I Hope This Finds You Well: Our Health Care System is at Risk

Progressive advocate Ruth Thompson warns how much Iowans have to lose if "Obamacare" is repealed. -promoted by desmoinesdem

With the new Administration and Republican led congress, The Affordable Care Act (ACA) is in peril. Republican leadership plans to use the Budget Reconciliation process to repeal at least parts of the ACA. They are expected to hold a vote in January that may include language to do just that. If this doesn’t happen in January, it will almost certainly happen by September, 2017.

The nonpartisan Urban Institute estimates that the partial repeal of the ACA would cause almost 70 million people Americans to lose health insurance. In 2016, 55,089 Iowans enrolled in health insurance coverage for 2016. US Census data show that the uninsured rate in Iowa in 2015 was 5 percent as compared to 9.3 percent in 2010.

In 2016, of the Iowans who signed up through the Health Care marketplace, 85 percent of them were eligible for an average tax credit of $303 per month and 70 percent could obtain coverage for $100 or less.

As to the impact to employers, the Kaiser Family Foundation reports that employer-sponsored health plans grew just 3.4 percent in 2016, extending a period of unusually slow growth since 2010. The White House Council of Economic Advisers reports that the average family premium in Iowa was $3,500 lower in 2016 than they would be if premiums had grown at the same rate as the pre-ACA decade.

While President-elect Donald Trump appears to have walked back some of his rhetoric about repealing the ACA, saying that the “good parts” need to be kept, but others need to be repealed. I would argue that there are way more good parts than bad. Health care advocates have advised: fix what isn’t working, expand what we can and leave the rest along. Mr. Trump, Congress, listen to them.

Along with repealing the ACA, the President-elect has talked a good deal about making Medicaid a block grant. One of the benefits of this, according to Mr. Trump is that it allows greater flexibility to the States.

But states already have a great deal of flexibility in designing and administering their Medicaid programs. Having worked either directly or very closely with Medicaid in three states, and having spent much of my career studying Medicaid systems across the country, I confidently can say that if you’ve seen one Medicaid program, you’ve seen one Medicaid program. Eligibility criteria, coverage and structure vary greatly from state to state. Medicaid is perhaps the most flexible program in the country.

Block grants are grants which would go the states to pay for a specific project or program, but after the grant is spent, states bear all the remaining cost of the program. As it stands now, Iowa’s Federal Medical Assistance Percentage is 63.8 percent, which means that for every dollar Iowa spends to support Medicaid, the federal government kicks in about $1.36. And there’s no cap on that. Block grants would put a cap on the amount of federal support we get for our Medicaid programs.

Saving money is a good thing, and even health care advocates agree that we have to figure out how to rein in the rising cost of health care for everyone, but at what cost? In Iowa status quo funding is the status quo. The State of Iowa, aside from traditional Medicaid that ensures that Iowans have access to health care has seven Medicaid Waiver programs that provide health care to groups of Iowans who have specific health care needs such as brain injury or who experience some type of disability. How will we manage our Medicaid budget without the maximum support from the federal government and maintain status quo funding

Opponents of the ACA cited non-existent death panels making decisions about who would get necessary medical care and who would die for lack of it. Health care advocates fear, rightfully so, that it will be through making it harder to qualify for Medicaid and the rationing of health care. We’ve begun to see it through the transition to Medicaid Managed Care and very recently learned that necessary non-emergency medical transportation services to 140,000 Iowans is being cut. This means that they have no way to get to the doctor. That’s one way to manage a budget.

What can we do? Contact our state lawmakers in the General Assembly and the Governor’s office and tell them that we need them to message to Washington that we reject the block granting of Medicaid because it would create a greater burden on the state. This will resonate with them. Contact our federal representatives and share our personal ACA story. Let them know that it’s working for Iowa and for us personally. Let them know that you we active voters and are watching how they vote on bills that matter to us and the State of Iowa. Tell them all at every level to keep their hands off our health care.

Top image: Guest author Ruth Thompson

Login or Join to comment and post.