Giving Iowans better access to health care is important, say both of the men who want to be Iowa’s governor. Democrat Chet Culver says one priority would be to help seniors pay for prescription drug coverage. Republican Jim Nussle says capping punitive damages in medical lawsuits would help to curb costs. Both say they would try to expand pooling of small groups to lower health insurance premiums.

In a health-care forum held last week in Des Moines, the two candidates outlined the approaches they would take to address the growing problems of high health insurance costs and the lack of access to care those costs can create for many Iowans.

Nussle pledged to build on programs he has worked on in Congress, such as better reimbursements to hospitals for Medicare patients’ expenses and increased funding for rural hospitals. He also called for a $250,000 cap on punitive damages in medical malpractice cases and programs to make Iowans more informed consumers of health-care services.

Culver said he would provide state assistance to elderly residents who face high prescription drug costs that fall in the “doughnut hole,” a gap not covered by the new Medicare D plan. He said Congress chose to ignore that gap so it could instead “give millions in tax breaks to the wealthiest Americans.” Culver also said he would provide outreach to get an estimated 58,000 Iowa children who are eligible for the Healthy and Well Kids of Iowa (hawk-i) program but are not enrolled.

More than 600 people registered to attend the free forum held Oct. 11 at Drake University’s Sheslow Auditorium. Sponsored by AARP Iowa, the National Health Policy Council and the National Coalition on Health Care, the forum was part of a series of similar events to be held in other states that will involve gubernatorial candidates.

Prior to the candidates’ remarks, the issues were framed by Dr. Henry Simmons, president of the National Coalition on Health Care. Simmons said Iowans, like all Americans, face three “large and interconnected problems” when it comes to health care: – rapidly rising health-care costs;

– a large and rapidly growing number of uninsured or underinsured Americans;  –   – an “epidemic of substandard and dangerous care.”   –    Regarding the quality of medical care, Simmons said medical errors have become the third-largest cause of death in the United States, with an annual cost of upwards of $500 billion a year.

The problems are “huge; they’re growing; they’re daunting,” Simmons said. “No state acting alone can solve them; actions are needed on a national level. And incremental reforms by themselves will not be enough. But this crisis is solvable.”

Culver said as governor, “my standard would be very simple: I think we should offer the same quality of health care that elected officials get.”

Culver said he would address the gap Iowa seniors face in Medicare prescription drug coverage by adopting the best practices of 18 states that have instituted assistance programs.

“We have a responsibility to our seniors,” he said. “That means we have to step up to the plate. We can’t wait for Washington to solve our health-care problems.”

In addition to reaching out enroll more eligible children into the hawk-I program, Culver said he would expand the program to cover their parents as well.

“For the other uninsured adults, we’re going to look at pooling,” he said. “Why can’t we look at a similar pool [as state government has] for small employers?” Culver said. Pooling of small groups could enable premiums to be reduced by 20 to 30 percent, he estimated.

“Our program would have the goal of everyone having access to health care and everyone being covered,” Culver said. “We would still need the private sector at the table, but we would be doing things a little differently.”

Nussle, acknowledging that an estimated 250,000 Iowans are uninsured, said health care is an issue “that is personal for all of us.”

Nussle called for an expansion of health insurance pools, which he said are needed because many of the 75,000 small businesses with fewer than 100 employees in the state can’t afford to offer health insurance.

“If we want to attract people to Iowa, one of the first questions they ask a company is: ‘What are your benefits?'” he said. “I believe it’s an economic tool to help the state.”

Getting consumers back in charge of their own health care is also important, Nussle said, “particularly in the area of prescription drugs.” He said Iowa should create a Web site similar to one provided by the state of Florida that allows residents there to shop pharmacies statewide for the lowest prices.

“The interesting thing about Florida is that prescription prices came down 30 percent,” Nussle said. “In Iowa, that would amount to about $10 million in savings.”

In regard to quality, Nussle said Iowa’s health care is “the best on the planet.” He advocated the state’s use of expanded Medicare reimbursements that he worked to secure in Congress to promote wellness programs. He also called for earlier recruitment of students for medical professions in Iowa, as well as increased efforts to recruit faculty for medical and nursing schools.