Today our Senate health committee passed The Affordable Health Choices Act by a solid majority. This legislation will dramatically reduce the number of people without insurance and bring major changes to America's health system, taking us one step closer to high-quality health care that reduces costs for families and businesses while protecting people's choice of doctors, hospitals and insurance plans. Perhaps most importantly, it begins to redirect our system to keep people healthy and well in the first place through prevention and public health efforts, rather than merely changing how we pay for people who get sick.
Reforming our nation's health care system is long overdue. According to a report released by Families USA in March, more than one out of four people (26.6 percent) in Iowa under the age of 65 went without health insurance for all or part of 2007 and 2008. Of that number, more than two-thirds (69.8 percent) went without health coverage for six months or more. Since 2000, the average family premiums have increased by 88 percent in Iowa and 19 percent of middle-income Iowa families spend more than 10 percent of their income on health care.
As I have been working to craft his legislation in Washington, my staff has been traveling to all of Iowa's 99 counties, holding listening posts on the issue. And everywhere they go, the message is clear: Iowans are fed up with the system and are ready for reform.
Put simply, this bill is going to cover the uninsured by building on what works. The bill will extend coverage to an estimated 97 percent of Americans, while protecting people's choice of doctors, hospitals, and insurance plans. Those who currently have affordable coverage will be able to keep it, but those who lack coverage will have new options available to ensure they are protected. If you like your doctor, you're going to be able to keep that doctor. If you like your insurance, no one is going to make you change it. If you don't, you'll finally have affordable options available to you.
Low-income families and individuals (those living below 150 percent of the federal poverty level) will be covered by an expanded Medicaid program. For those above that income level, insurance will be available for purchase through new state health insurance gateways. These subsidies will ensure that health care no longer breaks the family budget. The guarantee we'll make to Americans will be that no longer someone with a pre-existing condition such as a heart attack, cancer, or even being the victim of domestic violence, be prohibited from obtaining insurance.
Currently in Iowa, premiums can vary, within limits, based on demographic factors and health status, and coverage can exclude pre-existing conditions or even be denied completely. Availability and renewability of coverage will be guaranteed and health insurance plans will be prohibited from establishing lifetime or annual limits on benefits.
One of the choices available for purchase under the Gateway will be a strong public option. Of course, participation in a public option will be just that – an option. But in many parts of the country, including rural America, some private insurers have a virtual monopoly in the individual and small-group market. That is exactly why Americans need to have the option of a public plan as they shop for insurance. Every consumer knows that the best bet for getting a good deal is if two things are present: choice and competition. A public option is also about insurance portability, having at least one plan that is available in every part of the country. This will keep private plans lean and honest.
But rather than merely extending health coverage, The Affordable Health Choices Act will finally begin to reorient our health care system toward a culture of prevention and wellness. I have long believed that in America, we do not have a health care system, we have a sick care system. If you get sick, you get care. All of the incentives in our environment – from our workplaces to clinical settings and communities – encourage unhealthy behavior. This legislation realigns those incentives to make it easier to be healthy.
The Prevention and Public Health title creates incentives to prevent chronic disease and rein in costs across the health care spectrum. It creates a new inter-agency council to develop a national health strategy supported by a dedicated funding stream. It also provides doctor training and coverage of preventive services and the elimination of co-pays and deductibles for these services. At the grassroots level, it provides grants for community initiatives to encourage fitness, healthy eating and other initiatives. In short, it takes steps to reduce chronic disease – one of the biggest cost drivers in health care!
Currently, we are still debating how to pay for the costs of health reform. But my colleagues and I have made a commitment that this legislation will be fully paid for and we intend to keep it. We are determined to undertake this reform in a fiscally responsible manner, and will not add the cost of this bill to the deficit. But, what we cannot afford to do is allow the challenges of paying for the legislation prevent us from acting. Indeed, if we don't act now, the cost of health care will continue to hurt families, businesses and our economy as a whole. Health care costs are currently rising at twice the rate of inflation. The more than $2 trillion we currently spend on health care is expected to reach over $4 trillion by 2017. The cost of a family health insurance policy is currently 17 percent of median income, and is predicted to be 35-40 percent in ten years. Without reform, over the next 10 years, America will spend more than $33 trillion on health care. Not acting is not an option.
All in all, I am excited for the positive changes that this reform will bring to all Americans. I look forward to working in Congress to pass a strong bill that makes the promise of quality, affordable health care a reality for all Americans.
