WATERLOO, Iowa -- In the 2008 and 2012 U.S. presidential elections, the state of Iowa landed in the Democrats' column, helping Barrack Obama to become a two-term president. However, Republican candidate Donald Trump carried the state in 2016.
Now in 2018, this quiet, corn-growing patch of America's Midwest is set to be a swing state once more in the Nov. 6 congressional midterms. And Iowa's 1st Congressional District is representative of the struggle for the state's voters, who have made the future of health insurance the campaign's pivotal issue.
Eric Donat, 38, lives alone in an apartment in the city of Waterloo, smack dab in the middle of the congressional district in Iowa's northeast. Donat has disabilities in his arms and legs from the cerebral palsy and spinal bifida he has had since birth, and he cannot get around without an electric wheelchair. In July this year, one of the front wheels on the chair seized up.
Donat filed a request with his health insurer to have the wheel fixed, but the company managing his plan did not approve the repairs for three months. The $500 cost (about 56,000 yen) was too onerous to cover himself, so Donat effectively spent those three months shut up in his apartment. Having a broken wheel "means I'm stuck places. It means that I'm not out in the community," Donat said, adding that he felt like he was not "a contributing member of society."
Donat is registered with Medicaid, a federal-state government medical insurance program that covers some 600,000 low-income or disabled people in Iowa. In 2016, then Iowa Gov. Terry Branstad, a Republican, privatized Medicaid in the state. The goal was to save the state budget of some $5 billion (about 559.4 billion yen), but Iowa's Medicaid costs actually rose after the move, while service declined. The private insurers that had taken over management of the system changed the evaluation standards to provide coverage, resulting in a spike in payments to hospitals for emergency care and impacting the state's entire medical system.
Seeking to give all Americans access to healthcare, former President Obama introduced the health insurance system known colloquially as "Obamacare." One of President Trump's first orders of business when assuming office in 2017 was to try to pull this system down, and he has sought to suck the substance out of Obamacare through executive orders after failing to get a Republican health plan through Congress.
Here in the Iowa 1st District, health insurance became the main issue at an Oct. 16 House of Representatives candidates' debate, with 63-year-old Republican incumbent Rod Blum facing off against Democrat Abby Finkenauer, 29.
Blum, who favors repealing Obamacare, told the audience, "When it comes to healthcare, let's unleash the miracle of the private sector, of the free market," adding that this was the only way to bring down healthcare costs.
Finkenauer, who favors continuing with an upgraded version of President Obama's signature health policy, promised she would "make sure we take our healthcare and fix it in this country."
Labor union executive Cody Leistikow, 33, and his organization are backing Finkenauer. Leistikow noted that on top of the national debate about health insurance in the United States, Iowa voters were worried about the mess that had been made of Medicaid in their local communities, pushing the issue to the top of their election priorities.
"We (Iowa) get a lot of attention from the country because in presidential (election) years we are the first state to have a caucus," he said, referring to the local Democratic and Republican votes for who they want representing their parties in each presidential election. "It's the canary in the coal mine for a lot of candidates."
Iowa's early party caucuses in presidential election years mean political awareness is high in the state, and voters often display a particular sensitivity to the policy issues of the day. The midterm election campaign has seen a string of heavy-hitters come to the state to stump for local candidates from both parties, headlined by Vice President Mike Pence for the Republicans, and Obama administration Vice President Joe Biden for the Democrats. The bigwigs include multiple presidential election hopefuls, and some see the appearances as groundwork for the 2020 campaign for the White House.
Grain deposit facility worker Larry Block, 73, was an Obama supporter but voted for Trump in the 2016 election. However, he plans to cast his ballot for the Democrats in the Nov. 6 midterm poll.
"We just like to see changes," he said.
(Japanese original by Kota Takamoto, North America General Bureau)