Alright, Good afternoon everyone. My name is Aaron and I live in Des Moines and I'm very passionate about our health care delivery system here in the United States and the things that we can do to make it better and so I'm really excited to be here this afternoon to hear from stories from my fellow neighbors all across the third district here in Iowa and of course to talk with Representative Cindy asks me about all the things that she's doing in Washington to make a difference and so without like to turn it over to you for a few comments well, Thank you so much so grateful to be here with these incredible folks from our community and for all the great work that you do. Aaron. I'm really. Grateful for what you're doing to help our community, we all know that we've got a lot of issues when it comes to making sure that health care is affordable, making sure that we've got quality coverage in every part of this country certainly coming from States like ours that have urban and rural areas. we see the impact I think every single day with the issues that we're facing whether it's the inability to afford it or folks who can't afford their prescription drugs hearing from folks day after day. About the fact that they're taking half their insulin because they can't afford it. we know that that's not just terrible for them and their health and their family, but it's also not the right thing to be doing. it doesn't help our communities be successful. it hurts us economically as well so people's health care has a massive impact, not just on their them as individuals, but our entire community, our state and our country. so discussing it is so important. I'm glad to be here with all of you who to share so many of your stories. I got into this race because of some of the personal experiences that I've had with health care the first one being when I had my second son my husband and I were small business owners and we couldn't afford health insurance. we couldn't afford maternity coverage because back then they go folks 15 years ago. that was a preexisting condition and we couldn't afford the thousand dollar a month writer on top of my premium that I had to hold in place for at least a year before becoming pregnant. so we ended up selling personal items online just to cover the cost of my son's birth. I know the difficult. That families face I know that they can go into severe debt at the emotional toll that it takes and the physical toll that it takes on them from not being the healthiest person that they can be so I'm grateful that we're here to have this discussion. Thank you for being here to help monitor it and I'm looking forward to hearing what people have to say. Alright. Thank you so much so who would like to go first? And I'm from Council Bluffs, Iowa. my sister was diagnosed with stomach cancer in 2013 here in Des Moines. she started off at Urgent Care. They told her it was her gallbladder go ahead and go to the emergency room. she went ahead and went to Mercy emergency room and they said, Okay. It's your gallbladder. We've gotta do some scans and we'll go ahead and get that goal bladder out for you so after scans. Found a Mass in her stomach the first result that came back, they said It was curable Informa came back a little bit later and told us that it was stage four gastric cancer not knowing a whole lot about gastric cancer ourselves. we went online. she got set up with an oncologist, she said. Hey, I've never seen us a case of gastric cancer before I don't. I don't know what it is. I don't you know, but we'll work through this together After we found out the stage four, they said an operable didn't go in and do any type of exploratory to see what other organs may have been affected by it. so I mean she started chemo here. eventually we went ahead and moved her over to University of Nebraska Med Center to their cancer unit. she was seen by another oncologist who confirmed you know she's got a year or maybe less for her diagnosis they did cancel. They did radiation on her she did pass away almost a year to the day. it was definitely hard of my parents as her caregivers hard on me as her sister to watch her go through this, especially not having a whole lot of knowledge about it. so I've kind of immersed myself in gastric cancer and recently went to Washington actually last week to advocate for stomach cancer research and funding But what I found that was very stressful is that after her death, they went ahead and did gastric their genetic testing on her found out that her cat cancer was actually a genetic mutation. so they found a Gino in there. The CDH one gene my mom was tested. but as far as family history would go, they wouldn't just test us all even though my mother had supplied all the information. So now I have to go through the. Full process of now meeting with the genetic counselor, getting them, family history and diagnosis before I can even get blood work done. they're going to submit to insurance to see if anything is even gonna be covered. that to me is just a lot of work when you already know and you just wanna find out for yourself and then for your child. so you don't have to see your child go through what you had to see your sister go through and feel what your mother had to go through The other piece of that is, I called my GI specialist had a conversation with him about what we need to do for surveillance for family history and he said. I have to call you back so he did some research and called me back and said some documents say three years some say five years there's no definitive on screenings for gastric cancer via colonoscopy. Endoscopy so my sister passed away in 2014. we're now in 2020. so almost six years you know has passed essentially and there's still no framework for this. There's still no if this than this and I kinda find that hard to believe, especially. Your list for over six years so when I was advocating last week in Washington, we were asking that funding not because for for this, this type of research within the DOD