Iowa Public Television

 

Sen. Jack Hatch & David Heaton

posted on January 26, 2007

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Yepsen: HEALTH CARE IS MOVING TO THE TOP OF THE PRIORITY LIST AT THE IOWA STATEHOUSE. WE DISCUSS WHAT'S TO COME WITH SENATOR JACK HATCH OF DES MOINES AND WITH REPRESENTATIVE DAVE HEATON OF MT. PLEASANT ON THIS EDITION OF 'IOWA PRESS.'

FUNDING FOR THIS PROGRAM WAS PROVIDED BY 'FRIENDS,' THE IOWA PUBLIC TELEVISION FOUNDATION; BY THE IOWA BANKERS ASSOCIATION... FOR PERSONAL, BUSINESS, AND COMMERCIAL NEEDS, IOWA BANKS HELP IOWANS REACH THEIR FINANCIAL GOALS; AND BY THE ASSOCIATED GENERAL CONTRACTORS OF IOWA, THE PUBLIC'S PARTNER IN BUILDING IOWA'S HIGHWAY, BRIDGE, AND MUNICIPAL UTILITY INFRASTRUCTURE.

ON STATEWIDE IOWA PUBLIC TELEVISION, THIS IS THE FRIDAY, JANUARY 26 EDITION OF 'IOWA PRESS.' HERE IS DAVID YEPSEN.

Yepsen: IN THE BUSINESS OF ANALYZING HEALTH CARE NEEDS AND POSSIBLE SOLUTIONS IN FRONT OF US, THE NUMBERS ARE EYE-OPENING. NATIONALLY 47 MILLION AMERICANS ARE WITHOUT INSURANCE AND MILLIONS MORE ARE UNDERINSURED. IN THE PAST SEVEN YEARS, HEALTH INSURANCE PREMIUMS ON AVERAGE HAVE MORE THAN DOUBLED. IN 2006 ALONE HEALTH CARE EXPERIENCES ROSE BY ALMOST 8 PERCENT. STATE LEGISLATURES NATIONWIDE ARE WARY OF THE LACK OF RESPONSE FROM THE FEDERAL GOVERNMENT, AND SO THOSE LAWMAKERS ARE TAKING MATTERS INTO THEIR OWN HANDS. THE IOWA GENERAL ASSEMBLY MOST CERTAINLY WILL ACT ON A RANGE OF PROPOSED INITIATIVES, AND HERE TO HELP US SORT THROUGH THE SOLUTIONS ARE SENATOR JACK HATCH, A DEMOCRAT FROM DES MOINES WHO CHAIRS THE HEALTH AND HUMAN SERVICES BUDGET SUBCOMMITTEE IN THE IOWA SENATE, AND REPRESENTATIVE DAVE HEATON, A REPUBLICAN FROM MOUNT PLEASANT WHO IS THE RANKING MINORITY MEMBER OF THAT SAME COMMITTEE IN THE IOWA HOUSE. GENTLEMEN, WELCOME TO 'IOWA PRESS.' GOOD TO HAVE YOU WITH US.

Hatch: THANK YOU.

Yepsen: AND ALSO WITH US AT THE 'IOWA PRESS' TABLE ARE KAY HENDERSON, NEWS DIRECTOR WITH 'RADIO IOWA,' AND MIKE GLOVER, SENIOR LEGISLATIVE AND POLITICAL REPORTER WITH THE 'ASSOCIATED PRESS.'

Glover: SENATOR HATCH, LET'S START WITH YOU. THERE ARE A VARIETY OF HEALTH CARE PROPOSALS ON THE TABLE IN THE LEGISLATURE THIS YEAR. ALMOST ALL OF THEM ARE FINANCED BY A DOLLAR-A-PACK INCREASE IN THE CIGARETTE TAX. WHAT'S GOING TO HAPPEN WITH THE CIGARETTE TAX? IS IT GOING TO GO UP, AND IS IT GOING TO GO UP BY A BUCK? YOUR LEADER SAYS IT'S NOT.

Hatch: I THINK -- I THINK THE GENESIS OF ALL OF THESE HEALTH CARE PLANS IS BASED IN GOVERNOR CULVER'S COMMITMENT IN THIS ELECTION TO RAISE THE CIGARETTE TAX A DOLLAR. THE REASON HE DID THAT WAS NOT SO MUCH THE REVENUE THAT WAS GOING TO BE GENERATED BUT BECAUSE OF THE LIVES IT WILL SAVE. TODAY KIDS WHO ARE ALIVE TODAY WILL BE SAVED BY ELIMINATING THE HEALTH CARE EFFECTS ON THEM BY NOT SMOKING BY ALMOST 12,000.

Glover: PUT THE ARGUMENTS ASIDE. HOUSE SPEAKER PAT MURPHY SAYS THE LIKELIHOOD IS 40 TO 60 CENTS.

Hatch: WELL, THIS IS WHAT WE HAVE TO UNDERSTAND. IF YOU THINK ABOUT IT ONLY IN TERMS OF THE REVENUE WE'RE GOING TO GENERATE, THAT'S A WEAK ARGUMENT. BUT IF YOU LOOK AT IT IN TERMS OF THE OPPORTUNITY THAT THE LEGISLATURE HAS IN SAVING LIVES AND PREVENTING YOUNG KIDS FROM SMOKING, THAT IS A POWERFUL, POWERFUL ARGUMENT. THAT'S THE ONE WE'RE GOING TO BE BETTING ON. THAT HAS THE HIGHEST PRIORITY IN THIS LEGISLATURE. AND AS A RESULT, IF IT'S HIGH ENOUGH, THEN YOU WILL GET SOME REVENUE.

Yepsen: SENATOR HATCH, LET ME TRY A THIRD TIME. THE QUESTION ISN'T WHETHER OR NOT WE SHOULD RAISE THE CIGARETTE TAX. MIKE'S QUESTION IS WHAT ARE YOU GOING TO DO WHEN THE LEGISLATURE RAISES IT ONLY 40 TO 60 CENTS AS SPEAKER MURPHY HAS SAID WILL HAPPEN.

