AHCA Will Hit Iowans Hard

By Iowa Fiscal Partnership
6/22/17
Coverage losses in House AHCA sets low bar for Senate, White House;

AHCA would impose dramatically higher costs for Iowa and Iowa residents

{Ed. Note: The following are excerpts from a PDF posted by Peter Fisher at Iowa Fiscal Partnership}

The American Health Care Act (AHCA) passed by the House of Representatives would cut health insurance for nearly 200,000 Iowans in order to provide billions in tax cuts to wealthy individuals, drug companies, and insurance companies. Moreover, instead of fixing the problems with Iowa’s health insurance exchange, it would make those problems worse. As the Senate uses this legislation as the basis for its own proposal, supporters’ promises of more state flexibility and individual choice ring hollow. So-called “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 AHCA would fundamentally change Medicaid in two ways. First, it eventually would end the Affordable Care Act — or Obamacare — expansion of Medicaid, through which 150,000 low-income Iowans have gained coverage. Second, the AHCA would cut federal funding for the overall Medicaid program, which would force Iowa to find an estimated $336 million more in the state budget for 2023 in order to maintain current eligibility. Given Iowa’s chronic budget shortfalls, this is very unlikely to happen. As a result, the state would likely be forced to restrict Medicaid eligibility and cut benefits to children, the elderly and the disabled.

Altogether, some 191,100 Iowans — 38.1 percent of the nonelderly adult enrollees now served — could lose Medicaid under the House plan, according to new analysis by the Urban Institute.[1] This would make Iowa one of the biggest losers nationally, as only 11 states have greater shares of their Medicaid enrollees in jeopardy of losing coverage. Nationally, the loss is set at 1 in 4 enrollees.

The AHCA hits rural and elderly Iowans the hardest, both from the cuts in insurance subsidies and the cuts in Medicaid. In Iowa’s 78 counties outside metropolitan areas, a family of four with $40,000 income would face an average net increase in premiums (after subsidies) of $7,607 per year; their cost would about double. For an elderly couple with the same income, the increase would average $14,582. The likely loss of the Medicaid expansion would disproportionately harm rural Iowans, who are more likely to have health issues and difficulty paying for health care.

One of the most disingenuous claims by AHCA architects is that Americans with pre-existing medical conditions — now protected by the ACA — would keep that protection under AHCA. In fact, AHCA creates a state option to let insurance companies charge higher premiums and scale back coverage of now-required “essential health benefits.” The requirement that insurance companies cannot deny coverage is a hollow one, if they can simply price people out of it, or drop benefits they do not want to cover. And the fig-leaf funding provided by the bill would not nearly compensate for the costs to the millions facing these higher prices, including 1.3 million persons in Iowa with pre-existing conditions.

Editor comment:
There is much, much more solid analysis at the link. Fisher is well known for his in depth, accurate and no holds barred analyses.

Let us remind you that something like 2/3rds of Medicaid money goes to the elderly, often to pay for their nursing home care after all of their funds have been exhausted. Based on Fisher’s analysis you can easily see that when that money dries up some decisions will have to be made about the care of the elderly by their families.

As reported here before Iowa is a filial responsibility state. That means simply that if your elderly parent continues to get care in a nursing home and their funds are exhausted, you are responsible for their bills.

The alternative would be to take the elderly parent back into your home and care for them yourselves. Let me tell you that is hard and thankless work. Many times the children of the elderly are approaching elderly status themselves.

The AHCA is not a health care bill; the AHCA is a wealth care bill for the likes of Donald Trump. It is primarily a tax cut bill for the very wealthiest Americans. Elizabeth Warren explained in best on the Senate floor when she spoke in opposition to this bill Thursday:

About Dave Bradley

retired in West Liberty
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