the successful experiences of the Iowa Games and the Senior Olympics to promote physical fitness and wellness among Iowans of all ages.

Although all Iowans will be welcome to participate, I will focus this challenge on Iowans 50 and older. We need to get more Iowans moving to help prevent problems such as diabetes, heart disease, and cancer, and the Iowa Governor's Challenge will help make that happen.

Part IV – KEEPING IOWANS HEALTHY TO REDUCE COSTS AND THE NEED FOR MEDICAL CARE

Iowa currently ranks last among states in per capita public health spending. This is shortsighted and ultimately wasteful, as the State ends up paying for expensive health care that could have been prevented. As Governor, I intend to change that by:

• Launching an Iowa Employee Wellness Incentive: As Governor, I will launch an incentive program for Iowa state employees to engage in healthier lifestyles, in which employees can obtain a discount on their health insurance premiums by completing a voluntary, confidential health assessment, formulating a personal wellness plan, and sticking to the plan. This will augment existing employee wellness plans such as the Lighten Up Iowa promotion, which has had success within state government. A similar program in King County, Washington, is expecting to save $40 million in the first two years of the program.
  
  
• Purchasing Prevention: I will direct the Chief Prevention Officer, with input from the Department of Public Health, other health professionals and insurance companies, to coordinate a purchasing effort that ensures our state health care money goes only to insurance companies that provide appropriate prevention and disease management benefits to their enrollees.
  
  
• Senior Wellness Initiative: The Senior Wellness and pre-Medicare Initiatives described above will also be an important part of my plan to reduce preventable diseases and injuries in Iowa.

Part V - ENSURING QUALITY HEALTH CARE FOR ALL IOWANS

Quality Matters: Targeting our Dollars towards Health Care Quality

Quality in health care means that everybody receives the right care in the right place at the right time. Unfortunately, that doesn't always happen: research shows that, on average, patients receive the right care only one-half of the time. For example, surgeons performing hip replacements often fail to order antibiotics to prevent infections, which are especially threatening to older patients. More Americans die from medical errors each year than from highway accidents, breast cancer, or AIDS combined, costing billions of dollars each year. Iowans would never choose an airline that gets only half its landings right; they should not be expected to tolerate health care that gives proper care only half the time.

To help remedy this problem in Iowa, I will launch a statewide Quality Purchasing Initiative to ensure that the State of Iowa pays only for the highest quality care through programs such as the state employee health system, Insure Iowa, Medicaid, and Hawk-I. To further enhance our market power, we will invite other purchasers of health care, such as large employers, to join the Iowa Quality Purchasing Initiative. Health care professionals, hospital, nursing home, and health plan representatives will also be invited to join. The ultimate goal of the initiative will be to reform the way health care is delivered in Iowa so that medical errors and emergency room use are minimized, common diseases are treated according to the best possible evidence, and information technology is improved and standardized.

We will seek to build on existing efforts through the Quality Purchasing Initiative. For example, the Iowa Foundation for Medical Care and the Centers for Medicare and Medicaid Services are partnering with hospitals, nursing homes, doctors, and home health agencies to improve the quality of care provided in Iowa. As Governor, I will work to make sure these types of quality improvement efforts reach all Iowans, not just those who are patients in facilities wise enough to be engaging in quality improvement efforts. By using the purchasing power of the State, large employers, and other partners, we will provide a strong incentive for everybody to engage in quality improvement initiatives.