Hatch: WELL, IF THAT HAPPENS, WE'RE GOING TO HAVE TO FUND -- TO FUND OUR PLAN IN FRONT OF OUR COMMITTEE. WE'LL HAVE TO HAVE THE REVENUE SOMEWHERE ELSE. BUT I BELIEVE THAT WE'RE GOING TO GET A DOLLAR TAX. I THINK IT'S REALLY RELIABLE, AND I THINK THAT I'VE ALREADY SEEN LEGISLATORS MOVE FROM NONCOMMITTAL OF A DOLLAR TO A DOLLAR. AND SOME LEGISLATORS ARE PUTTING IN PROPOSALS FOR $1.17 AND $2. SO I THINK IT'S GOING TO BE A GOOD DEBATE, BUT I BELIEVE IN THE END WE'RE GOING TO GET IT. THE GOVERNOR IS GOING TO HELP ON THAT.

Yepsen: SO IT'S NOT WISHFUL THINKING ON YOUR PART?

Hatch: NO, I DON'T THINK IT IS WISHFUL THINKING, BUT I THINK IN THE BEGINNING WE HAD A PROBLEM. IN THE BEGINNING WE HAD THE SPEAKER AND MAJORITY LEADER TALKING ABOUT SMALLER INCREASES IN THE CIGARETTE TAX. I THINK ONE OF THE REASONS PEOPLE ARE MOVING AWAY FROM THAT IS THE BILL THAT WE'RE CONSIDERING IN OUR SUBCOMMITTEE, BECAUSE IT PUTS AN EMPHASIS ON THE PREVENTION AND THE TREATMENT AND THE ADDITIONAL DOLLARS FOR HEALTH CARE, NOT ONLY FOR THE PUBLIC SECTOR, BUT ALSO WE'RE LOOKING AT REFORMING THE INSURANCE LAWS TO HELP SMALL BUSINESSES AND FAMILIES.

Glover: REPRESENTATIVE HEATON, WHERE ARE REPUBLICANS ON THIS?

Heaton: I THINK REPUBLICANS ARE A LITTLE BIT HESITANT TO SUPPORT PERHAPS A DOLLAR. YOU'LL KNOW THAT LAST YEAR THE HOUSE OF REPRESENTATIVES WITH THE REPUBLICAN MAJORITY RESISTED THE INCREASE IN THE CIGARETTE TAXES. HOWEVER, I THINK NOW THERE'S A SENSE OF INEVITABILITY OF AN INCREASE, AND SO I THINK THAT MY REPUBLICANS ARE THINKING MORE ALONG THE LINES OF 40 TO 60 CENTS.

Glover: AND IT WILL HAPPEN AND IT WILL GO TO HEALTH CARE?

Heaton: THAT'S THE ONLY WAY THAT I'LL SUPPORT THE BILL. IF THIS IS GOING TO BE A GENERAL FUND THING OR MONEY GOING SOMEWHERE ELSE, I'LL VOTE NO ON THIS BILL IN A MINUTE.

Glover: AND, SENATOR HATCH, LET'S GO BACK TO THIS QUESTION OF IF YOU DON'T GET A DOLLAR, YOU SAY YOU'LL NEED SOME EXTRA MONEY FROM SOMEWHERE ELSE.

Hatch: CORRECT.

Glover: DO YOU HAVE AN IDEA WHERE THAT WOULD COME FROM?

Hatch: WELL, I THINK WHEN YOU TALK ABOUT THE PRIORITIES OF THE STATE, THERE IS NOT A HIGHER PRIORITY THAN SAVING LIVES AND PROVIDING HEALTH CARE SECURITY FOR PEOPLE WHO ARE RIGHT NOW, AND AS YOUR INTRODUCTION STATED, ARE VERY INSECURE AND VERY ANXIOUS ABOUT THE FUTURE OF THEIR HEALTH CARE SYSTEM. SO WE'RE PUTTING TOGETHER A BILL THAT WILL TAKE A LOOK AT $60-, $70 MILLION ON JUST PLUGGING THE PUBLIC SECTOR SAFETY NET HOLES. THAT'S MEDICAID, HAWKEYE, DENTAL CARE FOR KIDS AND ELDERLY. AND THEN WE'RE GOING TO HAVE TO TAKE A LOOK AT THE COST. IF WE'RE REALLY SERIOUS ABOUT PROVIDING SOME SORT OF ASSISTANCE TO SMALL BUSINESSES, WHERE RIGHT NOW THOUSANDS OF SMALL BUSINESSES CAN'T AFFORD HEALTH CARE FOR THEIR PEOPLE, TENS OF THOUSANDS OF ADULTS, ALMOST 300,000 IN IOWA ARE NOT COVERED BY ANY KIND OF HEALTH CARE, JACKING UP THE PRICE TO EMERGENCY CARE, HOSPITAL CARE, AND JUST GOING WITHOUT ANY CARE, WE HAVE AN OPPORTUNITY TO MAKE SOMETHING HAPPEN. NOW, IF IT'S NOT THE CIGARETTE TAX, THEN WE'LL HAVE TO GO TO OUR COLLEAGUES AND SAY IT'S GOING TO COME FROM THE GENERAL FUND. THERE ARE TOO MANY OTHER PRIORITIES. THERE'S TEACHER PAY. THERE'S ECONOMIC DEVELOPMENT. WE HAVE TO TAKE A LOOK AT HOW WE CAN RAISE THE MONEY FOR HEALTH CARE. THE CIGARETTE TAX IS THE BEST -- IS THE BEST ALTERNATIVE. AND LET ME JUST ADD THAT THOSE PEOPLE WHO ARE SAYING WE WANT 40 TO 60 CENTS, THAT WILL HAVE ABSOLUTELY NO EFFECT ON HELPING KIDS STOP SMOKING. THE CIGARETTE COMPANIES WILL PUT IN COUPONS AND WILL PROVIDE DISCOUNTS THAT WILL COUNTERACT ANY INCREASE LESS THAN 50 CENTS. WE'RE ABOUT SAVING LIVES OF YOUNG PEOPLE. YOU'RE NOT GOING TO DO IT WITH 50- OR 60-CENT CIGARETTE TAX.

