Health insurance is expensive because medical care is expensive. Medical care is expensive because the prices we pay are too high and the numbers of services are too numerous.

We will never fully recover if higher insurance premiums and fewer benefits remain the new normal. And, more affordable rates will not occur until we change the way our medical care is organized and delivered.

This is the reason Democrats are introducing a proposed Iowa Health Insurance Affordability Reform (Iowa HIAR) program. It is modeled after Rhode Island’s successful reform, which is considered one of the most innovative methods developed to tackle the high costs of health care insurance.

The Rhode Island program created a new state department with the sole goal of holding state insurers accountable for their practices. Our proposed legislation follows that successful law. The four main goals of our proposal are: to increase consumer protection, carrier solvency, fair treatment of providers, and comprehensive system reform by improving quality, efficiency and access.

Our proposal will create a new bureau within the Department of Insurance. To help direct the affairs of the bureau, a Health Insurance Advisory Council consisting of representatives from small and large employers, providers and consumers will explore and identify strategies that health insurers could use to improve the current system.

The insurance department and the advisory board will create a partnership in which all stakeholders are represented at the table. From the experience in Rhode Island, we believe that this program is one of the easiest ways to reduce some health care costs because the current fee-for-service system allows room for unnecessary services that increase insurance costs. If the focus is shifted to educating consumers on the importance of preventive care, the cost of health care insurance would potentially decrease.

The proposed bureau and the advisory council will develop four affordability standards: increase primary care spending by five percentage points, promote the expansion of the Chronic Care Medical Home, implement electronic health records and revamp hospital contracting and payment.

The hospital contracting and payment reform component consists of provisions that would place price caps on increases for inpatient and outpatient services, “performance incentives to reward quality and efficiency, transparency of affordability initiatives, improved clinical communications as well as unit of service payment rather fee for service payment.”

We will build on Iowa’s present rate review standards and expand them to small business group policies. Our rate review system will be used to determine any fluctuation, discrepancies and potential discriminatory practices among the various insurers. This will also allow us to rectify practices and predict future expenses that would lead to an increase in costs.

The rate review will include an examination of any adjustments from the previous year; costs associated with hospital inpatient and outpatient, pharmacy, primary care, medical and surgery, administration; and profits and revenues.

One essential component of Rhode Island’s reform is to increase the money contributed to primary care, which would ultimately decrease insurance costs as well as health disparities among underserved communities.