Repealing key health care provision could cost 125,000 Iowans coverage by 2025

Approximately 125,600 more Iowans would be uninsured by 2025 if President Donald Trump signs into law a tax bill repealing the individual mandate, according to new estimates from the Center for American Progress. The coverage losses would be highest in the fourth Congressional district, primarily due to far more people becoming unable to purchase more expensive policies on the individual market.

In fact, the Center for American Progress projects that 56,600 residents of IA-04 would become uninsured over the next seven years, more than twice as many people as in any of Iowa’s other three Congressional districts.

Follow me after the jump for Iowa’s statewide and district-level numbers.

I pulled these figures from a spreadsheet you can download here. I enclose below information on how the researchers arrived at these estimates.

Coverage losses through Medicaid and employer-provided insurance would be spread relatively evenly across the state. The majority of Iowans who would lose individual coverage live in the 39 counties that are part of IA-04.

Net reduction in health insurance coverage by 2025 due to individual mandate repeal
As calculated by health economists at the Center for American Progress
Congressional district Total coverage reduction Medicaid Individual market Employer-sponsored insurance
IA-01 21,800 11,000 2,500 8,300
IA-02 22,800 11,200 3,900 7,700
IA-03 24,400 12,200 2,400 9,800
IA-04 56,600 10,700 38,800 7,000
statewide 125,600 45,100 47,600 32,800

Although Congressional Republicans failed this summer to pass a comprehensive bill replacing the Affordable Care Act, these numbers show how much tax legislation now pending could reduce access to health insurance, and by extension medical care. GOP senators including Iowa’s Chuck Grassley and Joni Ernst voted to repeal the individual mandate as part of the tax bill passed over the weekend. House Ways and Means Committee Chair Kevin Brady said this morning he expects the final legislation to contain that provision.

Health economist Emily Gee of the Center for American Progress explained how that policy would affect people who buy health insurance on the individual market.

First, some healthy enrollees would drop out of ACA-compliant plans and become uninsured or underinsured. Second, because the remaining enrollees in the risk pool would be sicker on average, insurance companies would need to raise rates about 10 percent to cover the increased average cost. The resulting higher premiums would discourage even more people from obtaining coverage through the individual market.

Repeal of the mandate would spur healthy people to avoid purchasing coverage until they need it. Without the mandate, the millions who would become uninsured instead of being covered by Medicaid, employer-sponsored plans, or nongroup insurance would no longer have financial protection against catastrophic medical costs and would be more likely to forgo needed care due to cost.

Representatives Rod Blum (IA-01), David Young (IA-03), and Steve King (IA-04) have long supported repealing the individual mandate to purchase health insurance, most recently in a May vote. All three Iowa Republicans voted for the House tax bill in November, making them nearly certain to back whatever language comes out of a conference committee to reconcile the House and Senate proposals.

Next time Grassley, Ernst, Blum, Young, and King claim that their tax bills will save Iowans money, they should be asked about the thousands of their constituents who will be priced out of the health insurance market.

P.S. – In an unscientific survey, 60 percent of Young’s e-mail blast recipients said they opposed repealing the individual mandate.

From the Center for American Progress note on methodology:

Our estimated reduction in coverage in 2025 due to repeal of the mandate is based on national projections by the CBO [Congressional Budget Office]. The CBO estimates that 13 million fewer people will have coverage in 2025, including 5 million fewer people with Medicaid; 5 million fewer people with individual market coverage; and 3 million fewer people with employer-sponsored insurance. We used data from the 2016 American Community Survey Public Use Microdata Sample (ACS PUMS), available from the IPUMS-USA to tabulate the number of nonelderly people in each state by primary coverage type using a coverage hierarchy. We assumed that each state’s reduction in coverage would be proportional to its share of the CBO’s national total for each of those three coverage types. For more on the IPUMS-USA data set, see Steven Ruggles and others, “Integrated Public Use Microdata Series: Version 5.0” (Minneapolis: Minnesota Population Center, 2010). […]

For our congressional district estimates, we split each state’s reduction according to each district’s share of the state total for each coverage type based on data tables from the 2016 American Community Survey.

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