Henderson: LET'S TALK ABOUT THE MAGNITUDE OF THE PROBLEM. REPRESENTATIVE HATCH -- I MEAN SENATOR HATCH JUST SAID THAT THERE ARE 300,000 IOWANS WHO DO NOT HAVE HEALTH INSURANCE. REPRESENTATIVE HEATON, WHAT PERCENTAGE OF IOWA BUSINESSES DO NOT PROVIDE HEALTH CARE INSURANCE TO THEIR EMPLOYEES?

Heaton: I THINK A SIGNIFICANT AMOUNT OF THE PEOPLE THAT DO NOT HAVE INSURANCE ARE PEOPLE WHO WORK FOR SMALL BUSINESSES. IF WE COULD COME UP WITH A PLAN WHERE SMALL BUSINESSES WOULD HAVE THE OPPORTUNITY TO BETTER AFFORD TO PROVIDE INSURANCE FOR THEIR EMPLOYEES OR ALLOW THE EMPLOYEE THEMSELVES TO PURCHASE INSURANCE, WE'LL BE ON THE RIGHT TRACK. I'M READY TO PRESENT A PLAN THAT'S ALREADY IN PLACE IN MASSACHUSETTS CALLED THE INSURANCE EXCHANGE. IT'S SPONSORED BY THE HERITAGE FOUNDATION. THEY'VE DONE THE RESEARCH ON IT, AND I THINK IT'S JUST THE THING THAT WE'RE LOOKING FOR HERE IN THE STATE. YOU CREATE A SELECTION OF INSURANCE PLANS THAT ANY INSURANCE COMPANY IN THE STATE CAN SELL, BUT YOU STANDARDIZE THE CAFETERIA OF INSURANCE. AT THE SAME TIME THEN BY DOING THAT AND ALLOWING THE BUSINESSES TO VOLUNTARILY BE ABLE TO SELECT FROM THIS GROUP OF PLANS, YOU HAVE CREATED A SITUATION CALLED QUALIFYING FOR SECTION 125 OF THE INTERNAL REVENUE CODE. WHY IS THIS SO IMPORTANT? BECAUSE BUSINESS SOMETIMES CAN'T PAY THE FULL BILL FOR THE INSURANCE FOR THEIR EMPLOYEES, ESPECIALLY SMALL BUSINESSES. THEY CAN COME FORWARD, MAYBE PROVIDE 50 PERCENT OF THE COST OF THE INSURANCE. THEY GET TO TAKE TAXES -- THEY GET TO TAKE THEIR COST BEFORE TAXES, BUT WHEN YOU SET -- WHEN YOU QUALIFY FOR SECTION 125, THE EMPLOYEE ALSO HAS THE SAME ADVANTAGE AS THE BUSINESS.

Henderson: AND THAT MASSACHUSETTS --

Heaton: AND THAT'S WHAT MAKES IT SO IMPORTANT.

Henderson: THAT MASSACHUSETTS PLAN ALSO IMPOSES A FEE OR TAX ON BUSINESSES WHICH DO NOT PROVIDE HEALTH INSURANCE. DO YOU SUPPORT THAT?

Heaton: THAT IS -- THAT IS WHEN YOU MOVE FORWARD AND TRY TO OFFER INSURANCE TO ALL, IN OTHER WORDS, TO COVER THE UNINSURED. IF YOU WANT TO STICK WITH A BUSINESS -- A SMALL BUSINESS INSURANCE PLAN, YOU DON'T HAVE TO QUITE GO AS FAR AS THEY DID IN MASSACHUSETTS. BUT, YES, YOU ARE CORRECT; $295 A YEAR PER PERSON THOSE BUSINESSES HAVE TO PAY TO PROVIDE FOR THE UNCOMPENSATED CARE FOR THE PEOPLE WHO DO NOT HAVE INSURANCE.

Glover: SENATOR HATCH, THE PLAN THAT YOU HAVE TROTTED OUT WOULD BE A MULTIYEAR PLAN PHASED IN OVER A COUPLE OF YEARS. WHAT DO YOU WANT TO SEE HAPPEN IN THIS LEGISLATIVE SESSION? WHAT'S THE FIRST STEP YOU WANT TO TAKE, AND WHAT'S THE LIKELIHOOD OF THAT HAPPENING?

Hatch: WELL, THE FIRST STEP IS DIVIDED INTO THREE SECTIONS. FIRST, WE WANT TO CREATE -- WE KNOW THERE HAS TO BE REFORM IN THE INSURANCE MARKET TO CREATE OPPORTUNITIES FOR SMALL BUSINESSES TO BUY INSURANCE. WE WANT TO SET A COMMISSION UP -- LEGISLATIVE COMMISSION, WITH INPUT FROM SMALL BUSINESSES, INSURANCE, AND CONSUMERS, TO GET TO WHAT DAVID WAS TALKING ABOUT, TAKING A LOOK AT ALL OF THE OPTIONS IN FRONT OF US. WE'VE GOT TO BE DELIBERATIVE. WE HAVE AN INSURANCE INDUSTRY IN THIS STATE THAT CANNOT BE HARMED BY HOW WE SET THESE KIND OF CONDITIONS UP. SECONDLY, WE WANT TO PLUG THE SAFETY -- THE PUBLIC SECTOR HEALTH CARE SAFETY NET. THERE ARE PEOPLE RIGHT NOW, 35,000 KIDS ARE ELIGIBLE FOR HAWKEYE, WHICH IS THE INSURANCE PROGRAM FOR KIDS, THAT ARE ELIGIBLE BUT THEY'RE NOT SIGNED UP. WE HAVE PARENTS WHO ARE ELIGIBLE FOR RECEIVING ASSISTANCE FOR MEDICAID WHO HAVE SMALL CHILDREN. THEY ARE ELIGIBLE; THEY'RE NOT SIGNED UP. WE WANT TO OPEN UP THE SYSTEM AND CREATE GREATER AVENUES FOR THOSE PEOPLE. WE HAVE DENTAL CARE FOR CHILDREN. RIGHT NOW THEY'RE ELIGIBLE BUT WE DON'T HAVE ANY MONEY FOR IT, SO WE WANT TO PUT IN $15-, $16 MILLION TO BE MATCHED BY $30 MILLION FROM THE FEDS TO PROVIDE A DENTAL HOME FOR ALL CHILDREN UNDER TWELVE. AND THEN WE WANT TO BE ABLE TO RAISE REVENUE, AND THAT REVENUE IS BASED ON THE CIGARETTE TAX. THOSE THREE ELEMENTS ARE IN OUR BILL. THAT'S WHAT WE'RE DEBATING NOW. OUR BUDGET COMMITTEE, WE'LL HAVE ELEVEN OR TWELVE DAYS OF TWO-HOUR-A-DAY MEETINGS GOING THROUGH THIS BILL. WE'LL HAVE OVER 70 PEOPLE TESTIFY IN FRONT OF OUR COMMITTEE.

