Depending on who you ask, Iowa would lose funding or gain it with the latest Republican proposal to replace the Affordable Care Act.
Over the past week, a blizzard of studies have come out trying to predict the impact of the Obamacare replacement bill known as Cassidy-Graham.
The latest, from the nonpartisan Kaiser Family Foundation on Thursday, estimates that between 2020 — when the new system would kick in — and 2026, Iowa would come out a financial winner, gaining $405 million.
That analysis differs from two other studies, by Avalere Health and the Center on Budget and Policy Priorities, which predict that Iowa would lose funding in the short term.
In the long term — that is, past 2026 when block grant funding for Cassidy-Graham is scheduled to expire — all the studies agree that every state would take a fall.
Kaiser predicts that Iowa would lose $1.8 billion in 2027 if new money isn’t approved.
Backers of the legislation scoff at the idea that funding would just end. And a spokeswoman for Sen. Chuck Grassley, R-Iowa, said Thursday that health care, and funding for it, is a constant source of debate in Congress.
“It’s highly likely that if this bill passes, and remember, it would need to pass both houses of Congress, which is not a given, Congress would revisit health care before 2026,” Jill Gerber, a Grassley spokeswoman, said in an email.
Some in Iowa, however, are worried that long-term funding isn’t a sure thing.
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“Once you start heading toward that cliff, it would take a lot of money” to stop from going over, said Scott McIntyre, vice president for communications for the Iowa Hospital Association, which opposes the legislation.
In essence, it would be asking Congress to approve what started as Obamacare funding in the future.
In the short term, the varying studies of the bill authored by Sens. Lindsey Graham, R-S.C., and Bill Cassidy, R-La., make it hard to tell what would happen in Iowa.
The legislation repeals the main pillars of the Affordable Care Act and creates a new system, taking Obamacare money and sending it to willing states in the form of block grants. That would give states the ability to design their own programs. The plan also would redistribute how that money is currently allotted, which would result in a shift of funding among the states.
It’s that shift, according to Kaiser, that would benefit Iowa at the expense of other states, especially California and New York.
In fact, Iowa would be one of the few states that expanded Medicaid under the Affordable Care Act that would gain under the new system, according to Kaiser, although the organization warns those figures could change depending on how the new system were implemented.
Still, Kaiser says the gains would be enough to offset the losses Iowa would experience by shifting Medicaid to a per-capita funding system.
Currently, Medicaid, which covers the poor and disabled, is open-ended, paying for approved expenses for people who qualify.
Avalere Health, which released its study Wednesday, had a different take, saying Iowa would lose funding overall through 2026.
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The Center on Budget and Policy Priorities study said Iowa would lose $525 million by 2026. In 2027, it estimates, Iowa would lose $2.3 billion if funding weren’t reapproved.
The studies varied depending on their methods, including the data they used to establish baseline spending predictions under the current law.
No official report
The conflicting results, along with the level of uncertainty in the estimates, make it hard to determine what would happen in Iowa. But critics say they don’t think it will be good.
“I don’t think anybody knows the final dollar costs, but we are real confident a lot of Iowans would lose their insurance,” said McIntyre, of the hospital association, said. “And that’s where we are most concerned.”
The Congressional Budget Office, the official scorekeeper for Congress, hasn’t weighed in on the Cassidy-Graham bill, and it likely won’t have the time before a Senate vote.
U.S. Rep. Dave Loebsack, the only Iowa Democrat in Congress, said Thursday it’s wrong to move ahead without a CBO study.
“Unfortunately, I fear that Republicans don’t want Iowans to know what this terrible bill will do,” he said.