Here's where Iowa's candidates for U.S. House and Senate stand on key health care issues. (Photo by gorodenkoff/iStock/Getty Images Plus)
Health care remains a top issue for Iowa’s U.S. House and Senate candidates as the Nov. 8 election comes up, with most of them ranking the topic in their top five priorities.
Here are the Republican and Democratic candidates’ positions on several health care issues.
Expanding rural health care
Mike Franken, Iowa’s Democratic candidate for the U.S. Senate, grew up 10 miles away from the nearest town, Sioux Center, and knows how difficult it can be to travel to access care.
“I knew that health care was a necessity, but we had all these little towns with a doctor or a clinic or a small hospital to go to,” he said. “Today, none of them do. This is part of the reason why so many rural communities are withering up and desiccating away.”
Franken said elected representatives in recent years have not done enough for rural health care and now it’s withering. He pointed to former Sen. Tom Harkin, D-Iowa, as one of Iowa’s most recent federal leaders to put forward long-term, beneficial health care plans and policies for Iowans.
He said the U.S. health care system should care less about profits and more about ensuring people in rural areas have access to care.
Incumbent Republican Sen. Chuck Grassley has worked in previous years to create a Centers for Medicare & Medicaid Services designation to keep rural health care clinics, a spokesman said. Under a bill he cosponsored with Sen. Bob Casey, D-PA, the Rural Hospital Support Act, more hospitals and clinics across the country will be designated as Rural Health Clinics and receive extra Medicare and Medicaid reimbursement.
President Joe Biden’s administration is working on final regulations on the designation, Grassley spokesperson Taylor Foy said. He said the bill is one of many policies that “have always been and will continue to be high priorities for Sen. Grassley.”
“As Finance Committee chairman, Sen. Grassley successfully worked to support rural health care providers, including supporting rural hospitals in response to the COVID-19 pandemic and making mental telehealth visits a permanent benefit under Medicare,” Foy said.
Improving mental health care
Both Senate candidates say they are strong proponents of improving the mental health of Iowans.
Foy pointed to Grassley’s recent contributions to the bipartisan Finance Committee’s youth mental health discussion draft as a part of his health care policy focus.
“He is working in a bipartisan manner to ensure children with complex medical conditions are best served under Medicaid by getting them access to the right mental and physical health care providers,” he said. “His Accelerating Access to Kids Care Act builds onto his 2019 Advancing Care for Exceptional Kids law by streamlining access to providers and ensuring care coordination is focused on outcomes.”
Franken said Medicaid should be accessible to everyone who needs it, especially when it comes to paucity of mental health treatment options. Franken emphasized the positives of TRICARE, the health care program for armed services members — retired or active — and their families, and its outlook on mental health services.
Lowering prescription drug prices
Regardless of Biden’s October executive order to lower prescription drug costs, both Senate candidates say they are concerned about the expense and its impact on constituents.
Grassley has worked across the aisle to lower prescription drug prices throughout his 40 years in the U.S. Senate and intends to continue if he’s reelected, Foy said.
“He’s led several bills to hold accountable pharmacy benefit managers, the middlemen in the drug supply chain, improve access to affordable generics, and provide price transparency, among other bills,” Foy said. “He’ll continue to advocate for such legislation and conduct oversight necessary to improve access to affordable medications.”
Specifically, Foy said Grassley is working to pass the INSULIN Act to ensure the cost of the life-saving drug would only cost $35 per month out of pocket for people with private insurance.
Grassley voted against a similar proposal in August after Senate rules prevented Democrats from advancing it with a simple majority vote as part of a larger spending bill. So far this year, there has been insufficient Republican support to bring up bipartisan cap on co-pays for insulin.
Franken said the need for lower prescription drug costs across the board is immediate and clear.
“I don’t think anybody ought to be paying more for prescription drugs than the Department of Defense does,” he said. “That’s fair market value. Why would we be asking more money for people outside the department? I don’t get it … We have provided this disadvantageous position for the consumer.”