Glover: REPRESENTATIVE HEATON?

Heaton: WELL, I'D LIKE TO ALSO ADD THAT, YOU KNOW, THERE IS SOME FLEXIBILITY IN WHAT WE'RE LOOKING AT AS WE LOOK AT THIS EXPANSION. FOR INSTANCE, RIGHT NOW WE'RE LOOKING AT DENTAL HOMES FOR ALL CHILDREN FROM ZERO TO EIGHTEEN. IF WE CAN'T AFFORD THAT -- AND THE COST OF THAT RUNS AROUND $25 MILLION. IF WE CAN'T AFFORD THAT, PERHAPS WE CAN START WITH THE AGES OF ZERO TO FIVE, LIKE THEY HAVE IN RHODE ISLAND. AND THEN EACH SUCCESSIVE -- EACH SUCCEEDING YEAR THEY ADD A YEAR TO IT, SO EVENTUALLY YOU BEGIN TO COVER ALL CHILDREN ZERO TO EIGHTEEN, BUT THEY START WITH A SMALLER STEP. WE CAN DO THE SAME THING WITH A LOT OF THESE THINGS THAT WE HAVE IN OUR PLAN, STARTING WITH SMALLER STEPS IF THE REVENUES AREN'T THERE. I'VE GOT TO SAY ONE THING ABOUT CIGARETTE TAXES. IF YOU DON'T SET IT HIGH ENOUGH -- WE KNOW THAT PEOPLE ARE GOING TO QUIT SMOKING AS WE RAISE THE PRICE OF THE CIGARETTES. IF WE SET IT AT A DOLLAR, YEAH, RIGHT OUT OF THE GATE THERE MIGHT BE $120 MILLION AVAILABLE FOR HEALTH CARE. BUT WE -- THAT'S NOT OUR GOAL. OUR GOAL IS TO REDUCE SMOKING, WHICH MEANS THAT THE REVENUES ARE CONTINUING TO SHRINK OVER A PERIOD OF TIME. SO IF WE SET UP AN EXPANSION OF HEALTH CARE IN THIS STATE, WE NEED TO BE ABLE TO SUSTAIN IT. AND THAT'S WHAT I AM CONCERNED ABOUT RIGHT NOW.

Glover: SENATOR HATCH, WHAT'S THE BILL THIS YEAR?

Hatch: WHAT IS THE BILL?

Glover: MM-HMM.

Hatch: IT'S CALLED A COMPREHENSIVE AND AFFORDABLE HEALTH CARE FOR FAMILIES AND SMALL BUSINESSES.

Glover: PUT A DOLLAR AMOUNT ON IT. THAT'S THE KIND OF BILL I'M THINKING ABOUT.

Hatch: OH, THE BILL. THE INVOICE IS HOW WE PRIVATE SECTOR FOLKS LOOK AT IT. THE INVOICE FOR THE PRIVATE -- THE PUBLIC SECTOR SAFETY NET IS ABOUT $60 MILLION. IT IS UNKNOWN, BECAUSE WE DON'T KNOW WHAT KIND OF PROGRAM WE'RE GOING TO HAVE FOR THE PRIVATE SECTOR OF SMALL BUSINESSES, THAT COULD BE $20- TO $30 MILLION BECAUSE WHAT DAVID WAS TALKING ABOUT WITH MASSACHUSETTS IS AN INDIVIDUAL MANDATE. THAT MEANS EVERYBODY IN MASSACHUSETTS HAS TO HAVE INSURANCE. THEY'VE GOT TO PUT IT ON THEIR INCOME TAX. IF YOU DON'T HAVE INSURANCE, THEN THE STATE TAKES UP TO $300 PER PERSON. AND THEN THERE'S SUBSIDIES; SMALL BUSINESSES WILL BE SUBSIDIZED PARTIALLY FOR KEEPING PEOPLE IN AN INSURANCE PLAN. WE DON'T KNOW HOW MUCH THAT'S GOING TO BE, BUT 20 OR 30 -- SO WE'RE THINKING ABOUT MAYBE AS MUCH AS $90 MILLION OVER THE NEXT TWO YEARS FOR THE PLAN OUT OF $150- OR -60 MILLION THE CIGARETTE TAX WILL GENERATE, WHICH WILL LEAVE SOME MORE MONEY FOR HEALTH CARE.

Glover: REPRESENTATIVE HEATON?