because stomach cancer has also been linked through HP Laurie, which is affecting our military but that we get that funding that we need to get that framework built so in speaking with. your Aids who were fabulous by the way I just wanted to make sure that you know you got that documentation and are reviewing it to sign the dear colleague letter that will be coming out to keep funding up for gastric cancer. First and foremost, thank you so much for sharing your story. I'm got two sisters myself and I know that that's about as strong a bond as you can have they're my best friends and so I know how difficult this must be for you and I'm so sorry to hear about your sister and but thank you for doing the next step, which is advocating and and really living her memory for her so that somebody is standing up for the struggles that your family went through to try and help her and to help you now. And you know with with your family, are you a mom? Four -year-old daughter and she looks just like her Auntie Oh very good. well, you know you're absolutely right. We should have better processes in place where when these things have been identified and as you mentioned, this is a genetic thing. so it's within the family. we know that we should be able to move forward and and test all of you not have you go through some difficult process when it's already there in in front of you, you know so much of what we have in Washington is tied up in bureaucracy and and and Red So we've got to work our way through that one thing I will commit to you and tell you is we are trying desperately to ensure that there's more funding that goes into the National Institutes of health so that we can ensure that there's better research on diseases and cures and one of the things that we we will find in our HR three prescription drug bill. that's waiting for the Senate to take up which the AARP and and multiple health outlets have said this is about as impactful. A prescription drug bill that you can find I can get into the details on that later, but part of the savings that from reducing the cost of prescription for Americans is to put more investment into our research to exactly address the issues that your family is facing. We understand that all of these things are intertwined that we have to reduce the cost of health care in general and then we need to put a lot of that back into understanding how we can find cures how we can solve health issues with families and children who aren't getting the the effort that they need to put. That and I can tell you we're working on that in in Congress right now in the House and we need the Senate to act on those bills that will allow us to put more effort towards that good research that you're requesting. so thank you so much for first and foremost sharing your story for taking it on yourself to advocate as a working mom, one more thing, but you know how important this is for our country and that's how we're gonna make those changes. We appreciate it. Thank you so much. Alright. Thank you so under the next one and I. Wanna make sure we have enough time for quite a few questions so we wanna make sure we keep it up just a little bit brief. Hi. my name is Chelsea from The Point. I have a rare disorder called hereditary Angioedema it's potentially fatal. when I was diagnosed back in 1990, - three we barely had we had one treatment, which was daily doses of Dana's all which is an anabolic steroid, which comes with its own side effects and and for me and many others was not effective The the Hereditary Angioedema community has a National Association that through its advocacy advocacy advocacy. I was able to spread enough research to in the last 20 - five years to basically give us a number of of new treatments good treatments. We're actually in the last 10 years. We're actually on our second generation of treatments. so we went from anabolic steroids to an IV infusion that you took twice a a single subcutaneous shot every four weeks and for me and many others that they basically keeps us a symptomatic and and and healthy. my concerns are since this is you know with any medications for orphan drugs. They're very expensive and what the the current climate. you know. I'm worried about returning to the days of lifetime caps on insurance probations against preexisting conditions and Thing called Step therapy where where insurance companies are making us go back and try these older failed treatments that didn't work again. I'm I'm approaching retirement age. so I'm also wondering you know how are my meds gonna be treated under Medicare am I gonna be covered am I gonna be able to afford it. do I have to just work simply to afford my meds rather than retiring. so those are just some of the things that I'm I've been concerned about. Thank you so much for sharing your story and I'm glad to see that there's been advances that can help you have the medicine that you need it. Make it a little bit more user friendly for you and that you're hopefully moving forward in the right direction. I couldn't agree with you more that things are under threat right now from our social security to Medicaid. we are really trying to protect folks like you with you know, making sure that pre-existing conditions are covered right now. The ACA is under attack as we well know by this administration unfortunately moving itself through the courts across this country to try and dismantle it. So we're. Tooth and nail to keep that in place to cover folks like you with preexisting conditions. Listen, there's not one place where I go where I ask folks to raise their hands and I say do you have a preexisting condition or to someone you know have a preexisting condition. Every hand goes up. so we know how important this is and we're fighting tooth and nail to keep this in place. Secondly, I'd love to tell you going back to that. HR three HR three. If you haven't read about this bill it would ensure. That folks that are on Medicare have a cap of no more than $2000 for the drugs out-of-pocket expenses