Address ACA subsidies first

In Iowa, more than 130,000 people buy health insurance through the Affordable Care Act marketplace. Many of them are facing huge premium increases and higher deductibles.

It’s likely some Iowans hit by higher costs will drop coverage and return to the ranks of uninsured Americans, a group that had been cut nearly in half under the ACA.

Federal subsidies help middle and low-income individuals afford insurance. But it is enhanced subsidies approved during the Biden administration that have helped Americans weather rising health care costs and avoid dropping insurance.

Enhanced subsidies expire at the end of this month. If they are allowed to end, health care experts with the Kaiser Family Foundation estimate 68,000 Iowans will become uninsured.

One member of Iowa’s all-Republican congressional delegation is 3rd District U.S. Rep. Zach Nunn. He’s cosponsoring a bill that would extend the subsidies for two years, along with new anti-fraud penalties and income limits.

We may not like everything in the Nunn’s bill, but at least he is seeking a compromise both parties can accept. His process is the correct one — extend subsidies and work on any needed changes to the ACA in the months ahead.

But the rest of Iowa’s Republicans on Capitol Hill appear indifferent to the fate of Iowans who could use health insurance, which would be a disaster for some families.

Second District U.S. Rep. Ashley Hinson says that too many subsidies are going to “wealthy folks” who are defrauding the system. She also touts the use of health savings accounts.

First District U.S. Rep. Mariannette Miller-Meeks argues the ACA is “riddled with fraud” and subsidies are a giveaway to insurance companies.

U.S. Sen. Chuck Grassley also criticized premium help as a “government handout to the insurance industry.”

Grassley’s reaction is ironic. Back when the bill was being debated in Congress, Grassley strongly opposed including a public insurance coverage option in the ACA. Now he criticizes insurance companies that received help from that opposition.

We know there is fraud in the system. There are scams, such as unscrupulous insurance firms signing up fictitious clients to receive federal subsidy payments.

But the way to stamp out fraud is to focus on fraud and hold fraudsters accountable. Yanking away enhanced subsidies people need to pay for health insurance is not going to solve the fraud problem. Why punish all enrollees for the crimes they did not commit? Same with people who receive subsidies but are not eligible.

Republicans have been seeking to cripple the ACA since the moment it passed in 2010. And through all of that, they still have not come up with a plan of their own. Some say the free market will solve problems, but it has left millions uninsured. A Health Savings Account doesn’t pay for much if you can’t afford to save much.

Congress’s priority should be what’s most important now, and that’s extending subsidies in time to reduce the damage spawned by pushing Americans out of the marketplace. There will be plenty of time ahead to focus on other problems. Iowa Republicans should be following Nunn’s more responsible lead.

(319) 398-8262; todd.dorman@thegazette.com