Republican Rep. Mariannette Miller-Meeks, an eye doctor who is seeking a second term in the House, wants to improve access to health care.
“As a doctor, Congresswoman Miller-Meeks is keenly aware of the American health care system and well-positioned to offer solutions to help Iowans,” her campaign manager, Elliott Husbands, said in a statement. “When she is reelected, the congresswoman will continue to support and introduce legislation to lower drug costs, expand access to health services, and make health care more affordable.”
Miller-Meeks’ opponent, Democrat Christina Bohannan, said in a statement that she has traveled the district and has seen how many people lack accessible high-quality care for both physical and mental health. Bohannan, a state representative, pointed to the Blessing Health Keokuk hospital closure as one rural health casualty in the state that shows the state of Iowa’s health market.
The closure leaves nearly 10,000 residents without emergency health care within 15 miles.
Keokuk is in Iowa’s newly redrawn 1st District.
“Such closures are far too common in the rural parts of the district and leave many without adequate access to care,” Bohannan said. “In order to increase health care access, we need to expand the number of health care centers in rural areas and prioritize increasing the number of mental health care professionals and resources.”
Bohannan also supports expanding Medicare coverage to include dental, vision, and hearing insurance.
The cost of prescription drugs is also on Bohannan’s mind. She supports capping insulin costs at $35 a month for Americans. Bohannan said no Iowan should have to make the decision between putting food on the table and paying for life-saving medicine.
Liz Mathis, the Democratic candidate for Iowa’s redrawn 2nd District, and Republican Rep. Ashley Hinson both say they want to expand rural health care.
Mathis, a state senator, said she will continue her previous work to expand mental health care options to Iowans in rural counties.
“In the state Senate, I helped develop the children’s mental health system that needs to be funded,” she said in a statement. “We need mental health access centers in all counties like we have in Johnson and Linn counties. And we must work to recruit more mental health care providers so all areas of our state have access to the treatment Iowans need.”
Hinson is working to keep health care affordable for all Iowans and expand maternal health care for Iowa’s rural citizens, according to a statement from a campaign spokesperson.
“She has co-led bipartisan legislation to expand maternal health care access for women in rural areas by expanding midwifery services, access to freestanding birth centers, and stillbirth prevention efforts,” the statement read.
Hinson is opposed to any cuts to Medicare services. Mathis is looking to expand the program, standing with Bohannan in suggesting dental, vision, and hearing insurance are also covered.
Mathis said she wants to keep the annual cost of insulin under $2,000.
“We need to do more,” Mathis said in a statement. “… We must bring generic drugs to market quicker. I also support extending the savings gained from Medicare negotiating for lower drug prices to Iowans of all ages.”
Hinson wants to continue sponsoring legislation to decrease prescription drug costs across the board if she’s reelected.
“She is a co-sponsor of the Lower Costs More Cures Act, legislation that will lower prescription drug costs, increase transparency in the system, and help bring more life-saving cures to the market,” a campaign spokesperson said. “She looks forward to expanding on these efforts next Congress and will continue working in a bipartisan manner to improve quality, affordable health care access for all Iowans.”
Rep. Cindy Axne, the only Democrat in Iowa’s Washington delegation, agrees with the other Democratic House candidates in supporting expansion of Medicare.
Republican candidate Zach Nunn, a state senator, told KMA News last month he opposes a public option for health insurance and he is against changing or eliminating Social Security, Medicaid or Medicare.
Axne agrees with Grassley on the need for continued funding for the 9-8-8 national suicide prevention hotline.
Axne is one of the lead sponsors of the Garrett Lee Smith Memorial Act to reauthorize numerous youth mental health programs. That shows her commitment to mental health care expansion, Communications Director Paige Godden said in a statement.