for their prescription drugs ensures that we as Americans pay no more than 20 percent over what another country would pay for those same drugs that by the way your taxpayer dollars are used to research develop and produce here in this country and thirdly the biggest piece that allows us to negotiate the most expensive about 250 drugs most utilized. Within Medicare and then use that same cost extrapolate that out to every single American they'll get that same savings. so what we wanna do is put in place parameters around Medicare that will ensure that when you get there and congratulations on almost retiring that when you get there that you're going to have the social security you need as well as Medicare coverage that you need and that those drugs are affordable. so that you can retire with a life of dignity. so that is. Our goal again, we're gonna be putting that savings back into research. We're also gonna be putting it back into coverage of vision dental and hearing within Medicare which are certainly folks who need that. so we're gonna keep pushing for this agenda. I'm so grateful to hear the things that then some advance to make life a little bit better in the drugs that you do take but it sounds like we have a heck of a long way to go and certainly in making sure that diseases like yours that are very and you mentioned diseases that are very rare that we have more folks. On figuring out solutions to those So thank you so much. thank you. Hi, I'm Jen Steele from West Des Moines, Iowa. I am a mother of two I have my daughter Allie. She's 14 and my son, Bennett is four. both have been diagnosed with a rare congenital anomaly called Eco Dermal dysplasia. Eco dermal displays requires extensive medically necessary treatments to live healthy and happy lives. shortly after my daughter was diagnosed with quickly learned that advocating for her needs would become part of our everyday life. she requires. A school medical accommodation plan or a 504 due to her inability to sweat and her congenital missing teeth for her to be able to eat and be safe in her eating. we also learned that the repair of her congenital anomaly would not be covered by our federally regulated health insurance. It is estimated that it's gonna cost us between 80 and a hundred and $50000 out of pocket. our advocacy that we do in our daily lives is transitioned into advocating for federal legislation My family has partnered with several other families to the National Foundation for Ector Dermal dysplasia to create a family driven advocacy Committee. through this, we've been able to have a bill written. It's called the Ensuring Lasting Smiles Act. This will provide coverage for all Americans who have are born with a congenital anomaly that require medically necessary treatments to restore function by closing the loophole in current legislation This will allow all Americans with congenital anomalies received the medically necessary treatments through their own current medical insurance. I'm wondering what it is that you have done and what you can continue to do to help advance the insuring lasting Smiles Act well, first and foremost. Thank you for that question and thank you so much for the advocacy that you have not just for your incredible children. but for children across this country, we couldn't be doing what we need to do if it wasn't for parents and individuals advocating for their family members. As you mentioned, we have the insurance. Lasting Smiles Act which I'm proud to have been an original was one of my bills and and proud of very proud of that bill working with Senator Ernst on the Senate side. we absolutely need to get that moving through and signed into law. the the it's it's just unbelievable that we we should have that you guys would have to come to us and point out that insurance companies have said that they shouldn't be covered because it's cosmetic. Well, we know there's nothing cosmetic about a child being able to chew and swallow and and we know that as a result of those congenital issues that they have then intestinal issues and certainly I've met your wonderful children incredible advocates alley. I think will be leading this world someday and and I'm gonna do everything we possibly can to move this bill forward. I've talked with Senator Ernst about where it is in the. At this time, I know they're trying to find package that it can go into and I'm gonna continue to push to move that forward. What we need to continue to do as well is is invest in more opportunity more research to ensure that we're looking at these rare diseases and hoping to find a cure and again, I'm gonna go back to why we need to invest in the National Institute of Health, we need to invest in multiple areas there, including mental health as well. but we certainly need to make sure that we are finding solutions to help children like yours and thank you for your advocacy. Alright, who's next? Hi, my name is Allison Bailey. I'm from Ames. so I was diagnosed with type one diabetes when I was 12 years old. it was really something you know. it's a fairly manageable disease when it comes right down to it. We've analog insulins have been around since the mid nineties a couple going 2016. I went to the pharmacy to purchase my insulin prescription and the price took my breath away. I like was in tears the pharmacy I was like $400 I. For a month supply and this is for a drug that's been around since the mid nineties so last year last year, Yeah, I started the Iowa insulin for all chapter. Shortly thereafter. I joined the staff at International and we're a global nonprofit who advocates for people with type one diabetes around the world Worthy Organization behind the insulin for all movement. We now have 30 - four chapters across the United States and we've been really pleased to see all the legislation that's come across HR three the fact that it's gonna negotiate for for insulin prices but. We're still seeing is the uninsured we know of at least seven people at least seven people who died last year