Heaton: IF YOU DON'T GO FOR ADDRESSING ALL THE UNINSURED AND YOU ONLY WANT TO LOOK AT SMALL BUSINESS, YOU DON'T REALLY HAVE TO PUT IN ANY ADDITIONAL MONEY. IT'S THE STRUCTURE THAT YOU CREATE, ALLOWING FOR SECTION 125 OF THE IRS CODE TO BE UTILIZED SO THAT THE EMPLOYEE OWNS THE INSURANCE, NOT THE EMPLOYER, WHICH IS CURRENTLY THE WAY IT WORKS. AND WHEN YOU OPEN IT UP AND YOU LET THE EMPLOYEE OWN THE INSURANCE, THAT MEANS IT'S AFFORDABLE, IT'S ACCESSIBLE AND, ABOVE ALL, IT'S PORTABLE. MOST PEOPLE SWITCH JOBS SIX TO SEVEN TIMES IN THEIR LIFE. I MEAN THE TRAGIC THING ABOUT OUR SYSTEM RIGHT NOW IS THAT WHEN A PERSON SWITCHES JOBS, THEY DISCONNECT FROM THE INSURANCE PLAN THAT THEY HAVE. I'VE GOT FOUR BYPASSES IN MY HEART HERE. IF I WOULD QUIT MY JOB AND MOVE SOMEWHERE ELSE, I WOULD LOSE THE INSURANCE THAT THE EMPLOYER HAD ON ME AND MY HEART THEN WOULD BE RATED ON THE NEXT POLICY THAT I BUY. I MEAN THEY WOULD DISCOUNT ANY INJURIES THAT WOULD OCCUR BECAUSE OF A HEART. THAT'S NOT FAIR.

Henderson: REPRESENTATIVE HEATON, I WANT TO ASK YOU KIND OF A BIG-PICTURE QUESTION. REPUBLICANS AND BUSINESS TYPES OPPOSED THE CLINTON HEALTH CARE PLAN OVER A DECADE AGO. WHY ARE YOU NOW PARTICIPATING IN THE DEBATE ABOUT EXPANDING GOVERNMENT PAID HEALTH CARE COVERAGE?

Heaton: I'M NOT LOOKING AT GOVERNMENT PAID HEALTH CARE COVERAGE. I'M LOOKING AT GOVERNMENT AIDED.

Henderson: SO DO REPUBLICANS OPPOSE HAVING THE GOVERNMENT STEP IN?

Heaton: I THINK PEOPLE TODAY HAVE COME TO THE REALIZATION THAT SOMETHING HAS TO HAPPEN. YOU KNOW, FORTY YEARS AGO WHEN WE STARTED DOING ALL THESE BENEFITS WITH THE EMPLOYEES, HEALTH CARE WAS AFFORDABLE AND IT WAS CHEAP. WE WENT THROUGH DOUBLE-DIGIT INFLATION FOR THE LAST DECADE ON THIS ISSUE WITH HEALTH CARE, 15- TO 20-PERCENT INCREASES ANNUALLY. EMPLOYERS ARE DROPPING THEIR INSURANCE PLANS OR TRIMMING THEM BACK. THEY'RE PUTTING MORE RESPONSIBILITY ON THE EMPLOYEE TO HELP PAY FOR THAT PLAN. I THINK PEOPLE ARE COMING TO THE POINT OF SAYING SOMETHING HAS TO HAPPEN. WE'VE GOT TO ADDRESS THIS THING IN A DIFFERENT WAY, AND I THINK THE PEOPLE IN MASSACHUSETTS ARE ON THE RIGHT TRACK; HOWEVER, I QUESTION WHETHER OR NOT WE HAVE THE RESOURCES TO REALLY DO WHAT THEY DO IN MASSACHUSETTS.

Yepsen: MR. HEATON, I WANT TO GO TO A POLITICAL QUESTION HERE. IT SEEMS FROM THIS CONVERSATION, JUST TO AN OBSERVER, THAT IT'S A COMPLICATED SUBJECT BUT SO FAR IT'S NOT BECOME A PARTISAN ONE UP THERE. I DON'T HEAR YOU AND SENATOR HATCH STAKING OUT PARTISAN POSITIONS. IS THAT A FAIR ASSESSMENT?

Heaton: THE ONLY WAY YOU'RE EVER GOING TO HAVE ANYTHING SUCCEED IS TO BE ABLE TO HAVE SUSTAINABILITY. AND THAT MEANS TEN OR TWENTY YEARS FROM NOW, YOU'VE GOT TO BE ABLE TO BE DOING BASICALLY THE SAME THING. I MEAN FOR A MAJORITY PARTY TO TAKE CHARGE AND RAM THROUGH A PLAN THAT IS NOT SUPPORTED BIPARTISANLY IS MAKING A BIG MISTAKE, BECAUSE ONCE THE OTHER PARTY GETS INTO POWER, THEN ARE THEY GOING TO TAKE DOWN THE PLAN AND START ALL OVER AGAIN.

Yepsen: LET ME COME BACK TO THE MASSACHUSETTS THING AND JUST PUT A FINER POINT ON THIS THING. MR. HEATON, DO YOU WANT TO SEE IOWA ENACT A REQUIREMENT THAT INDIVIDUALS CARRY THEIR OWN HEALTH INSURANCE -- HAVE HEALTH INSURANCE?

Heaton: WHAT WAS THE BIG QUESTION DURING THE CLINTON ADMINISTRATION: WHO'S GOING TO PAY FOR ALL OF THIS? AND THE PUBLIC BECAME VERY CONFUSED AND EVENTUALLY TURNED AGAINST THE PROPOSAL. THERE'S A SIMPLE ANSWER TO THIS ONE. WHO'S GOING TO PAY FOR THIS? WE'RE ALL GOING TO PAY FOR THIS. EVERYBODY INDIVIDUALLY HAS TO PROVIDE FOR THEIR OWN INSURANCE.

Yepsen: SO IS THAT A YES OR NO? DO YOU WANT THE -- DO YOU WANT IOWA TO DO WHAT THEY'VE DONE IN MASSACHUSETTS, WHICH IS TO SAY TO THE INDIVIDUAL YOU HAVE TO HAVE INSURANCE?

