Industry-funded groups have recently spent more than a million dollars on television and online advertising in Iowa opposing Democratic plans to expand access to health insurance.
Some ads primarily focus on single-payer plans (often known as Medicare for All), which more than half a dozen presidential candidates are supporting. But Partnership for America's Health Care Future has used its hundreds of thousands of dollars in the Des Moines market targeting more modest proposals to offer a "public option" on exchanges selling private health insurance policies.
Many central Iowa Democratic activists were surprised and upset to see Loretta Sieman, a longtime West Des Moines city council member, in one of the partnership's commercials. Sieman spoke to Bleeding Heartland on September 11 about why she opposes the public option and why she agreed to appear in the ad, now in heavy rotation on YouTube as well as Des Moines broadcast and cable stations.
WHO'S RUNNING THE AD
Health care industry heavyweights founded Partnership for America's Health Care Future last year to turn public opinion against single-payer reform, Karl Evers-Hillstrom reported at the time for Open Secrets. The American Hospital Association, America's Health Insurance Plans, the Blue Cross/Blue Shield Association, Pharmaceutical Research & Manufacturers of America, the Federation of American Hospitals, and the National Association of Health Underwriters are still involved.
The American Medical Association left the alliance this summer after the partnership's messaging began to target the public option, Dan Diamond and Adam Cancryn reported for Politico on August 15.
Some members listed on the partnership's website represent industries where employees often lack health benefits (the International Franchise Association, Iowa Retail Federation) or the business community more broadly (Master Builders of Iowa and chambers of commerce including the Dubuque Area Chamber).
The partnership is organized as a 501(c)(4) group and does not disclose its donors.
"THE CONCERN ABOUT PUBLIC OPTION IS MY FEAR WITH ANYTHING THE GOVERNMENT RUNS"
Partnership for America's Health Care Future has produced several spots for television and Facebook nationally. The commercial playing on Des Moines stations (which reach about a third of Iowa counties) and on YouTube for many Iowa users was unlisted on the group's YouTube channel. But it's there if you know where to look.
Loretta Sieman's voice: I am a Democrat, and I served on the West Des Moines City Council for 17 years. [photo of her in front of city hall]
The major issues we're facing right now is quality of health care and access. [footage of Sieman walking on a sidewalk in an upscale residential neighborhood]
The concern about public option is my fear with anything the government runs--they'd take total control of it. [Sieman speaks on camera, sitting in someone's living room; her name and "West Des Moines, IA" are on screen]
I'm not sure they should get into the business of deciding what kind of health care I should have.
Sieman's voice: And I don't want the taxes raised for people that can't afford it, [viewer sees footage resembling a hospital or clinic; words on screen: "GOVERNMENT-RUN INSURANCE: 'REQUIRE TAX HIKES ON MIDDLE-CLASS FAMILIES' -THE WASHINGTON POST, 3/28/19"]
And then tell them they can't go to the doctor they want. [Footage of patients in a waiting area; words on screen "PATIENTS MIGHT FACE INCREASED WAIT TIMES AND REDUCED ACCESS TO CARE" -CONGRESSIONAL BUDGET OFFICE REPORT, 5/1/19]
Sieman on camera again: We can't do it to the average American. [logo and web address for the Partnership for America's Health Care Future on screen; paid for message in small print near bottom]
"I DID IT BECAUSE THIS IS WHAT I BELIEVE"
Sieman declined to specify who approached her about filming a commercial on health care reform. How did they find her? "I think because I've been so strong with mental health, because they knew my history" and organizations she'd raised money for. "They had a lot of information on me."
The numerous local boards and fundraising committees Sieman has helped include Variety - The Children's Charity, March of Dimes, Blank Children's Hospital, Broadlawns Medical Center, the American Red Cross, the American Cancer Society, the National Kidney Foundation, the American Heart Association, and Bernie Lorenz Recovery (a facility for women recovering from substance addiction).