from rationing their insulin and you know a lot of the state and federal bills that are coming out just still don't you know don't speak to that. even though they're the most vulnerable in our community, I think all seven of those people perhaps maybe didn't have insurance so it's we know it's one in four people who are rationing, but the uninsured or are the most at risk. So my question is what. Do to help the uninsured. Look for first and foremost. Thank you so much. I know that you have really expanded the work that you're doing in in regard to making sure people understand the issues surrounding getting insulin the the affordability of it and and bringing up stories like that that are just heartbreaking and as a matter of fact, when I did rural health care tour and visited with health care providers visited with patients, rural health care clinics and hospitals. I asked the providers. What are the what are the most important health issues that you're facing out in our rural communities and they said, diabetes and mental health two things. I'm really focusing on when I really really try and impress the fact that we need broadband across this country so that we can address things we need. That's why we need rural broadband because we've got a lot of folks in our rural communities who if they had an opportunity to interact with their doctor on a regular basis that could check where they're at make sure that they're following the the procedures that need to keep them healthy, taking all of their insulin. we'd have a much better opportunity to keep people healthier. now I know that's. Difficult for those folks that are uninsured for most, we need everybody can walk into a doctor and get the services that they need in this country and so I'm I'm adamantly behind affordable quality health care for everybody. you know we we shouldn't we should make sure that anybody who has diabetes can get the insulin that they need and can get the attention from the doctor on a regular basis basis that they need to keep themselves healthy as we all know by now. Being by not taking all of it, you just mentioned, unfortunately seven people that died. you know we. We also know people who get into that routine. We catch them in the Middle of it and then you know that they become very unhealthy and then they also increase the burden on economically on the system because we've gotta bring them back to to where they were because they weren't doing what they needed to do. So. there's just a lot of things that we need to make sure that happen. We've got a sore up the Affordable Care Act and ensure that. we don't take the provisions away from there that are protecting people with preexisting conditions. We need to lower the cost within it. I wanna Institute a public option so anybody can buy into Medicare or Medicaid and afford what they're what they're getting and we also need to ensure that just the overall cost of health care in general, come down so that folks can actually you know be insured whether it's through a public option or through their own private insurance, you know when we're seeing just dry. Prices you know catapulting in expense when when folks can't afford to go into the hospital because they're afraid they're going to come out with a bill that they can't afford when when my kids were little and we were paying for our own insurance with our small business there were times where I literally didn't take them in hoping that they would feel better and waiting til the last minute. No parent should have to do that because it's not the right thing to do so in general across this country, we've got a lower the cost of health care across the board taking out farm. Benefit managers out of that out of the system that are really burning burning the cost of our prescription drugs and health insurance companies aren't gauging people they're actually in there to do the right thing, which is to keep people healthy. So I'm gonna do everything I possibly can to lower the cost to get HR. three past will get insulin their first drug that we're gonna be doing is looking at insulin. That's how important I'll be honest. That's how important HR three is I would encourage every single person. This room and anybody listening to this to contact your federal representatives and senators and let them know how important it is to get HR three through so that we can protect those people if they could have afforded their insulin. they could even they could still be uninsured and have afforded their insulin. that doesn't mean we shouldn't make sure folks have coverage that they need, but it means we could have had a system in place where they could have afforded those drugs, insured or uninsured. Thank you go ahead. I'm at Dave Mills. I'm a volunteer with AARP. I was just on my taxes the other day and I got a shock when I looked and found out what my medical cost for the year where it was also the required cause of of car insurance and property taxes, and those things together alone took over 60 percent of my fixed income for the year and to me that that was kind of a a shocking thing. I also. During this past year had had some medical issues of with my daughter they were serious in nature. she required assistance that outside of what the insurance company with their employer would pay and we had to come up with some dollars to even get her into the treatment on upfront cost and in some of the cost Associated after that or astronomical but this. My story is it is small in my mind because I've had to be where I am and I've had to give up some social things, which is okay. I've adjusted to that, but I go around the state listening to people tell their stories and and several years ago at the state fair. we we had some things filled out by people from around the state that that. Talked about health care access to health care talked about drug prescription costs and of those 11000 a cards I went through them personally categorize them into 10 or 11 categories. The top two categories were were drug costs