Heaton: IF WE HAVE THE RESOURCES TO DO THIS, THE SUGGESTION MADE BY GOVERNOR MITT ROMNEY BEFORE HE LEFT OFFICE AND THE COMPROMISE THAT WAS WORKED OUT WITH THAT LEGISLATURE WOULD BE AN EXCELLENT FIT FOR IOWA. I JUST QUESTION WHETHER OR NOT WE HAVE THE RESOURCES TO DO IT.

Yepsen: SENATOR HATCH, THE SAME QUESTION. DO YOU THINK THIS LEGISLATURE WILL OR SHOULD ENACT A MASSACHUSETTS STYLE MANDATE?

Hatch: I PERSONALLY LEAN TOWARD THAT AND I THINK -- I THINK THAT'S ONE OF THE SIGNIFICANT OPTIONS WE HAVE DURING THIS NEXT YEAR WHEN WE STUDY THAT. I THINK IT'S GOING TO BE A BOLD ATTEMPT. I THINK IT'S GOING TO BE A BOLD SOLUTION. I THINK IOWANS WANT REFORM IN THE HEALTH CARE SYSTEM. THE INDIVIDUAL MANDATE THAT MASSACHUSETTS HAS PUTS THE ACCOUNTABILITY RIGHT ON THE INDIVIDUAL. IT HELPS THE SMALL BUSINESSES AND REDUCES -- WE BELIEVE WILL REDUCE THE COST FOR EVERYBODY. RIGHT NOW CANCER, WHICH CAUSE -- WHICH IN IOWA, 6,000 PEOPLE DIE OF CANCER A YEAR; 2,000 ARE FROM SMOKE-RELATED DISEASES -- SMOKING RELATED. THAT MEANS FIVE IOWANS DIE OF A SMOKE-RELATED DISEASE EVERY DAY IN THIS STATE. THERE'S A COST TO THAT, AND TAXPAYERS' COST IS ASSUMING MOST OF THAT COST. TO ANSWER YOUR QUESTION SHOULD WE HAVE A MANDATE, WE NEED TO HAVE A MANDATED PROGRAM FOR HEALTH CARE. AND IF THAT MEANS WE'RE GOING TO ALLOW THE CITIZEN TO HAVE -- BE ACCOUNTABLE, THAT THOSE THAT NEED ASSISTANCE, WE'LL GIVE THEM ASSISTANCE, THOSE COMPANIES THAT CAN PAY FOR IT WE, CAN CONTROL THE COST, I THINK THAT'S A WIN FOR EVERYBODY AND WE'D BE IN FAVOR FOR THAT.

Glover: SENATOR HATCH, LET'S TO A BIGGER PICTURE QUESTION AS WELL. MOST PEOPLE WHO HAVE HEALTH INSURANCE HAVE HEALTH INSURANCE THROUGH THEIR EMPLOYER. WE HAVE AN EMPLOYMENT-BASED HEALTH INSURANCE SYSTEM IN THIS COUNTRY. IS IT TIME TO MOVE AWAY FROM THAT?

Hatch: WELL, RIGHT NOW THAT'S BEING CHALLENGED. AND I THINK SOME OF THE THINGS THAT WE'RE TALKING ABOUT, NOT A SINGLE-PAYER GOVERNMENT RUN SYSTEM BUT A MANDATED SYSTEM WHERE PEOPLE HAVE MORE CHOICES, MAY FORCE THE INSURANCE COMPANIES TO UNDERSTAND -- AND EMPLOYERS THAT THEY HAVE TO GET BETTER AT CONTROLLING THEIR COST AND WE HAVE TO BE BETTER AT DELIVERING THE SERVICE. THE UNITED STATES LEADS THE COUNTRY -- LET'S THE WORLD IN ONE STATISTIC IN HEALTH CARE, ONLY ONE: THE COST. IT'S THE HIGHEST COST PER PERSON OF ANY HEALTH CARE SYSTEM IN THE WORLD. WE HAVE TO UNDERSTAND THAT WE'VE GOT TO BRING THOSE COSTS DOWN. STATES LIKE IOWA, CALIFORNIA, MASSACHUSETTS, VERMONT, TENNESSEE, THEY'RE BEGINNING TO CHALLENGE THE STATUS QUO, AND WE'RE WILLING TO -- WE'RE WILLING TO STAND UP TO ANY SPECIAL INTEREST AND COME UP WITH SOMETHING HERE.

Glover: REPRESENT HEATON, THE SAME QUESTION TO YOU. IS IT TIME TO MOVE BEYOND THE WHOLE CONCEPT THAT WE'RE GOING TO GET HEALTH INSURANCE THROUGH OUR EMPLOYMENT?

Heaton: NOT NECESSARILY, IF THE EMPLOYER CHOOSES TO PROVIDE THE INSURANCE. BUT TO BE QUITE HONEST, IF YOU COMPETE ON THE WORLD STAGE, YOU WILL FIND THAT BUSINESSES THAT WE COMPETE AGAINST, THE COST OF BENEFITS -- THE COST OF HEALTH INSURANCE IS NOT PART OF THEIR COST IN THE COMPETITION. WE'RE AT AN IMMEDIATE DISADVANTAGE OF ALMOST 25-PERCENT HIGHER LABOR COSTS AGAINST FOREIGN COMPETITION WHEN YOU TALK ABOUT THIS ISSUE. WE THINK -- WE THINK IT'S WORKING AGAINST US, THAT THE EMPLOYER HAVING TO PROVIDE THE INSURANCE WOULD WORK AGAINST US.

Glover: I DID A EUROPEAN TRIP A FEW YEARS AGO WHERE WE MET WITH SOME MINISTERS OF HEALTH IN SOME VARIOUS COUNTRIES, AND THEY THINK WE'RE IDIOTS. THEY THINK DO YOU UNDERSTAND -- YOU'RE GOING TO PAY FOR HEALTH CARE; IT'S JUST HOW YOU PAY FOR IT. YOU PAY FOR IT IN TAXES. YOU PAY FOR IT IN INSURANCE. YOU PAY FOR IT IN MEDICAL BILLS. YOU PAY FOR IT ONE WAY OR THE OTHER. WHY DON'T WE GET THAT HERE?

