Tag: health care

Categories
Living in Society

On Opioids

Lettuce for my neighbors, May 25, 2021.

Beginning with pain in my tooth after biting a piece of cheese last Thursday, it only got worse.

By Friday afternoon I was ready to see a dentist, although because it had become so late in the day I couldn’t get in until Monday morning. It was a sleepless, uncomfortable weekend because of the pain, even with Ibuprofen.

It was tooth #14, the same one on which I had a root canal in 2018. At the end of eight hours of diagnosis, including a three dimensional X-Ray, the endodontist determined the large root had cracked open and re-doing the root canal would provide no positive benefit. I went back to my regular clinic where they extracted it.

After the morning visit, I went to the pharmacy to get a prescription for pain killers and antibiotics. I knew it was serious medicine when the pharmacist asked to see my driver’s license. The guide to medication said, “Even if you take your dose correctly as prescribed you are at risk for opioid addiction, abuse, and misuse that can lead to death.” The handout mentioned death a couple more times. I waited until I returned home from the extraction to take the first pill.

I intend to get off the opioid as soon as I can tolerate the pain.

I have a couple of things to say about the episode.

First, both clinics were very accommodating to get me in for the emergency procedure. The fact that I get a regular checkup created a health care infrastructure upon which I could rely with the onset of unexpected pain. I sent each clinic a thank you note for going above and beyond normal expectations.

I’ve had dental care most of my life, since I grew teeth. I also worked at the University of Iowa Dental Clinic and had work done by students. I’ve learned to pay attention to what the practitioner says and does. Understanding each step of the process as we went along relieved any anxiety I may have had. Local anesthesia highly recommended.

Over the weekend, in my sleepless delirium, I had a dream that I went to the garage and extracted the tooth myself, and with ease. In real life, the top part of the tooth broke up during extraction because it had become brittle. Each of three roots had to be extracted individually. The one that had cracked open proved to be particularly difficult. Moral: don’t try to extract your own teeth even if you think you can.

The episode took six days out of my life and just today I got out in the garden to work for a while. I’m supposed to take it easy for a couple of days. I’m not sure I know how to do that, but will try. While I’m on opiods, there were only twelve pills and I don’t plan to get more.

The drug did ease the pain.

Categories
Living in Society

Feeling A Cage

Peppers gleaned from the garden.

While riding my bicycle around the trail system I press against the edge of a boundary. It is mental, not physical.

I feel trapped in a cage, ready to break out.

June 18 was the first bicycle trip. I don’t remember where I went. The scale told me this morning I dropped two pounds since then. The purpose of increasing daily exercise wasn’t weight loss though. It was a way to deal with my diabetes diagnosis.

Since seeing my health practitioner in June I developed five types of exercise to get my heart going, produce a sweat, and support whatever magical physiological workings reduce blood sugar. I missed only three days of 25 minutes or more of exercise that included bicycling, jogging, using a ski machine, walking, and sustained gardening and yard work that produced a sweat. Combined with watching my carbs, eating fewer big meals, taking Vitamin B-12, an 81 milligram aspirin, and a cholesterol drug, my numbers came down to a more normal range. If I went to a physician today I wouldn’t be diagnosed with diabetes.

I’m ready for what’s next.

Part of me wants to ride and ride the bicycle. Mostly I run one of four five-mile routes and once or twice a week ride 10-14 miles. I have no interest in riding across Iowa with the tens of thousands who do so most years but I’m pressing the limit. I want more.

Desire is balanced by caution because of my age and the age of my 40-year old bicycle. Bicycles are always needing repair, adjustment, and maintenance so I’ve learned new skills and identified a bicycle repair shop. Even though I don’t work outside home there is a lot to do and I can’t afford a two or three-hour daily trip just because I’m restless. My lower body is strengthening and my jeans fit better. For the time being that may have to be enough.

During the days before the Nov. 3 U.S. general election the limits of my range are more profound, the cage more tactile. A lot depends on the election outcome. If Trump and Republicans do well, there is one course. If Biden and Democrats win there is another. I expect the results to be mixed in Iowa. There is a broad Republican base where Democrats win majorities only when everything aligns. Recent polling showed Biden leading Trump by 14 points in national popular vote polling. Hillary Clinton led Trump by 14 points in the same polling exactly four years ago. Political work remains this cycle.

With cooler weather approaching I’m not sure how much more outdoors exercise I can accomplish before winter. I have a good start on the ski machine and expect that to be my daily regimen until it warms again. Between the plan and reality comes a shadow.