“(It) passed the House as part of a larger mental health package in June 2022,” Godden said. “Rep. Axne hopes to continue addressing this matter by supporting legislation that expands the mental health workforce in rural areas and strengthens the implementation of the new mental health crisis hotline, 9-8-8.”
Nunn wants to see Iowa’s approach to mental health care replicated on a nationwide scale. He also supports transparency from drug manufacturers and companies in their pricing.
“That means making sure your local pharmacist has access to not only telemedicine, like we did here in Iowa, but you truly know the cost of what both the patient and the provider, or doctor in this case, are paying,” he said to KMA News, “so that the insurance companies can’t run away and jack up prices well beyond what the costs of drugs are.”
Both candidates say they would work to reduce prescription drug costs. Nunn has said he plans to reach across the aisle to lower costs across the board, according to the Des Moines Register.
“Families are struggling to afford health care due to out-of-control prescription drug prices,” he said, according to the Register. “In Congress, I would work across the aisle to lower the cost of prescription drugs to help patients, families, and providers. As proven by work in Iowa, both sides can work together to stop price gouging, foster innovation and ensure access for our rural and urban communities.”
During her time in Congress since 2019, Axne has voted for the Inflation Reduction Act, which will cap insulin prices for Medicare beneficiaries at $35 a month, and reduce drug costs by allowing Medicare to negotiate drug prices with manufacturers. Godden said Axne would continue her support for lowering costs.
“These changes are historic and are expected to lower the cost of prescription drugs filled by Medicare beneficiaries in Iowa’s 3rd District by an estimated $34 million,” Godden said. “Still, there is more to be done. Rep. Axne plans to take further action by addressing the role that pharmacy benefit managers play in inflating drug costs, getting safe generics on the market faster, and limiting the amount that pharmaceutical companies can charge for life saving drugs.”
Rep. Randy Feenstra, the Republican incumbent seeking reelection in Iowa’s 4th District, told the Des Moines Register in October he wants to prioritize mental health treatment as a part of addressing gun violence.
“I also voted for the Restoring Hope for Mental Health and Well-Being Act, which expands mental health resources for our families and schools,” he told the Register. “I’ll continue to work to deliver mental health resources for our communities and protect our children from unspeakable tragedies while also protecting Iowans’ constitutional Second Amendment rights.”
Ryan Melton, the Democratic candidate for the 4th District, said rural health care is a concern of his as he runs for office.
“We’re facing a massive mental health care availability crisis,” he said. “A lot of countries in our district don’t have a single OBGYN and a lot of rural hospitals are facing immense financial pressure. A big reason for that is because the private insurance system puts up so many obstacles between patient and provider and that leaves out health care providers in a tenuous position where they struggle to keep the doors open.”
Melton is a proponent of a universal health care plan and would want to work toward that if he’s elected.
“I definitely am a believer in a Medicare for all, single payer universal health care option,” he said. “… As far as with privatization in the state, I’m certainly not in favor of that and we’ve seen a big increase in the number of denied claims that really are impacting our most vulnerable Iowans.”
At the federal level, Melton said he wants to stop privatization since it leads to the same issues.
During Feenstra’s first campaign in 2020, he said in an interview with Iowa Capital Dispatch that Iowa needs to create competition in health care. He said he supported the Affordable Care Act’s protection of individuals with preexisting conditions, but the bill needed to be eliminated.
“Government-run health care through Medicare isn’t working,” Feenstra said. “All of a sudden, you have the government making decisions on who gets the new hip. That should never be what health care is about.”
He stood by these beliefs in a Radio Iowa interview in October 2021. He also told Radio Iowa he believes lowering the cost of medications is a big concern that should be addressed at the state and federal level.
Melton agrees that lowering prescription drug costs is a top priority.
“The cost of medical care is way too high in general,” he said. “The upcharges we’re seeing on very basic services if you go to the hospital are astronomical. We clearly need to do more as far as capping vital prescription drugs and addressing price gouging in the prescription drug space now.”
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