‘Iowa Nice’ on public display at Braley town hall

Participants at a health care forum hosted by U.S. Rep. Bruce Braley in Independence did not let high emotions keep them from asking questions and hearing answers from their federal lawmaker.

INDEPENDENCE — Amid news reports of emotional outbursts and violence at Congressional health care forums across the nation, one hosted by U.S. Rep. Bruce Braley Wednesday afternoon stood out not for its content, but for its context.

No individuals with signs lined the streets adjacent to the Independence Public Library in anticipation of the meeting. Inside, few spoke out of turn as Braley walked participants through a 28-slide presentation regarding where reform currently is in Congress, what’s been done so far and the various myths associated with proposed reform measures. When the room for the presentation and forum filled, at least 100 participants politely and quietly stood in the library foyer or on the front lawn and listened via a speaker system.

Those attending held very strong opinions about the prospect of reform — some as passionately in favor as others were against — but the differences of opinion did not disintegrate the meeting into a shouting match. Participants sat or stood, mostly in respectful silence, while Braley went through the presentation and then opened the meeting up for questions. During the question-and-answer session, members of the audience were quick to offer applause when they agreed with a speaker, but were just as quick to quiet down and listen to Braley’s response.

The many questions were similar if not exact to those that have been poised at other forums: Euthanasia, abortion and overall cost-effectiveness of proposed reforms. At one point, while answering a question posed by a Marine about “excessive government spending” and the perceived fast-track of health reform, Braley experienced one of his few audience interruptions.

“A lot of people have already forgotten where we were at the start of this year. We were facing the next Great Depression and tough choices had to be made,” Braley began before he was cut off by a ripple of laughter.

“And people … people can make fun of that all they want to, but that is the reality of what we were presented by the last President and our current President. When you have to make tough choices in a short amount of time you can make mistakes. I’ll be the first to admit that. However, I will argue that some of the things you are talking about have not been boondoggles, but have been very helpful to the economy. … The other thing is that when you don’t do something and things get really bad, you get criticized for that too.”

Braley acknowledged that reform measures, if passed, may have unforeseen consequences or might need further Congressional review.

“If this thing doesn’t work out and we have to go back and adjust what we’re doing, I will be the first one there arguing to do it,” he said.

“I’ll be real honest with you. I don’t take votes in Congress because I’m holding them up to a mirror to be re-elected. I’ve had a lot of other great life-experiences before. If you decide the job I’m doing is not worth sending me back to Congress — that’s your choice in a democracy. But you elected me to go to Washington and to be engaged in these important issues, which is why I did highlight this bill and I read it and I wrote notes and I asked tough questions. [I did that] so that when I had to vote on these things, I’m at least thinking about what I believe is in the best interest of the people I represent. You can tell just by this meeting today that there is a lot of diversity of opinion about what is wrong with this country.”

The two issues discussed by Braley which drew the largest swath of contention among the audience were measures intended to make health care more affordable for small businesses and a revamp of the federal formulas that place Iowa, a state with quality medical outcomes, at the bottom of the payment scale for Medicare and Medicaid reimbursements.

Under the current House bill (HR 3200), businesses with 25 or fewer employees will receive a tax credit and will be allowed to purchase health insurance through the proposed Exchange, which will be a marketplace of both public and private insurance plans. Braley said that small businesses in Iowa could save between 25 and 37 percent per year on health care costs under House reform proposals.

Reconfiguration of current federal reimbursement rates to health care facilities and providers is a much more complex and difficult subject. The current formula rewards states based on the quantity of medical services they provide in lieu of quality of medical services as determined by medical outcomes. The state with the highest reimbursement rate, according to Braley, is Louisiana, which is also the state that has the worst medical outcomes.

“I have had some of the most heated discussions on health care reform with the chairman and the leadership in my own party, who didn’t want to do anything to make sure that Iowa health care providers got a level playing field,” Braley said. “They had a vested interest because they had to go tell their doctors, their hospitals and their nurses that they have been overpaid from what they should have been based on the lousy results they are getting.”

Because Iowa providers are so negatively impacted by the current formula, nearly the entire federal delegation has been working on reform in that area. Only recently the Iowa delegation, by partnering with members from other adversely impacted states, were successful in initiating a two-year plan for reconsideration of the current payment formulas.