For now, I’ll continue what I’ve been doing. At the same time this bird wants its freedom and to break loose from restrictions of a cage where we’ve been living too long. Not today, but soon.

Categories
Home Life Writing

Bicycling Again

Gaddis Pond Rest Area, Big Grove Township.

When my medical practitioner diagnosed plantar fasciitis in 2015 it mean I had to give up running. I’d been running for exercise since 1976 when I enlisted in the U.S. Army.

Doc suggested bicycling. I took my Austrian-made Puch Cavalier ten-speed down from the hooks in the garage and delivered it to the bicycle shop where I bought it in 1980 to get tuned up. Parts were scarce for the old bike, but the technicians found them. I brought it home and hung it in the garage where it stayed until this month.

During a recent medical check up I asked again about running. I needed more exercise and my feet felt better. I could run again, I thought, maybe not five daily miles as before, but something. He said if I returned to running, plantar fasciitis would flare up again. I started walking and it wasn’t enough.

On June 18 I dusted the bicycle off and rode for the first time: about five miles. I’ve been out the last four days and expect to continue bicycling, gradually increasing my daily distance.

I’m a cautious bicyclist. I have a good sense of myself on the bicycle and know how to use the derailleur gears as they were designed. I couldn’t locate my helmet or riding gloves so I adjusted our daughter’s helmet so it would fit. I put a fanny pack over the handlebars to hold my mobile device and the garage door opener. I still have the plastic water bottle I got when the bike was new. I have two pair of bicycling pants with the cushion in the crotch. I’m wearing my old running shoes for now.

While I was in graduate school I ran and rode a lot. I would run from my apartment on Market Street in Iowa City out to the Coralville dam and back. Afterward I rode the bicycle for another ten miles. I was a restless soul then. I made all the usual rides: to Sand Road Orchard; to Kalona before dawn where I saw kerosene lamps illuminating homes and barns; to Stringtown Grocery; to the Kalona cheese factory; through Hills, Lone Tree and Wellman. I was a primitive rider, having no training and an undisciplined approach. I made a century ride with the Bicyclists of Iowa City and experienced glycogen burn out. At the time I didn’t know what was happening to me and it was a little scary. Not freak out scary though, and I made it home safely.

I need more exercise. It’s cheap medicine. Today I rode 7.6 miles with a goal of being able to make it to Ely without stopping. After that, who knows? For now it’s enough to feel the cool breeze as I ride and make progress toward an unspecified goal.

Another part of life in Big Grove Township.

Categories
Living in Society Social Commentary Writing

Coping in a Pandemic

Onion Starts

We each need something to cope with the coronavirus pandemic.

The linked video by Dr. David Price of Weill Cornell Medical Center in New York helped me and it might help you. Click here to view the 57 minute video.

It is a recording of a video conference call in which Dr. Price explains what is COVID-19 and how to protect ourselves while living as reasonable a life as may be possible as we keep our distance from each other. It relieved stress about living away from friends, family, neighbors and co-workers. It explained how we should interact with a small group of family members who live with us. It is presented in a way that is persuasive and practical. Unlike so much of the hyperbole, misstatements, and falsehoods I read and hear elsewhere, Dr. Price is believable when we need that as much as isolation from the virus.

I yearn to get out of the house and trips to the garden and yard are not satisfying enough. Armed with knowledge, I plan to go to work at the home, farm and auto supply store in a couple of hours. I’m not afraid any more. I’m not being foolish. I’ll be keeping my distance from co-workers and customers and washing my hands a lot, trying not to touch my face. Absent a general call to stay in place, either at the federal or state level, we must go on living as best we can.

Social distancing would be more tolerable if the ambient temperature would warm up by about ten degrees. Getting my hands in the soil and doing much needed yard work would take my mind off the coronavirus and self-imposed isolation.

As a writer, I’m used to working in isolation. It gives me strength and an ability to distance myself from social media and unwanted contact with others. I find a chance to think clearly about my life with others and how it will be lived. There cannot be enough of this time.

As the number of cases of COVID-19 rises in the United States we don’t know how the infection will escalate. In New York, the number of cases is doubling about every three days. In Iowa, we have limited testing availability for the coronavirus, so what numbers we have don’t tell the whole story. The first person died of COVID-19 in Iowa yesterday. While tragic, I’m not sure what it means in the context of everything else going on.

