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IFP News: ACA repeal plans jeopardize health care gains in Iowa

As Senate builds legislation in secret, House approach hits Iowa hard 

Full report (or 10-page PDF)

IOWA CITY, Iowa (June 22, 2017) — Proposed legislation to repeal the Affordable Care Act (ACA) jeopardizes Iowa’s recent health coverage gains and puts the state’s most vulnerable residents at risk.

A new Iowa Fiscal Partnership report shows the stakes for Iowans — particularly seniors and rural Iowans — are significant. Losses of federal subsidies to obtain individual insurance are disproportionately greater in rural counties, and for seniors, under the legislation.

Besides those inequities, the report by Peter Fisher of the nonpartisan Iowa Policy Project (IPP) notes cuts in health coverage for vulnerable Iowans come in exchange for “billions in tax cuts to wealthy individuals, drug companies, and insurance companies.”

“Supporters’ promises of more state flexibility and individual choice ring hollow,” Fisher said, adding flexibility “means an enormous cost shift requiring the state to spend millions more and cut services. Meanwhile, ‘choice’ for thousands of Iowans would be stark: go without health insurance that had become unaffordable, or go without basic necessities such as food.”

The report focuses on the impact of ending the expansion of Medicaid to low-income adults and placing a “per capita” cap on benefits in the regular Medicaid program.

In addition, the House bill would:

  • Permit states to undermine current protections for patients with pre-existing conditions;
  • Shift federal Medicaid funding to a per-capita formula that does not reflect actual costs, particularly in difficult economic times or epidemics, or for patients needing higher-cost care.
  • Ignore coming higher costs in aging states, like Iowa, for coverage of the senior population.

As Fisher notes in the report, the Medicaid expansion “greatly increased access to health coverage in Iowa’s rural areas, where the percent of non-elderly residents who were uninsured was cut nearly in half between 2013 and 2015.”

These are the kinds of gains threatened by the American Health Care Act (AHCA) and the similar legislation emerging in the Senate.

“President Trump was happy with his crowd of 6,000 last night in Cedar Rapids, but many times more Iowans could lose health care under the House-passed American Health Care Act,” said Mike Owen, executive director of IPP.

“Today, we are learning of the plan that was hatched behind closed doors in the Senate. That proposal needs to be judged not against the low bar set by the House plan for the health coverage in our national safety net, but against the expanded role for Medicaid that provides coverage for 150,000 Iowans under Obamacare.

“Any legislation that takes Iowa backwards — by shifting federal Medicaid costs to the states, ending the Medicaid expansion, placing kids, seniors, and people with disabilities who depend on Medicaid at risk, and increasing out-of-pocket costs for low-income Iowans — is unacceptable.”

Fisher’s report includes estimates by the Urban Institute that 191,100 Iowans could lose Medicaid coverage under the House plan — or 38 percent of non-adult enrollees now served. Only 11 states have a greater share of their Medicaid enrollees in jeopardy of losing coverage.

A principal reason many of the enrollees have gained coverage is the Medicaid expansion, in which expanded federal subsidies to states encouraged 31 states and Washington, D.C., to offer Medicaid eligibility to more residents. The AHCA — and the emerging Senate proposal — would dramatically phase down the amount of federal dollars that states receive to cover new enrollees, including people who come off Medicaid and need to go back.

To maintain the expansion, Iowa would have to spend an additional $192 million in 2021, nearly tripling what the state spends now on that population.

The higher state cost would come from the state making up the difference between the subsidy under current law — 90 percent federal share of the cost — and the regular Medicaid reimbursement of 58.5 percent for Iowa. Expansion states like Iowa would have to determine whether to pay the additional cost and cut other programs (and/or raise taxes), or reduce Medicaid services to keep their budgets in balance.

“By 2023, the state’s additional cost would be $335.8 million, a 288 percent increase over current spending on the expansion population. It is highly doubtful that the state would find that much more in its budget for Medicaid,” Fisher wrote.

Owen noted Census data have shown Iowa uninsurance dropped from 8.1 percent in 2013 to 5 percent in 2015, largely due to the Medicaid expansion.

“Not only would changes proposed in the AHCA reverse these gains, but they would end Medicaid as we know it,” Owen said. “These changes would virtually guarantee gaping holes in the nation’s safety net for vulnerable Americans in many states, and push enormous new costs onto state budgets already stretched thin.”

The Iowa Fiscal Partnership (IFP) is a joint initiative of the Iowa Policy Project and another nonpartisan organization, the Child & Family Policy Center in Des Moines. Iowa Fiscal Partnership reports are at www.iowafiscal.org.

 

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