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Posts tagged ACA

AHCA: Shifting Costs to States

FOR IMMEDIATE RELEASE TUESDAY, JUNE 6, 2017

Cutting Medicaid Expansion: Huge Cost Shift to Iowa, Other States

IOWA CITY, Iowa (June 6, 2017) — A new report shows Iowa would have to spend almost three times what it does now to cover low-income adults who would lose health coverage under the House-passed American Health Care Act (AHCA).

To keep up the benefit to those families, AHCA would force Iowa and the 30 other states that expanded Medicaid to absorb a greater share of the cost. The Center on Budget and Policy Priorities (CBPP), estimates the cost to Iowa to rise $192.5 million in 2021.

“This is an enormous cost-shift to Iowa, and we already have seen our state’s leaders cutting back revenues, and trying to cut more. Facing those fiscal constraints already, it is hard to see how the state could pick up those costs, which puts health coverage for many thousands of Iowans in jeopardy,” said Mike Owen, executive director of the nonpartisan Iowa Policy Project (IPP).

The new analysis by the Center on Budget and Policy Priorities shows that Iowa’s costs would continue to soar. By 2023, the state would have to find an additional $335.8 million to maintain coverage for people benefiting from the Medicaid expansion. That would be a 288 percent increase from the cost under current rules.

“The real question is whether Iowa’s political leaders on both sides of the aisle are willing to speak up about this to assure Iowa’s senators, Charles Grassley and Joni Ernst, are aware of the decisions being put on state lawmakers’ plates,” Owen said.

Peter Fisher, IPP research director, noted that about 150,000 Iowans benefit from the Medicaid expansion, which was part of the Affordable Care Act (ACA).

“Many thousands of Iowans have health coverage now because of the ACA and the Medicaid expansion,” Fisher said. “As we have stated before, any plan to replace ACA can be judged on how well those gains are maintained.

“The House bill would at best jeopardize the gains, and with higher costs for insurance, almost guarantee far greater numbers of Iowans would be uninsured.”

The CBPP report estimates the bill would jeopardize coverage for 11 million newly eligible low-income adults who enrolled in Medicaid under the expansion.

The report is available at http://www.cbpp.org/research/health/house-republican-health-bill-would-effectively-end-aca-medicaid-expansion.

In states that adopted the Medicaid expansion, the federal government pays at least 90 percent of the expansion costs — an enhanced rate compared to the regular Medicaid program. This change cut uninsurance rates in half for non-elderly adults in Medicaid expansion states, from 18.4 percent in 2013 to 9.2 percent in 2016.

Under the AHCA, however, the federal government would pay only the regular Medicaid matching rate, 58.5 percent in Iowa, for new enrollees beginning in 2020. Anyone whose Medicaid coverage lapses for more than two months becomes a new enrollee. Because Medicaid recipients cycle on and off the program, in the space of just a few years most enrollees would be “new,” and would lose Medicaid coverage altogether unless the state came up with the millions required to keep them on.

With the loss of the Medicaid expansion, the percent of Iowans who are uninsured could rise to levels even higher than existed prior to Obamacare. That is because those individuals who received some coverage from IowaCare, and who since moved to the Medicaid expansion, would not have IowaCare to fall back on when the expansion ends.

The Iowa Policy Project is a nonpartisan public policy analysis organization based in Iowa City. IPP and the Child & Family Policy Center in Des Moines together analyze fiscal policy issues as the Iowa Fiscal Partnership, www.iowafiscal.org.

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Jeopardy for women, rural health

Posted May 16th, 2017 to Budget, Economic Security

IFP NEWS — 

House bill jeopardizes health for women and rural Iowans

National reports pinpoint issues for Iowans with loss of Medicaid expansion

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Capitol-DSC_0119-240200IOWA CITY, Iowa (March 16, 2017) — The House plan to cap and cut Medicaid — and effectively end the Medicaid expansion — will have a disproportionate impact on women and hinder coverage as well in rural communities.

Two new reports by the Center on Budget and Policy Priorities (CBPP) illustrate the challenges as attention turns to the Senate. Of particular note is the threat to the expansion of Medicaid in Iowa and 30 other states to low-income adults previously not covered.

“Previous analysis has shown the Medicaid expansion currently assures coverage to as many as 150,000 Iowans. The call to ‘repeal and replace’ the Affordable Care Act is a hollow one in that we have yet to see a replacement that protects access to health care to this vulnerable population,” said Mike Owen, executive director of the nonpartisan Iowa Policy Project (IPP), part of the Iowa Fiscal Partnership (IFP).

A summary by IFP and CBPP of the previous House Republican plan had estimated that the earlier House Republican plan not only would cut health coverage, but also cut taxes for the wealthy while making health care more expensive for poor and rural Iowans. The report noted the Congressional Budget Office had projected the plan would wipe out all gains in health coverage achieved under the ACA.

The new reports by the Center on Budget and Policy Priorities — last week on women’s coverage and Tuesday on rural communities — clarify the challenges further. (See links to the CBPP reports below.