My remedy was to view Dr. Price’s video, and use the information in it to go on living. We’re doing the best we can.

Categories
Living in Society Social Commentary

Getting a Grip on the Pandemic

Above the fold at the Solon Economist, March 19, 2020.

When I started this blog there was no intention to write daily about a pandemic. Isolation, quarantine, social distancing, shelter in place, self-quarantine, and more are words to describe our behavior in response to the coronavirus.

As a writer and blogger I understand the concepts. Who knew it would feel important to write so much about them.

The words suggest something — communal behavior, loneliness, or disruption. I’m not sure exactly which. It’s as if once we understand what’s going on we know what to do.

When I returned from yesterday’s shift at the home, farm and auto supply store my spouse was waiting on the stairs.

“Give me your phone,” she said, ready to disinfect it on the spot with a homemade disinfectant swab.

I was directed to the kitchen sink where I washed my hands, then to the bedroom where I changed clothes. If I carried something home it could be isolated and not spread throughout the house.

I recognize these instincts from spending time with my maternal grandmother who took no quarter against threats to her household. One has to wonder why they are not my own instincts.

Nuclear, biological and chemical military training well prepared me for the coronavirus pandemic. Except for the phone part, I knew the drill, and can execute it without losing focus on main events. Being an infantry soldier prepares us for life in unexpected ways.

A co-worker said they wished “the thing would run its course and be done so we can get back to normal.” I don’t know what that means. We are all active agents in a pandemic. The number of cases of Covid-19 and resulting deaths is largely dependent on what we do as a society. It’s not a given that any particular thing will happen or that a specific result is preordained.

At work a local medical facility ordered 800 welding shields to protect health care workers. We had them express shipped from the supplier to arrive overnight. If they can protect an arc welder from getting sparks on their face, they can likely prevent moisture droplet borne contamination from reaching a physician or nurse’s face. If we lose front line health care providers to the coronavirus we’re sunk.

We don’t know the future of the coronavirus, but it is likely here to stay. The pandemic will run a course but coronavirus will infect many of us potentially creating an immunity for those who survive it.

In China, where the virus originated, we’ve gone two days in a row without a new case being diagnosed. The first inklings of trouble there were in late December so if that is the course of the pandemic, 11 to 13 weeks, that’s better than it could be. It’s unknown whether the delay in recognizing the threat in the United States, and our apparent slow response will lengthen that trajectory. It will have an impact that takes additional lives.

Yesterday the home, farm and auto supply store announced a paid leave program for full and part time employees who must be quarantined. It’s not the same pay as working, but it is recognition by the family who owns the business and their managers that they must be socially responsible to remain in business. They have been flexible with other time off related to the pandemic.

Midst all of this, Spring arrived yesterday. May the gentle rain falling this morning wash away our concerns so we can accept our lives and become positive forces in the outcomes of friends and neighbors.  We hope for that regardless of whether there is a pandemic. If this blog helps readers that way, then I’m doing my job.

Categories
Living in Society Social Commentary

Living with the Coronavirus

Lettuce in the greenhouse.

Estimates of how long the coronavirus pandemic will last vary from a couple of weeks to several months. The best guess is we’ll have a better idea once the number of contagious incidents reaches its peak.

Two and a half months after the virus emerged in China the government is beginning to lift the draconian measures implemented in its wake. Public health officials there remain vigilant for a second or third wave of the disease. The pandemic is not over.

In the U.S. we continue to be on the upward slope of the curve, and in our county the case count ticks upward with no indication we have peaked. News media explain we are a week to ten days behind Italy as the viral course continues to develop.

A friend in town displayed symptoms and was tested. He waits for the test results at home in self-quarantine and shut down public access to his place of business for two weeks. The pandemic is pretty close to home and we are just getting started.

The continued shortage of testing obfuscates the path of the vector. If we were testing more, one believes there would be more reported cases. We aren’t so we don’t know.

Given the expectation of a several month pandemic it’s hard to decide what to do about work at the home, farm and auto supply store. They are okay with people taking off work for any illness, but at some point they will need me to show up. They don’t seem aware of the idea that employees might be infected by going to work. They’ve had no discussion about closing the retail store and for the time being, I want to keep the job. I’ll probably go in today after calling off yesterday, and try to maintain a distance from co-workers and customers. We’ll see how that goes.

