Healthcare more important to voters than candidates in Iowa

Mitt Romney won in Iowa Tuesday by a slim margin of eight votes over Rick Santorum and a few percentage points over Ron Paul. Although healthcare was not a major topic of debate for GOP candidates, it’s a matter of great importance to Iowans.

Indeed, issues of particular importance to Hawkeye State citizens include the fate of the Accountable Care Act, the cost of healthcare and, naturally, rural healthcare.

“Outside of the Affordable Care Act, cost is the most important concern that Iowans have,” says Mariannette Miller-Meeks, MD, director of Iowa’s Department of Public Health. “In general, Iowans, like other Americans, are extremely concerned about rising costs of healthcare and rising costs of premiums.”

Iowa is fortunate to have what Miller-Meeks describes as “a high penetration rate of insurance coverage.” So, while Iowa as a state may have less to gain from the individual mandate than others, “people are concerned about the individual mandate as an issue in context of the reach of government, and in context to the Constitution,” Dr. Miller-Meeks adds.

Sharing that sentiment, Peter Damiano, DDS, director of the University of Iowa Public Policy Center in Iowa City explains that “because the caucus-goers tend to be people a little more at the fringe of both parties, they are going to tend to think of the health reform law as evil.”

Which is not to say Iowa as a state is resisting initiatives – namely health information exchanges and health insurance exchanges – that promise to advance healthcare, be that via legislation or otherwise. The Department of Health and Human Services, in fact, recently awarded Iowa $7 million with which to stand up a health insurance exchange.

Perhaps the predominant healthcare issue in Iowa is not related to technology, but rather geography.

Indeed, whereas 20 percent of Americans as a whole live in an area classified as "rural" by heathcare standards, nearly 50 percent of Iowans do – not surprising in a state whose land is 90 percent rural under the same consideration.

So why, exactly, was healthcare obscured in the Iowa caucuses?

“Caucus-goers focus on how candidates differentiate themselves, and because they understand that every candidate is committed to repeal, the issue of healthcare receives less attention," explains Dan Holler, communications director of Heritage Action for America, the political arm of the conservative Heritage Foundation. "Each of the GOP presidential candidates adamantly support the repeal, with some going so far as to embrace the use of reconciliation."

Just how they would go about such repeal and reconciliation is something of a mystery this early in the primary season. What with Romney and Newt Gingrich backtracking on healthcare viewpoints, all the candidates have been somewhat elusive on the topic – other than to say they are against the health reform law, in fact, each has revealed little about any plans for actually improving healthcare if elected.