Not only do women make up a majority of Iowa’s Medicaid beneficiaries, but they also are the primary users of family planning and maternity benefits, and are more likely to use Medicaid’s long-term services, CBPP analysts reported.

“The Medicaid expansion loss alone is critical for women, even though it is not the only impact,” Owen said. According to the analysis, women are 54.6 percent of the Medicaid population in Iowa, but 50.4 percent of the total population of the state. In addition, the report stated, 40 percent of total births in Iowa in 2010 were covered by Medicaid.

CBPP’s report Tuesday notes that Medicaid “has long played an essential role in delivering health care in rural America.” It also notes that the rural share of the 11 million people — 14 percent — who gained coverage through the Medicaid expansion is greater than the rural makeup of the population as a whole (12 percent).

Iowa is among the eight Medicaid expansion states where more than one-third of expansion enrollees live in rural areas, the report stated. It estimates 61,600 — or 44 percent of all expansion enrollees in Iowa —live in rural areas.

“If rural health matters, then clearly the Medicaid expansion needs to be a priority and not an afterthought tossed aside for political purposes,” Owen said.

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 http://www.iowafiscal.org.

 

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For more information, see:

Interactive map with county-by-county and congressional district breakdown of Medicaid expansion enrollment (January 2017) http://www.iowapolicyproject.org/2017Research/170325-ACA-MedicaidExp.html

IFP backgrounder, “Replacing ACA: What You Need to Know About the AHCA.” March 16, 2017. http://www.iowapolicyproject.org/2017docs/170316-acha-bgd.pdf

Center on Budget and Policy Priorities report: “House-Passed Bill Would Devastate Health Care in Rural America,” May 16, 2017. http://www.cbpp.org/research/health/house-passed-bill-would-devastate-health-care-in-rural-america

Center on Budget and Policy Priorities report: “Medicaid Works for Women — But Proposed Cuts Would Have Harsh, Disproportionate Impact,” May 11, 2017. http://www.cbpp.org/research/health/medicaid-works-for-women-but-proposed-cuts-would-have-harsh-disproportionate-impact

Health care ‘reform’ gets worse

Posted April 27th, 2017 to Blog

The House Republican plan to replace Obamacare (the Affordable Care Act) with the American Health Care Act (AHCA), which a few weeks ago failed to even come to a vote, has been reincarnated. The new version of the AHCA has apparently won the support of the Freedom Caucus in the House, but in so doing has become significantly worse for millions of Americans.

Here are the key points about this new attempt to “repeal and replace” Obamacare:

  • Despite repeated promises to keep the most popular part of Obamacare, the provision prohibiting insurance companies from refusing to cover those with pre-existing conditions, the new version returns us to the bad old days. While a particular state may choose to keep the prohibition, there is no longer any nationwide requirement that insurance companies issue affordable policies regardless of pre-existing conditions.
  • Nationwide standards for health insurance policies will be rolled back; plans will no longer be required to cover services such as mental health, maternity care, or substance abuse treatment.
  • The nationwide prohibition on lifetime and annual limits on benefits will be gone, meaning the possibility of medical bankruptcy will loom once again for many.
  • The modified version of the bill still effectively ends the Medicaid expansion; about 150,000 Iowans now covered under that provision could lose insurance altogether.
  • The bill still cuts $840 billion from Medicaid over 10 years, most of the savings going to wealthy individuals, drug companies, insurance companies, and other corporations.
  • Premiums and deductibles will still rise for large numbers of persons buying insurance on the exchanges, especially for the elderly, those with lower incomes, and those in high-cost states or areas, such as most of rural Iowa.
  • Under the bill, there would be no limit on the premium an insurance company can charge based on medical history; thus someone with pre-existing conditions could in theory be offered coverage, but at a cost that is simply unaffordable. There is little difference between this situation and straight denial of coverage. A state could choose to prohibit this practice (i.e., to keep the Obamacare provision in place), but few states chose to do so before Obamacare.

While the proponents of this revised plan may argue that it keeps the prohibition on gender discrimination, a woman would pay substantially more for a plan that included maternity coverage. Such coverage would not be a required part of all plans, but instead would be an expensive option.

Just how this revised bill would affect overall coverage rates, premiums, and out-of-pocket costs, awaits a new analysis by the Congressional Budget Office. But it is quite possible that the bill will be voted on in the house without the benefit of that analysis. Part of the pressure to pass the bill now comes from the desire on the part of the Trump administration to come up with large savings to the federal government that can then be used to finance cuts to corporate and individual income taxes.

The bottom line: worse health care coverage at higher cost to millions, loss of coverage entirely to millions more, in order to finance tax cuts for corporations (and probably millionaires as well).

Posted by Peter Fisher, research director of the nonpartisan Iowa Policy Project. pfisher@iowapolicyproject.org

Also see Fisher’s March 2017 policy brief for the Iowa Fiscal Partnership: “Replacing ACA: What you need to know about the AHCA.”