I don’t know if the coronavirus will be personally life-changing. My outlook is we can avoid infection, although I’m not sure how I came to that conclusion. It’s likely positive thinking of which the coronavirus is unaware. During my sick day yesterday I considered whether this pandemic would precipitate changes that are coming in my life anyway: leaving the regular job, staying home more, and conserving our income. As it runs its course I’ll consider that more. For now we’re sustaining our lives in a pandemic-stricken world and doing our best to survive and thrive.

Categories
Living in Society Social Commentary

Watering Hole

Bar and Grill Parking Lot, March 13, 2020.

By last Friday traffic in bars, coffee shops and restaurants had slowed considerably. It was hard to determine whether it was because of the coronavirus, spring break at the university, or something else.

It made being a guest at the establishments a positive experience with little perceived danger of the virus being transmitted.

Our county now has the highest number of confirmed cases of COVID-19 in the state, 14 of 18 as of this morning. The high number is attributable to a local bank trip to Egypt where returning travelers were exposed to the coronavirus and contracted COVID-19.

The parking lot was packed at a bar and grill on Friday afternoon. From the look of things, it was a popular watering hole for trades workers. When my friend and I entered, every man was seated on a stool around the U-shaped bar drinking beverages, looking at their mobile devices, and talking with neighbors. The bartender was the only woman present. The rest of the bar was empty.

We ordered drafts of Bud Light so as to fit in and chose a table away from the bar.

What speech I made with a friend was not my normal one. The one I know by rote and by heart. The theme that never changes, come what may, “Radix malorum est cupiditas.”

It’s not that the worn phrase has no currency. Many are the emails from political candidates who say we must overturn Citizen’s United, then, in direct order, request a donation. The old saw still cuts wood. This prologue has never been in abeyance or irrelevant despite the waxing and waning of political candidates and their ilk. What’s hard is to listen.

What did I hear? Murmuration among the tradesmen making sense of their lives in a pandemic they hardly acknowledged. Individuals all. Resolute. Of strict father figure families no doubt. Gathered together around the bar in between a career that requires a pickup truck and a home that remained unseen that afternoon.

When we finished our beers and left, most were still present and would be until either the happy hour ended or home beckoned. It was hard to discern, but I suspect the watering hole was the best part of many of their days. So it was for mine.

Categories
Living in Society Social Commentary

Modernity of Social Distancing

Los Agaves Mexican Grill, Iowa City, Iowa at lunch time on Friday, March 13, 2020.

When it comes to “social distancing” Iowans know what to do. We tweak our normal behavior. Many of us are not socially close by nature so it’s not a big step.

Epidemiologists are using the term “social distancing” to refer to a conscious effort to reduce close contact between people and hopefully slow community transmission and spread of the coronavirus.

A grade school friend and I met in the county seat on Friday. His nonagenarian mother lives in an assisted care facility which was quarantined after he arrived in Iowa to visit her. He spoke to her on the phone, but couldn’t pay an in-person visit.

It was a tweak.

More tweaks are coming.

Last night Governor Kim Reynolds’ office issued a press release which said, “The Iowa Department of Public Health has determined, based on the new COVID-19 case and the announcement this evening of community spread in Omaha, Neb., there is now community spread in our state.”

The release continued to explain:

Community spread occurs when individuals have been infected with the virus in an area and cannot specifically identify the source of the infection, or do not know how or where they became infected.

Due to the detection of community spread, there are new recommendations for individuals with underlying conditions, and all Iowans should be prepared for cancellations and disruptions in routine activities.

Mitigation measures should be implemented immediately to have the most significant impact on slowing the spread of the virus.
Leaders of institutions and organizers of events should begin to act on their contingency plans related to large gatherings, including church services. Iowans should not hold or attend large gatherings of more than 250 people, and consider making adjustments for smaller gatherings with high risk groups.

It appears the governor is following Centers for Disease Control and Prevention guidelines which include monitoring the progress of community spread and under certain conditions, making recommendations for social behavior. For now, school can continue, but not church where there are large congregations.

There is a political aspect to the coronavirus pandemic and it appears our state is taking reasonable actions if the federal government is lacking in its response. Regular communication and compliance with CDC guidelines should reflect positively on Reynold’s handling of the global pandemic’s mitigation in Iowa. As a former six-year member of our county board of health I don’t see a benefit to criticizing the governor as the state works to understand the progress of the disease and take appropriate action.

