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Fall Work Session

Apple Harvest

Continuous daily work shifts since July 31 have taken their toll. It’s  been challenging to find time for mowing, cleaning, repairs and household chores. It’s also been hard to get enough sleep. And to write. I need time to take care of things.

Monday and Tuesday are job-free so I can prepare for winter. Yard maintenance is high on my to-do list as are catching up on community organizing and the apple harvest. I want to get organized for the next few days, but not too much. I plan to go with the flow of time for a while.

This week U.S. Senator Joni Ernst held a few town hall meetings in the state, including one in Iowa City. I’ve read every news article I could find about the event and I don’t see a political downside. Tough questions were asked of her, including some by people in my social network. Ernst gets credit for holding a public meeting in the liberal bastion simply because the senior Iowa senator has not for so long.

Iowa is a state that voted for Donald Trump by a 9.4 percent margin. In 2014, Ernst beat Democratic candidate Bruce Braley by a margin of 8.3 percent. The wide margin is significant. Ernst is enabled to point to it and say she represents Iowa when she votes for legislation many of us find reprehensible. I can’t think of many policy issues where I agree with Ernst, yet she won the election big. That she would hold a town hall meeting in the county that voted for Hillary Clinton and Bruce Braley only reinforces her status with the people who elected her. Ernst is not the senator Iowa City wanted in 2014 nor the one they want going forward. The lesson is Johnson County liberals don’t elect people statewide and Ernst knows it.

The topic of the day was the Graham Cassidy bill to repeal the Patient Protection and Affordable Care Act. Graham Cassidy was a loser from the git go. Reaction to the bill has been lopsidedly negative. With Senator John McCain (R-AZ) announcing he will vote no should it come up for a vote, it seems dead in the water.

Graham Cassidy dominated news media attention obscuring some important health care issues.

The Affordable Care Act is barely affordable, even with the federal insurance premium subsidies. If a person gets sick, the co-pays and deductibles are high enough to disrupt the financial life of those who qualify for participation in the ACA Marketplace. The total monthly premium for health insurance under the law is much higher than anyone can afford. It is also more expensive than the cost of Medicare. If the government were about saving money, those eligible for coverage under the ACA should be enrolled immediately in Medicare.

Health care sucked under the ACA. I had coverage through the Marketplace for two years and experienced something new. My doctor raised the issue of Essential Health Services during my annual appointment, saying what he could and could not do. Rather than listen to my questions as his predecessors in the small, rural clinic did for 20 years, he injected politics into my appointment. He was afraid to give me treatment either because of the ACA or because of instructions from his employer. I did not return to see him and he has since left the clinic.

Health care in Iowa has been bad on many fronts. The mental health consolidation was incomplete at best, failing to include a program for disabled children. Outsourcing Medicaid to private companies has been a costly disaster that delays patient treatment and provider compensation. Despite one of the best healthcare organizations in the country it is difficult to get needed care in this state.

The idea that Medicaid would be block granted to states, as proposed in Graham Cassidy, is one more in a thousand cuts to Iowans. The lesson is Senate Republicans don’t have a clue how to make health care meaningful, cost effective and do no harm.

My fall work session will address our family’s health care transition to Medicare as we both become eligible in January. It’s one more challenge to sustaining a life in a turbulent world.