She has been active with the Iowa chapter of the National Alliance on Mental Illness, and has spoken publicly about how hard it was for her and her husband Robert Sieman, a retired obstetrician, to find care for their late son who suffered from delusional paranoid schizophrenia.
Did Partnership for America's Health Care Future provide a script for her to read? "No."
Was she paid to be in the ad? "Absolutely not."
She decided to do the commercial because "I am involved with the medical community," working to improve access to mental health care, "and I'm watching hospitals and programs close, I'm watching the lack of doctors, and I'm concerned about rushing into something where everybody can have medical care, and can we service that? Can we really do that? And have we sat at the table with the right players" to talk about the costs?
"I did it because this is what I believe."
"I'M A VERY INDEPENDENT VOTER"
Sieman introduces herself in the commercial as a Democrat. I had the impression she was a Republican when she served on the West Des Moines city council. Is that accurate? "I was born a Democrat."
She elaborated, "When I was on the council, everybody was a Republican. Nobody ever asked me. Nobody ever said anything about it, because we don't run as political parties" in local elections. Sieman recalled that some Republican friends who had raised money for her campaigns were surprised to learn years later she was a Democrat.
Sieman's voter registration record indicates that she has participated in some Republican primaries, most recently in 2014 and 2016. She explained that she first voted in GOP primaries to help her close friend, former State Senator Mary Kramer. She has supported other Republicans she knew personally. "I'm a very independent voter."
"CAN WE DO THAT REALISTICALLY"?
Some members of the Partnership for America's Health Care Future lobbied strenuously against the Affordable Care Act when the bill was pending in Congress. Does Sieman think the landmark 2010 law was good for the country? "Yes, I think it was good. I don't know that it worked for everyone, but I think it was a good start."
Should the U.S. set a goal of everyone having health insurance?
I would love to. I would love to have the wand that would make sure everybody could get the health care they need. My question is, can we at this point in our country, can we do that realistically?
Was Medicaid expansion a good thing for Iowa? "Yes. I think it's good." She's not for further expansion of the Medicaid or Medicare programs "until I know that we can afford it, and that the people can receive it, and receive the medical care that they're claiming."
That view puts Sieman out of step with most Americans and a vast majority of Democrats. A nationwide poll commissioned earlier this year by the Kaiser Family Foundation found 77 percent of respondents favor allowing people between the ages of 50 and 64 to buy into Medicare, and 75 percent favor allowing those who don't get health insurance through work to buy into their state's Medicaid program. One of Kaiser's tracking polls found that around 90 percent of Democrats support creating some kind of public option to compete with private health insurance plans.
Sieman wasn't aware that the American Medical Association recently pulled out of Partnership for America's Health Care Future after the group began advertising against the public option.
She confirmed that she and her husband are on Medicare. Has the government limited their health care choices? She mentioned friends with chronic illnesses who have been restricted in the care they receive.
Some people find it odd that a person on Medicare would be in an ad criticizing government-run health care. How would Sieman respond?
Well I am using it right now, because I can afford it. And I can do it. What I'm saying to you is, if we decide to do it for everyone, will we be able to actually do that, the way it needs to be done?
I myself have waited for care. Now I'm trying to figure out, how do we give care? How many hours can you wait? If you're having a heart attack, how quickly can you get into a hospital that is full? That's what I'm concerned about.
"HOW DO WE INTEND TO PAY FOR ALL THIS?"
During our interview, Sieman repeatedly returned to the question of how Americans could pay for universal health care. "How are we going to pay for it?" "How do we intend to pay for all this? How do we intend to make it work so that everybody does get the care they need in a place where there's no care?" She's concerned about hurting existing programs.
The ad centers on a different argument: the government supposedly would control everything. How would that work? People on Medicare can still choose their doctors, right?
Can you? And will you be able to? That's not true with all insurances. That's not true with all care. [...]
And how can you see the doctor when there is none?