and accessibility to health care more recently at the state Fair, I've had thousand cards that were focused just on the cost of prescription drugs and then just last week. Guy was at a meeting and the people were telling their stories and I looked at 11 of them and of those 11 people. I was totally shocked. one said that the cost of the medication was a hundred and 30. - $5 is now gone to 360 - five that to me that's unthinkable. what was sad about last week's stories was that three. I just can't afford that I'll I'll just have to accept dying. my story goes to the bottom of all those list of the others, but those stories that they tell are extremely important. unfortunately, you know we do a lot of spend a lot of time talking about the stories and creating the stories and now I think what we need to concentrate on is talking about solutions solutions that we can go, we know. That the drug companies have over 500 lobbyists for a lot of money and how do we as individuals organize ourselves to get not just our stories but our proposals and the plans and the way we think things can be a worked out and adjusted to lower prescription drug costs and say what's the first and foremost? Thank you for all of your advocacy and and the work that you do on your daughter's behalf as well. you know you hit the nail. The head with all the lobbyist that are out there I don't take corporate pack money as a matter of fact, I think that that's one of the biggest influences that we have on lawmakers right now is that big farmers in the pockets of too many people who are making the decisions about America's health care and and that's gotta stop. So I you know one thing that I would absolutely stand up in and put out publicly is expect that you're that your lawmakers aren't in the pockets of big Pharma and that and hold them accountable. Are because when they are, they're not making the decisions that are in the best interest of the people in this country, they're figuring out what's gonna allow them to to win their next election and that's why we need to get you know this type of money out of politics. So that's that's an issue. you know, number one secondly again. We've got a bill sitting ready to go that that literally has been you know with your work by the AARP and how and how how impactful they think. Bill will be expected to say 350 to 700 billion dollars during the lifespan of which it's being implemented to reach those 250 some drugs that were gonna be able to lower the cost of imagine how much that could help us. We talked about it, adding to Medicare through vision dental and hearing coverage, but also by allowing us to invest in greater research to where we're here listening to the these diseases that folks have. And there's not enough research being put aside for those so there's so much opportunity out there. It truly is a matter of making sure that those lawmakers set aside their own personal agenda and do what's right by this country, which is move those bills forward that will help every single American and not just help us as I said from a health care perspective. But our country pays on you know about 19 percent of our GDP for our health care expenses, which is almost twice as much. Any other advanced country that has you know similar type of health care coverage. that's unacceptable. I think if we could put eight percent 10 percent back into our economy as opposed to the health care system where it's not benefiting anybody. we could be doing so much more to help folks across this country with education with getting better jobs with ensuring that we you know help folks with trade skills and apprenticeship programs. So I think. How this is so intricate weaved into our entire economic and social fabric of our country and why it's so important that we move this agenda forward to lower the cost of prescription drugs. because folks need to take a step back a minute and again remember that this is not just about saving yourself. $20 on on you know on these pills you need to take or a hundred dollars you know on your nebulizer. This is look at this from your long term for your entire law. how much this cost individuals and it's costing them their lives because they cannot afford it. I've heard the stories of all of you in here. I've talked to folks who you know who literally told me they they had to determine. Will they put food on the table or will they take their insulin? Well they have children and they wanted to put food on the table. So now that parent who needs to be there for them is compromising their health so that their kids can have food. This is where we're at in the country. Like ours, absolutely unacceptable, so we're gonna continue to push this agenda forward. I ran on solving health care problems in this country covering people with preexisting conditions lowering the cost of prescription drugs. All of my colleagues did as well. Those bills are there. We're trying to get those through and I hope you'll help us make that happen. Hi, I'm Susan Brown from Waukee and I have three adult children to of them have a genetic syndrome called Fragile X and that's a syndrome that causes severe intellectual disability. So you know I could talk about many things related to that. But today I wanted to just focus on the patient experience in health care so most industries that you know Exist today, focus a lot on user centered design and the customer experience, and I feel like that's not necessarily the case in health care. So while my kids over their lifetime have seen wonderful professionals, the system does not accommodate them well because the system is very scary to them and it's hard for them to navigate. so for example, we drive over to Iowa City to see a. Specialty clinic that Medicaid wants us to go to they're on the the waiver program and it pulls them out of their routine, which they don't understand and they literally go there and sit on the floor. While I talk to the health care professionals and they are required to go to manage their medications