Heaton: WE'VE GOT A CERTAIN PERSONALITY IN THIS COUNTRY THAT DISTRUSTS GOVERNMENT. THEY DON'T REALLY BELIEVE THE GOVERNMENT IS THE ONE THAT SHOULD BE HANDING OUT THE HEALTH CARE. THEY ALSO ARE VERY SUSPECT OF A SINGLE-PAYER SYSTEM. I MEAN LET'S FACE IT, WE LIKE WESTERN MOVIES TOO, DON'T WE? AND EUROPE CAN'T UNDERSTAND WHY WE LOVE THESE SPAGHETTI WESTERNS SO MUCH. I MEAN WE HAVE A CERTAIN PERSONALITY IN OUR COUNTRY THAT THEY DON'T HAVE.

Yepsen: SENATOR, WHY DO YOU --

Hatch: BUT, YOU KNOW -- BUT, YOU KNOW, ON THOSE SPAGHETTI WESTERNS, THEY'RE NOT VERY GOOD, AND THAT'S WHERE OUR HEALTH CARE SYSTEM ISN'T VERY GOOD EITHER. IF WE DON'T MOVE FORWARD TO A SYSTEM THAT PROVIDES A COMPREHENSIVE AND NEAR UNIVERSAL ACCESS TO HEALTH CARE THAT IS AFFORDABLE AND LOW, YOU WILL FIND THAT THE PRIVATE SECTOR OR THE EMPLOYER-BASED HEALTH CARE SYSTEM WILL CHANGE.

Yepsen: SENATOR HATCH, YOU ACT LIKE YOU'RE IN CONGRESS. I MEAN THIS IS A STATE OF IOWA PLAN. WHAT MAKES ANY STATE LEGISLATOR THINK YOU'RE GOING TO SOLVE A PROBLEM THAT'S A NATIONAL PROBLEM AND DO IT HERE IN IOWA WITHOUT CREATING A SITUATION WHERE WE'RE UNCOMPETITIVE?

Hatch: REPRESENTATIVE HEATON MENTIONED IT EARLIER, PEOPLE ARE FED UP IN IOWA AND ACROSS THIS COUNTRY. THE FEDERAL GOVERNMENT HAS FAILED TO PROVIDE THE ECONOMIC AND HEALTH CARE SECURITY THAT WE REQUIRE IN THIS COUNTRY, AND STATES ARE TAKING THE INITIATIVE. WE CANNOT REACH -- I MEAN WE CANNOT SOLVE THE PROBLEM, BUT WE CAN GET CLOSE TO IT. AS GOVERNOR RAY SAID OVER THE SUMMER WHEN WE WERE WORKING ON THIS, HE SAID, 'YOU KNOW WHAT, I'VE COME FULL CIRCLE. STATES HAVE TO TAKE THE INITIATIVE. AND ONLY WHEN STATES TAKE THE INITIATIVE WILL WE BE ABLE TO FORCE THE FEDERAL GOVERNMENT TO COME UP WITH A NATIONAL HEALTH CARE PLAN.' AND THAT'S WHAT WE'RE DOING. WE'RE TAKING THE LEAD. I APPRECIATE REPRESENTATIVE HEATON'S LEADERSHIP ON THIS. THAT'S PART OF THE REASON YOU'LL SEE FROM OUR COMMITTEE A BIPARTISAN ANSWER TO THIS. I THINK WE HAVE -- I THINK WE HAVE AN OPPORTUNITY.

Henderson: SENATOR HATCH, HOW DO YOU GET BUSINESSES NOT TO DUMP PEOPLE, NOT TO GET RID OF THEIR HEALTH INSURANCE IF THIS PLAN COMES TO PASS?

Hatch: WELL, THAT'S ONE OF THE -- THAT'S A GOOD QUESTION AND THAT'S ONE OF THE REASONS WE'RE GOING TO BE PUTTING THIS INTO A COMMISSION WHERE WE CAN LOOK AT THAT. ONE OF THE THINGS WE DON'T WANT TO DO, WHICH MASSACHUSETTS DID, WAS THEY HAMMERED THIS OUT BEHIND CLOSED DOORS AFTER FIVE MONTHS OF A CONFERENCE COMMITTEE. WE'RE GOING TO ANSWER ALL THOSE QUESTIONS IN THE OPEN, AND WE'RE GOING TO HAVE INSURANCE COMPANIES THERE. WE'RE GOING TO MAKE SURE THAT TWO THINGS HAPPEN: THAT, ONE, THE COST -- WE HOPE. THE COST OF HEALTH CARE WILL COME DOWN AND THAT THERE WILL BE PARTICIPATION FROM INDIVIDUAL MEMBERS OF OUR SOCIETY AND INDIVIDUAL BUSINESSES THAT WILL ATTEMPT TO LOOK AT THE ADVANTAGES OF LOWER HEALTH CARE COSTS AND THE ADVANTAGES OF BEING COVERED BY HEALTH CARE. WE ALL WIN ON THAT SO WE'RE GOING TO TRY TO KEEP THAT OPEN.

Glover: REPRESENTATIVE HEATON, WILL MENTAL HEALTH PARITY BE A PART OF THIS? >>

Heaton: IT IS PROPOSED IN SENATOR HATCH'S BILL.

Yepsen: DO YOU THINK IT WILL WIND UP BECOMING LAW?

Heaton: LIKE I SAY, I'M IN THE MINORITY, HE'S IN THE MAJORITY, AND IF HE WANTS THAT BILL TO PASS, IT'S GOING TO PASS.

Yepsen: EXCUSE ME, MIKE. WHAT ABOUT -- WHAT'S YOUR ANSWER TO KAY'S QUESTION ABOUT ARE YOU WORRIED THAT THE PLAN WILL PROMPT EMPLOYERS TO DUMP COSTS ONTO THE STATE?

