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Candidates' views on healthcare reform important but not crucial in Iowa

Iowa voters likely will use healthcare to gauge a candidate’s view of the role and size of government but not choose a candidate’ based on solutions to healthcare issues, according to Dr. Peter Damiano, director of the University of Iowa Public Policy Center in Iowa City. The center provides interdisciplinary academic research in health care, human factors and transportation and housing policy.

Damiano offered some insights on the role of health reform and healthcare issues in the run-up to the Iowa caucuses Jan. 3. Damiano also is a professor of preventive and community dentistry at the University of Iowa.

Q: How are healthcare issues influencing Iowans choices in the caucuses?

A: For healthcare issues that people are thinking about for the caucuses, I think at this level it’s going to be much more the global healthcare reform, or ObamaCare, or whatever term you use, and how people feel about that, for whether that’s going to influence which caucus they’re going to go to and which candidate they may support.

Q: Is there a general sense of how Iowans think about health reform?

A: My impression is that it’s like in most places. You’ve got a group that is supportive, some that say it is evil, and then most people who just don’t really understand — and you have that in both groups — the specifics and what’s in the law and when it’s coming. It’s very difficult for anyone to understand the issues in healthcare reform, which are both complex and personal. So the way you end up feeling about it from a political perspective is even more challenging in a lot of ways than something like Wall Street reform or some other complex policy issue.

Q: Whoever wins the caucuses, will their view of healthcare contribute to their victory? 

A: Because the caucus goers tend to be people a little more at the fringe of both parties, those are going to tend to be, this time for the Republican Party, to think of the health reform law more as evil. For those who believe that’s a central issue or a reflection of a candidate, I think Mitt Romney will be the person who will most get hurt by that and somewhat by Newt Gingrich because there is evidence that both supported a proposal that had an individual mandate component. That’s one of the pieces that people are most upset about here. I think the real question is where does healthcare reform and healthcare in general rank relative to the other issues on which they are voting. My sense is that if you ask people about it, it is not necessarily that high in and of itself, but it gets at their underlying doctrinal belief level about a particular candidate or party, their different approaches to the size and role of government. I think that’s where healthcare is going to be probably more influential and in ways that you may not necessarily pick up when you ask about issues. I don’t think it’s as central in their thoughts, but I do think that it reflects on their perception of the role of government.

Q: Most candidate websites provide only high-level summaries about their healthcare views. How important is it that most candidates do not provide details about how they will handle important issues in health care?

A: That’s true with Republicans in general on health care. It hasn’t been an issue that they believe is at the same level of importance as do Democrats in general. Even Romney’s proposal is not very specific when it comes down to an implementation level. But that’s not uncommon for any candidate’s types of proposals. They don’t want to necessarily be too specific at this point because it gives them flexibility to adjust on-the-fly later. Whatever they would do in office is going to be influenced by so many different things than what their individual beliefs are. It isn’t a reflection of what they would do as president. For example, Pres. Barack Obama ran against an individual mandate covering everyone, whereas Sec. Hillary Rodham Clinton was the person who was calling for coverage for everyone. These things obviously change and are influenced by so many other things, such as Congress.

Q: How is Iowa progressing with rolling out health reform and health IT?.

A: Iowa just signed a contract for a vendor for health information network and received $7 million from the Health and Human Services Department for the state health insurance exchange. Iowa is working on implementation issues between the insurance commissioner’s office and the Department of Public Health and the Department of Human Services. After he was elected, our governor joined the lawsuit against the health reform law although the attorney general did not yet still accepted the $7 million for the exchange. In the press release, he called it a government takeover of health care but still accepted the money for the implementation. That is not uncommon. The practical side of that is that many don’t want the government telling them what to do, and the only way that can happen should this continue forward is by setting up your own exchange, otherwise the feds will set up their own.


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