and I just feel like there has to be a better way with all of the technology that exists and tell a health and I know that Telehealth is you know gaining in use but I feel like the government. It should really be accelerating how to incentivize programs that are more designed around the patient and efficiency and use of technology. It wouldn't just benefit my kids that would benefit people in rural areas. maybe medically fragile adults. I just think we have to get away from this notion that brick and mortar health care is the only way to see a patient. one on one face-to-face visits is the only way to see patients. It could help with the mental health professional shortage that we have so I guess my appeal is just accelerating incentives. cuz providers are still paid to see you face to face and they do a lot of what I feel are unnecessary lab tests on my kids. It's how they they earn their living. They have to see them face to face they have to order to test. They have to have them undergo procedures and the incentives are crazy. they should be incentivize. To you know be innovative and think outside the box, use technology and focus on the patient experience versus just what works for the health care system. Thank you. It's first and foremost. thank you for all the work that you do for fragile X very much appreciate that you know you you mentioned your children and you know I'd I'd be curious to know what you this is disrupts a whole day. you take them out from whatever they're involved with. I know you work and what what kind of impact does this have on your family when you have to go to another location for something that you probably could have done as you mentioned via Telehealth. but you're going two hours to University of Iowa so that you can basically fulfill what needs to be done for your kids, but really because it's the structural setup that we have what other impact does that have on your family by having to take time out to do that. Well, I mean it's the last day of work for me and you know all of my days off are rolled into one Bank of PTO. I don't get a special Bank. Of days to care for you know sick children and so you know it comes out of my my PTO Bank, but more importantly, so my son, for example, is in the the functional skills program at Waukee High School. He's almost 20 - one so he's finishing there, but just to put him on the bus and then go pick him up an hour later to have to stop on the way there and deal with his you know, personal needs and And you know, try to figure out how I'm gonna feed him throughout the day as we're traveling and then sitting in in the office and waiting so it's it's just you know and then they they don't understand why he doesn't comply with the things that they are asking him to do during the visit and it's because he's already spent three hours out of his routine and he's totally confused and scared. frankly, so you know it's more of the. Sort of stress that it puts on him and then they aren't able to accomplish a lot of what they need to in the visit because he's not compliant by that time. he's non verbal. so I mean those are just some examples and then and Medicaid pays for our mileage because they want us to be seen there and I feel like that's just a waste of Iowa Iowa dollars they they reimburse us for meals. I mean the whole experience costs several hundred dollars not including the professional fees for the visit, so just there has to be. Better way Absolutely, let's let me let me see what we could do at a federal level certainly working with our state. I have a lot of issues with our privatization of Medicaid in the in the state of course, which I think has been very harmful to the people that live here but certainly this is something that we should be looking at both at a federal and state level because listening to you. It's not just the fact that it's inconvenient and can be done for less money which. To our two good things to overcome, but you just said that, for instance with your son because it's taking him out of his normal patterns, he it's now more difficult to see how well he is progressing because he isn't as compliant as you would like him to be for the doctor and that's completely understandable of course. so what's the benefit to your son and yourselves if you're not in a setting that allows the doctor to be as impactful as they could be by able to diagnose how your son's doing at that point. Moment there's so many things that you've rolled into that one story that I'm gonna take back with me and that we should be changing. I couldn't agree with you more. We gotta quit inconveniencing people for a system that's not working for us. We need to make the system be convenient for us so that you don't have to experience these types of things appreciate it. Glenn Hurst. I'm a family medicine physician from Minden, Iowa and I appreciate everybody who's who's coming and who's spoke about very specific conditions and access to to treatments and and I think you would expect a provider to to have those same responses like you heard on your your tour that we've gotta be able to take care of diabetes better. We've got to be able to take care of this condition better, but the level that I wanna take this to is not just about my individual patients suffering and and death and health, but but my whole commu. That this problem with accessing health care is the death of rural communities. I have patients that I've seen since they were young children young boy and girl who I recently was not able to see anymore because the family's insurance changed to a closed network and I'm outside of that network. And so now this family that lives 30 miles away from the next in network provider. To make that type of trip back and forth to to take care of their their kids, it's a death to our community and that's income that's money that comes out of our community. Now you know I shop at the local grocery store. The local grocery store comes to my clinic. My pharmacy, Our town is blessed. We have a physician