For our small family, it doesn’t take much to be socially distant. Yesterday I decided not to attend a legislative forum 10 miles from our home. I went to town to mail a package. On the way home I stopped at the pharmacy to see if I could buy a bottle of 90 percent isopropyl alcohol. They we sold out of all alcohol and sanitizing items. We’ll make do with what we have. Today I’ll go to the farm for our weekly seeding session.

A late winter snow fell, covering everything except the driveway and roads, which were too warm in this meteorological spring. For a day it was still winter by the calendar and by the weather.

There is never a problem staying busy at home. I completed the U.S. Census on my mobile device after reading in social media our state senator did his. It took ten minutes even after I had to re-do it. Between reading, writing, cooking, laundry, and preparing for planting, there was plenty to do. I put some bird seed out on the front door landing but they hadn’t found it by sunrise this morning.

While we were isolated, it didn’t feel that way. Iowans are used to working in isolation and with modern communications it is easy to stay in contact with friends and neighbors.

The news about the coronavirus from Europe, the Middle East and China is pretty startling. We really don’t know how many people are infected, although public health officials seem to be tracking the number of deaths.

Estimates of the impact of the 1918 influenza pandemic range widely yet are relevant. Global population was between 1.8 and 1.9 billion people at the time. The estimated number of deaths ranges between 17 and 50 million, maybe more. In the United States, the death rate was between 0.48 to 0.64 percent of the population or toward 650,000 deaths at the high end.

If we use the lower number in the range (0.48 percent) to determine how many deaths the 1918 pandemic would cause in the 2020 U.S. population, it would be more than 15.8 million. We are nowhere near that and likely to see only a fraction of that number with coronavirus. There is a modernity today that didn’t exist in 1918, with advanced public health and research organizations, better communications, and a resulting ability to coordinate between government and non-governmental agencies.

The phenomenon of social distancing looks to create a positive result. People will die of Covid-19 and the loss will hurt families. It will hurt us all. At the local level, we do our best to understand the pandemic and live our lives accordingly. We not freaking out. We are learning.

We’re sustaining our lives in a turbulent world that’s becoming infected by coronavirus. This may not be the last pandemic in my lifetime, so I hope we learn from it.

Categories
Living in Society Social Commentary

Influenza, Viruses and Sickness in the Land

Vegetarian Soup Stock

On Monday I went to the Urgent Care clinic for a persistent cold.

After a thorough examination, and many questions about the trajectory of symptoms, doctor leaned against the counter in the small examination room and pronounced, “it’s viral.” It could persist for another two weeks, she said.

I’ve run the course of Benzonate she prescribed for the cough. It is getting better. She wrote a second prescription for Amoxicillin and said hold it to see how things progressed. Later this morning, I’ll get it filled. I’m on the mend, but not well.

At least 43 Iowans died from influenza and viruses this season. Because of the delay in autopsy results, the actual number is likely higher.

At the home, farm and auto supply store employees have symptoms similar to mine. The store manager distributed a couple dozen aerosol cans of Lysol so we would keep everything sprayed down and hopefully disinfected. I don’t know if I gave the virus to others, or they gave it to me, but the whole workforce is coping. We are a sick land this January.

Today is the first time I’ve been able to concentrate on anything, and there is a backlog of post ideas and work delayed. Yet, I’m still here, sustaining our lives in a turbulent world.

Categories
Living in Society

Letter to Iowa Senators on Graham Cassidy

I do not support Graham Cassidy and hope you will ask your senate colleagues to gather more information about the impact of the bill on Iowa populations before scheduling a vote. More specifically,

1. CBO score: Delay holding a vote on the measure until the CBO scores the bill and the public has a chance to evaluate it.

2. Impact on veterans: Elimination of Medicaid, as the bill is said to do over time, would have a disproportionate negative impact on veterans. Many military veterans I know fall within the federal poverty guidelines and it would be wrong to leave them behind by eliminating Medicaid.

3. Impact on Nursing Home Residents: It seems cruel to kick nursing home residents off Medicaid. Like most people, our family is working to live on our own for as long as possible. That’s not possible for people with limited means as their health deteriorates toward the end of life. Ending Medicaid would disproportionately impact seniors who rely upon it. It would be just plain mean and not reflective of who Americans are as a society.

4. Essential Health Benefits: Insurance is by design intended to help all policy holders pay for the medical needs of every policy holder. Changing the basic framework of who is covered and at what cost requires more sunlight than it has gotten thus far. I oppose altering essential health benefits established in 2009 without agreement between all parties involved, including insurance companies, medical personnel, hospitals and clinics, and importantly, members of the general public.