Heaton: THE REPORTS THAT I'M GETTING FROM MASSACHUSETTS, THEY HAVE NO FEAR OF THAT. THEY STILL LOOK ON -- THEY STILL FEEL THAT EMPLOYERS STILL LOOK ON THEIR EMPLOYEES AS WANTING TO PROVIDE THEM BENEFITS TO ENCOURAGE THEM TO WORK FOR THEIR COMPANY. THE WHOLE THING HERE IS THE PORTABILITY ISSUE, BEING ABLE TO MOVE FROM ONE COMPANY TO THE OTHER, THAT WHERE YOU GO TO OTHER STATES YOU CAN'T HAVE THIS BUT IN MASSACHUSETTS YOU CAN, THE ACCESSIBILITY, AFFORDABILITY. THESE ARE THE THREE THINGS THAT THIS MASSACHUSETTS PLAN CREATES. I'M NOT HEARING ANYTHING OUT OF MASSACHUSETTS THAT APPEARS THAT BUSINESSES ARE GOING TO DUMP THEIR EMPLOYEES.

Glover: SENATOR HATCH, MENTAL HEALTH PARITY?

Hatch: WELL, LAST YEAR WE PASSED A PORTION OF IT WITH BIPARTISAN SUPPORT.

Glover: IT WAS A PRETTY LIMITED PORTION.

Hatch: IT WAS LIMITED. THIS ONE EXPANDS IT TO COVER ALCOHOLIC AND SUBSTANCE ABUSE TREATMENT, AND WE THINK IT'S GOING TO PASS. WE WOULD LIKE TO KEEP IT IN OUR BILL. IT HAS A GREAT IMPACT ON THE HEALTH OF THOUSANDS OF IOWANS.

Henderson: SENATOR HATCH, YOU HAVE A FORMER MASSACHUSETTS GOVERNOR RUNNING AROUND THE STATE CAMPAIGNING FOR PRESIDENT. YOU HAVE OTHER PRESIDENTIAL CANDIDATES TALKING ABOUT THIS ISSUE. HOW DOES THE DEBATE AT THE NATIONAL LEVEL INFLUENCE THE STATE-LEVEL DEBATE?

Hatch: I THINK THOSE PRESIDENTIAL CANDIDATES ARE GOING TO BE COMING TO IOWA AND OTHER STATES TRYING TO FIND OUT WHAT WE'RE DOING. AND I THINK THAT THEY'RE GOING TO BE VERY INTERESTED IN THE LOCAL RESPONSE AND THE STATEWIDE RESPONSE, BUT IT IS GOING TO BE -- I BELIEVE, IT WILL BE THE BIGGEST DOMESTIC ISSUE AFFECTING THE PRESIDENTIAL RACE THIS COMING YEAR.

Henderson: DO YOU AGREE, REPRESENTATIVE HEATON?

Heaton: OUTSIDE OF THE IRAQ WAR, I FEEL THAT THIS IS THE NUMBER ONE ISSUE ON PEOPLE'S MINDS ACROSS THIS COUNTRY.

Glover: AND IS THAT GOING TO FORCE ACTION?

Heaton: I THINK IT'S GOING TO FORCE ACTION. I THINK THAT OUR PEOPLE ARE LOOKING FOR SOME TYPE OF SOLUTION. I WAS IN THE HOSPITAL THE OTHER DAY, THE DAY BEFORE YESTERDAY IN THE EMERGENCY ROOM. MOM AND A CHILD, WHOOPING COUGH, YOU KNOW, AND THAT CHILD WAS VERY SICK. AND ALL OF A SUDDEN YOU BECAME AWARE OF WHAT IT'S LIKE TO BE IN THE EMERGENCY ROOM AND WHAT IT'S LIKE NOT TO HAVE INSURANCE AND YOU'RE BEGGING FOR CARE.

Yepsen: MR. HEATON --

Heaton: BAD THING.

Yepsen: MR. HEATON, ALL OF A SUDDEN I'M AWARE OF THE CLOCK, AND WE'RE OUT OF TIME. THANK YOU BOTH FOR BEING WITH US TODAY. APPRECIATE IT.

Heaton: WELL, THANK YOU.

Hatch: THANK YOU. THANK YOU ALL.

Yepsen: AND WE LEAVE YOU WITH TWO PROGRAM REMINDERS. THIS COMING TUESDAY GOVERNOR CHET CULVER WILL ADDRESS A JOINT SESSION OF THE IOWA GENERAL ASSEMBLY, AND IOWA PUBLIC TELEVISION WILL BE THERE. IT'S THE GOVERNOR'S ANNUAL BUDGET ADDRESS, HIS FIRST, AND HE'LL LAY OUT HIS HOPES FOR THE NEXT STATE BUDGET. IPTV WILL AIR HIS SPEECH LIVE AT 10 A.M. ON TUESDAY WITH A REBROADCAST AT 8 P.M. THAT EVENING. AND ON NEXT WEEKEND'S 'IOWA PRESS,' GOVERNOR CULVER WILL JOIN US TO DISCUSS THAT BUDGET AND A LITTLE POLITICS TOO. AIRTIME IS AT 7:30 P.M. NEXT FRIDAY, WITH A REBROADCAST SUNDAY AT 11:30. I HOPE YOU'LL BE JOINING US. I'M DAVID YEPSEN OF THE 'DES MOINES REGISTER' SITTING IN FOR DEAN BORG ON THIS WEEK'S EDITION OF 'IOWA PRESS.' THANKS FOR JOINING US.

FUNDING FOR THIS PROGRAM WAS PROVIDED BY 'FRIENDS,' THE IOWA PUBLIC TELEVISION FOUNDATION; BY THE IOWA BANKERS ASSOCIATION... FOR PERSONAL, BUSINESS, AND COMMERCIAL NEEDS, IOWA BANKS HELP IOWANS REACH THEIR FINANCIAL GOALS; AND BY THE ASSOCIATED GENERAL CONTRACTORS OF IOWA, THE PUBLIC'S PARTNER IN BUILDING IOWA'S HIGHWAY, BRIDGE, AND MUNICIPAL UTILITY INFRASTRUCTURE.


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