But Democratic Gov. Pat Quinn of neighboring Illinois said he could see the lives of people in his state improving roughly 18 months after the law began to take effect. The law has allowed tens of thousands of parents to keep their children on their insurance plans until they are 26, and protected thousands more children from being denied coverage due to earlier health problems.
“It’s already working,” Quinn said. “We’re enthusiastic advocates. No apologies.”
Republicans and Democrats, as expected, disagree heartily about whether the health-care reform law is worth its benefits to state residents — or creates more harm by overburdening state budgets. Both Walker and Quinn are members of the National Governors Association’s health committee , which met Sunday morning in a downtown Washington hotel with the goal of recommending ideas to cut states’ health-care costs for needy residents.
It is a critical moment for the Patient Protection and Affordable Care Act, which was signed into law in March 2010. Republican presidential candidates are calling for its repeal, and the Supreme Court is scheduled to hear arguments next month challenging the law’s constitutionality in requiring all Americans to have insurance.
When the national governors met a year ago, both Republican and Democratic members also complained about crushing budget pressures from Medicaid, an insurance program for the poor that is managed by states and jointly financed by the states and federal government, and whose membership rises with the health-care reform effort. The governors then sought more flexibility in implementing the law from the Obama White House, which soon afterwards offered states the option to forgo some provisions if they could achieve the goals another way.
Republicans said that it didn’t help them control their budgets if their states still had to provide more coverage to more people.
This year, despite the divisiveness over the reform, the NGA’s health committee met in a collegial fashion and never once mentioned the law that many Republicans derisively call Obamacare and many Democrats consider a major progressive milestone. Instead, both Obama’s assistant health secretary, Howard Koh, and Iowa Gov. Terry Branstad, a major opponent who sued to block the law, focused Sunday on what they could agree on: cutting medical suffering and costs by encouraging disease prevention and healthier lifestyle choices. Both sides agreed that the majority of the nation’s health-care costs are now due to chronic diseases that are largely or entirely preventable, among them some cancers, high blood pressure and diabetes.
The committee got to view a startling color-coded map of the United States that showed the nation’s losing fight against obesity from 1985 until the present day. State after state changed over the years from white and light blue, indicating high rates of “lean” citizens, to the red and yellow shades that mean high rates of dangerous obesity.
The map was an introduction to Branstad’s new state program to increase healthy choices and reduce obesity among Iowa residents. Two-thirds of adult Iowans are considered overweight or clinically obese. A public-private partnership to reduce unhealthy choices, called the Healthiest State Initiative, seeks to move Iowa from its healthiness ranking of No. 19 among the 50 states to No. 1.
Branstad and state agencies largely provide cheerleading efforts for the initiative, but the work is financed by Iowa’s largest insurer, Wellmark Blue Cross and Blue Shield, with support from a major grocery chain in the state, Hy-Vee .
The initiative will target 10 pilot communities in Iowa, where national wellness and community design experts will help them make moderate changes in schools, offices, grocery stores and parks. Communities will be asked to move vending machines away from workers, encourage walking, add sidewalks and bike paths, and label food packages with healthiness ratings so consumers can make quick, healthy choices.
The estimated savings are striking, said Laura Jackson, a Wellmark vice president who is running the program. Iowa could save up to $268 million in health-care costs by 2013 if it simply kept the number of obese residents from rising above 2009 levels. It could save as much as $16 billion over five years if Iowans moderated their lifestyles on several healthy measures.
As the presentation ended, the philosophical divisions resurfaced, albeit mildly. Quinn and Lincoln Chafee, the Republican-turned-independent governor of Rhode Island, asked whether the government should be involved in removing subsidies for unhealthy products or taxing manufacturers that produce the most sugary and unhealthy foods.
“We’ve tried to focus on the positive,” Branstad said. “Get people to make the right choices without penalizing people . . . and without saying we’re going to tax this or that.”