Thanks for reading my message. Good luck in your deliberations over Graham Cassidy.

Regards, Paul

~ Submitted electronically to U.S. Senators Chuck Grassley and Joni Ernst on Tuesday, Sept. 19, 2017

Senator Chuck Grassley’s response:

September 20, 2017

Dear Mr. Deaton,

Thank you for taking the time to contact me. As your Senator it is important for me to hear from you.

I appreciate hearing your thoughts about legislation proposed to replace the Affordable Care Act(ACA), or Obamacare. Obamacare has failed to deliver. While the ACA promised affordable care, Iowans saw their premium payments, copayments, and deductibles steadily rise significantly. While promised to keep plans if they liked them, Iowans lost their plans when Obamacare was enacted. Because of Obamacare’s failures, 72,000 Iowans currently don’t know if they will be able to purchase health insurance for 2018.

I support having the Senate consider the Cassidy/Graham bill. We need alternatives to Obamacare, which hasn’t worked, and that reality has been acknowledged across the political spectrum. Health insurance is much too expensive for too many Iowans. I like that the bill addresses one of the fundamental flaws of Obamacare. It returns power to individuals and states. It’s not perfect, but the bill recognizes that each state has different needs that each state is best equipped to decide how to meet. There’s also a phase-in period and the opportunity to make changes in the future. Keeping Obamacare as is will cause people to go without insurance either because Obamacare has collapsed in a state or face coverage that no one can afford to use.

You can be sure I will carefully consider any legislation that comes before the Senate, and will continue to support access to health insurance for Iowans going forward in my role as senator.

Thank you again for contacting me. Please keep in touch.
Sincerely,

Chuck Grassley

Senator Joni K. Ernst’s Response:

September 21, 2017

Dear Mr. Deaton,

Thank you for taking the time to contact me about the Senate’s ongoing work on health care reform. It is important for me to receive direct input from folks in Iowa on policy matters such as this, especially when they affect people on such a personal level.

As you know, the U.S. Senate considered various legislative ideas regarding health care the week of July 24th. Throughout the debate, I shared how the Affordable Care Act (ACA) is failing in Iowa, with choices dwindling and costs rising. Premiums have increased in Iowa up to 110% since the health care law went into effect. With Medica remaining as the only health insurance provider selling individual market plans in every county statewide for 2018, folks in the state’s individual market will endure another massive rate increase. The reality in our state is that continuing with the status quo is no longer an option.

On September 13, 2017, Senators Bill Cassidy (R-LA), Lindsay Graham (R-SC), Dean Heller (R-NV), and Ron Johnson (R-WI) introduced health care reform legislation, known as the Graham-Cassidy-Heller-Johnson proposal. If enacted, this proposal would give states flexibility to innovate and design their individual markets tailored to the specific needs of their state.

This proposal would also reform the Medicaid program to a per capita allotment for its traditional patient population. As you may know, the federal government’s auditor has identified Medicaid as a high-risk program for more than a decade due to its size and growth. Therefore, it is important that we look at reforms, but also focus our Medicaid dollars on the most vulnerable in our society – the elderly, children, and individuals with disabilities.

To learn more about this proposal, Senator’s Cassidy website has more information here.

Further, Chairman Orrin Hatch (R-UT) announced that the Senate Committee on Finance will hold a hearing on Monday, September 25th to discuss the Graham-Cassidy-Heller-Johnson proposal. While I am not a member of the Finance Committee, I will be closely monitoring the committee’s work and look forward to receiving its analysis of this proposal.

Throughout the Senate’s work on health care reform, I have emphasized how we must pursue solutions that enhance competition, increase flexibility, and constrain rising costs. The ACA is unsustainable in Iowa, and it’s critical that we work together to address the evolving needs of our health care system, and ensure folks have a voice in their own health care decisions – and not Washington deciding what is needed in a health care plan.

At this time, I am carefully reviewing the Graham-Cassidy-Heller-Johnson proposal to see how it could affect insurance availability and affordability, as well as provide folks access to health care coverage. It’s imperative I hear personally from Iowans, such as yourself, on their unique experiences in accessing health care, so that we can secure the affordable, patient-centered solutions our state critically needs. I appreciate your feedback at this time, and look forward to hearing from you further as the Senate continues to work on health care reform.

Sincerely,
Joni K. Ernst