or pharmacy and a dentist in the town of 600 people. If you can believe it our pharmacy suffers when incentives from insurance companies to move prescriptions to mail in pharmacies. Takes that prescription out of the local pharmacy. It takes traffic out of the local pharmacy because of that, and our community starts to to die critical access hospitals where we start to limit the availability of of providers. What we now don't have OBGYN services or labor and delivery services in rural communities. who would move there who would come to a young family come to a rural community when we don't have have the things that they need and and the. Our communities are are dying, so I speak on behalf of the death of rural America and and ask where this is is being addressed at the the federal legislative level. Yeah. Thank you Doctor and thank you for serving one of our underserved communities here in Iowa and in the third District. We're very grateful for that and and your story about having a dentist, a doctor and pharmacist they are in a town of 600 is that's we know that that's incredibly rare. it is a matter of fact I've in my year plus that I've been in this seat have already seen some of our pharmacies closed down. so this is a crisis and and you know as well in some of our rural communities. Our pharmacists are our last hope. Health care delivery and the ones who quite honestly know more about some of those family members than even the doctors do because they're in there more often talking with them, understanding the prescriptions they take and how they interact with with each other and ensuring that folks like discharged nurses that that that the that those patients are following what those what they were discharged with. so we we have a huge crisis here in this country. I'm starting to address this issue because. I agree with you nobody's doing what we need to do to take it on. so I'm gonna take it on. I've already written multiple rule rural health care bills certainly to address physician shortages absolutely to close reimbursement gap rates for rural health care clinics as you're aware dependent on how they are structured. If they're not owned by a hospital, they don't get covered for all of their expenses. So we've got rural health care clinics falling by the wayside just because they're not owned by a hospital getting reimbursed at about 80 percent of what they should be. while those hospitals are getting about a. One percent reimbursement rate you can't you can't stay in business, so we're seeing you know folks like that own. you know clinic out in in Guthrie County who are real concerned about keeping that clinic up and running the next closest place is gonna be to have folks come into the urban area in West Des Moines which would require people like people were talking about today with their health issues that they have having to get in a car and go somewhere and exacerbate that and certainly. Our older Iowans that's a huge problem having to travel. You know an an hour just to go to a doctor. so we need to we need to nip this in the bud, rural health care reimbursement rates. I'm working on the physician shortage. I'm also working on a bill to help us address rural health care across this country and ensure that we don't close down more hospitals. As you know, we've closed down critical access hospitals in rural Iowa and across rural parts of this country. One of the most important things is for people in Congress and and those who I work with to understand how we're connected with each other and why it's important to support rural health care. If we lose rural health care and you implied this. If we lose rural health care, we will see our communities literally die because they there will be no place for folks to go to with with the services that they need. that's gonna impact our small businesses, our manufacturing communities and Many of these towns so it's imperative on people like me to reiterate to folks who live in big urban areas. How important it is to support rural because for God sake every ball bearing made for every Ford Explorer that Detroit people benefit from is made from a small town here in Iowa. Now. If we don't have people who can can go there and live because they say well, why would I go there? There's not even a safety net for my health concerns or for my children. I'm not gonna. Out to that community, we're gonna start seeing a huge impact and you you brought this up economically across this country and that is why another reason why it's so important to address not only is it the right thing to do. It's really a smart thing to do for us to be successful as a country. So I'm gonna continue to push these agendas. I'm working on with Senator Grassley on the Senate side so that we can get a bill together that will really help repair a lot of the issues with our rural health care, especially access to. and we're gonna keep pushing for that. The other thing we're trying to do is move those those physicians residency slots that are open in other States where they're not using them here in the States like Iowa, where we need them and bringing them into communities like yours so that we can actually ensure that we've got folks who would stay in those communities and service residents. So there's a lot that we can be doing. There's no reason that we should be leaving rural America behind and I'm gonna make sure that that doesn't. Alright, we have time for one last question. I work here in Des Moines at a large hospital. I'm a care coordinator. so when people go to leave the hospital, I tried to help them with things that they need like medicine like nursing home care. whatever that might be one of the things that I see that such a huge waste in our system is when we have people that are not able to be cared for at home by their loved ones anymore. They need to go to a care facility. maybe for for the rest of their lives to be cared for because it's become too much for their families and the. Of getting insurance approval making that