Iowa's health insurance exchange has failed to provide stability; several companies came and went during the past five years. For a while it was unclear whether any insurance provider would sell through the exchange in 2018. (Medica ended up being the sole participating company that year.) Wouldn't a public option help self-employed people and others who buy their own insurance, by guaranteeing that at least some plan would be available for purchase?
I don't know if the public one will work, and even if it works, do we have the facilities, the physicians, the health care people to take care of everyone? We don't. Iowa does not.
So I can imagine that some of our southern states that are struggling do not. I don't know of any state that could really take care of every single person.
Sieman says during the widely-viewed ad that she worries the government would take control of a public option. How would that work?
And you know, we're the government. So if we're going to take care of it--yes, we have representatives in Congress et cetera--but if we're going to take care of it, we're responsible. We're responsible for the cost, we're responsible for all of this. And we need to know, can we really do this?
But how would the government be taking control if I have the choice to buy a Wellmark Blue Cross/Blue Shield policy or the public option?
Would we really have the choice? That's my question. You and I have the choice right now, but not everybody has the choice.
How would they be able to, how would the insurance companies be able to do this, if everybody could pick what they wanted? I'm just curious.
Just like they now compete with each other, they would be competing with each other and also with a government plan.
But could the insurance companies afford this? Could the government afford this, which is us? We would be paying for that, that's us. Can we afford that? And can we really do it? That's my question to you. Can we feasibly do it?
Sieman noted that Iowa and the U.S. have enacted laws on mental health "with no funds to back it. And so the things can't get done if you don't have the money to do it."
The message of the commercial is that government shouldn't get into the business of deciding people's health care. I'm still trying to understand how a public option would produce that result. It sounds like Sieman is mostly against Medicare for All.
I'm talking about both. I'm saying that what I want as a member of government is for the players to sit down when they're talking about this public option, and anything that involves Medicare, and see where are the other things we can do first, before we decide to do something that may not work for everyone.
Has she gotten positive or negative feedback on the ad? "Extremely positive." (Not in the Democratic circles I run in.)
Sieman said she has a lot of Democratic friends who feel the same way she does, "but they're afraid to say anything." Maybe so, but as mentioned above, the Kaiser Family Foundation's polling shows overwhelming support for some kind of public option, especially among Democrats.
IMPLICATIONS FOR KEY 2020 RACES
Every Democratic candidate for president and nearly every Democrat running for Congress supports either building on the Affordable Care Act with a public option or moving toward a single-payer approach.
Sieman hasn't endorsed a presidential candidate and has attended events for several contenders. Would she vote for someone who advocates for a public option? "It would be very hard for me."
Would she consider voting for Donald Trump over this issue? No, Trump "is totally off the radar for me" for various reasons, in particular "the way he treats people."
Sieman was an early endorser of Cindy Axne for Congress in 2018, but Federal Election Commission records show no contributions from her to Axne or to Republican U.S. Representative David Young, whom Axne defeated. Had she supported Young in the past? "No." She likes Young and went to a party for him, "but he and I are totally on opposite ends." As a past board member of what was then called Planned Parenthood of Greater Iowa, Sieman has been disappointed that Young didn't support women's rights while serving in Congress.
Axne and Young will face off again in what looks like a toss-up race. Iowa's third Congressional district may become the most expensive U.S. House battleground in our state's history.
When asked about health care, Axne has consistently said she's not for Medicare for All but wants to improve on the Affordable Care Act by making a public option available. Sieman still considers herself a supporter of Axne, who is responsive and aligned with her on other issues, such as education. As for the Democrat's position on a public option, Sieman said, "That's ok that she supports it, but I'm going to be on her back every minute of every day," asking how we'll pay for it.
Partnership for America's Health Care Future and other groups seeking to influence the debate about health policy don't mention any candidates in the current batch of tv and online commercials. But Republicans and conservative interest groups are bound to spend heavily next year on ads that echo Sieman's talking points as a way to take down the Democratic presidential nominee and the party's candidates for Congress.