transition happen primarily with the insurance process is my big big frustration. I would say easily 20 to 30 percent of the patients that when I leave on Friday are staying for the weekend. That's what they're staying for. these are acute care beds that people are waiting for sleeping in the ER overnight waiting for acute care beds. while we have people waiting for nursing homes for weeks up on the floors so if you could address the insurance in. I would appreciate that absolutely and we just we have a problem in general with a skilled nursing in this country and we're going to need it more than ever and States like ours, first and foremost of our populations of fourth oldest and in the country. it's gonna be really really important that we've got an opportunity to have good quality skilled nursing for every single person in the state. let's listen, I couldn't agree with you more as a matter of fact, my dad was in and out of skilled nursing most of last. He had a fall in both knees were torn so I experienced it firsthand the difficulties that people face dependent on what their insurance is dependent on what Medicare coverage that they have. and then I've heard same stories from folks who are have contacted our office that have loved ones in skilled nursing. This is rampant it's you know. it's not just the fact that we have to address the insurance side of it, which we absolutely need to. but we also have to multiple areas. We need to make sure that. Paying people appropriately who are taking care of folks in our skilled nursing centers. They are trying so hard and they need more support. we just put I just did another bill to protect a folks in hospitals from physical violence in some cases with their with patients and you know because that's another situation that they're facing. We don't have enough skilled nurses and people working in those facilities to give them a break once in a while. That secondary person that could help them lift somebody or deal with an agitated patient. so there's so much that we need to get done when it comes to that and I'm anxious to work on that because I think that's gonna be the next crisis in our country. as we start to see more people need skilled nursing as they age. I also wanna make sure that we can look at being in your home and getting the services that you need in your own home. so that you don't have to go to a skilled nursing facility if it's something that you could recuperate through. Home and that's a whole other issue that we aren't putting the resources to as well. I think those two things are so important that we address in this country and we'll be moving in that direction. Alright. Well, I think that's all the time that we have today. so thank you all for sharing those stories and for all that you're doing to take all of that back to Washington and find some solutions to these issues and turn over to you to kinda wrap up the event well, first and foremost. Thank you for spending your time and coming out here and sharing these stories. The reason we get things done in this country is through advocacy and I think what we're seeing right now is is an immense increase of folks who are standing up and saying this health care system just isn't working for us. so we've got a lot. We need to do the first thing is let's get those bills passed that are already there waiting that literally can make a difference from day one and I'd ask every single person who's listening to this contact your representatives at a state and federal level. If there is a law out there that you know will enhance your lives will put more money back in your pocket. will help your family be healthier. be loud about it. We won't change this. you know with with you know overnight, but we will change it more quickly if we have a lot more people standing. For it fight back against the system, let us know what we can do to help you at at a state federal and local level went with your elected officials go straight to and put owners on them. just like you're doing with me today. there's no better way to address this issue than to come out and actually tell your elected officials. What needs to get done because the stories are there and that's how we're going to make the impact. So I'm so grateful for what you're all doing. We're gonna continue to work hard in the Democratic House. majority to put forth more bills that lower the cost of prescription drugs that protect people with preexisting conditions to fight back against any attacks that we're seeing with this administration that could put people in harm's way when it comes to their health care. We're gonna be there for you every step of the way and I'm so grateful for everything that you do whether it's in your jobs as providers or whether it's in your role as an advocate. I couldn't be more grateful. We we need to work on this. A systemic issue that has so many elements that are complicated, but we can bit by bit make sure that we improve the system in general and I'll be honest. I don't think it matters really what plan you put in place. We've we talked about an ACA Medicare for all. you know public option. We've got system problems to fix as well. We can put whatever plan we want to in place, but we also need to make sure that the systems behind that are working because. Doesn't matter what it's called if we have waste in the system if we have inefficiencies if we're not addressing the the issues that we need to through better research and through support of finding cures, then we're gonna continue to see a lot of these problems. You know not not go away. so I wanna make sure we dig down deep and fix the inequities within the system and get out the money making profitability out of it so that you know so that everything is focused on people's health care and not just how. More money can go back in the pockets of like big pharma and companies like that. so thank you so much for coming out and providing this information. I've got more homework to take back with me to Congress next week.