Affordable Care Act repeal could see 230,000 Iowans without health coverage: report

Repealing the Affordable Care Act could leave 230,000 Iowans without health care coverage, including 25,000 children, according to a new report out Thursday.

'The ACA pretty substantially reduced the number of Iowans who were uninsured,” said Peter Fisher, research director at the Iowa Policy Project, an Iowa City-based self-described nonpartisan not-for-profit. 'There was a 37 percent drop since the ACA went into effect,” falling from about 8.1 percent uninsured rate to 5 percent.

The report, which provided breakdowns for the state's 10 most populated counties, shows that the uninsured population in Linn County dropped from 7 percent in 2013 to 4.7 percent in 2015. In Johnson County, the uninsured rate stayed relatively stable, sitting at 6.8 percent in 2013 and 6.7 percent in 2015.

While talk of repeal has been dominating the headlines since President-elect Donald Trump's November win - including Trump saying in recent days that he wants repeal and replacement of the ACA to happen almost simultaneously - there have been few details on what that replacement plan might include.

Experts have looked at an attempt by Congress in 2016 to repeal President Barack Obama's signature health care law to gain insight into how the repeal might play out. In that attempt, Congress, through budget reconciliation, would have dismantled the law by getting rid of funding for Medicaid expansion, the mandate and money for tax subsidies.

According to the Iowa Policy Project report, the state could lose $446 million in federal Medicaid funding in 2019 and a total of $5.4 billion from 2019 to 2028 if the ACA is repealed.

What's more, the largest chunk of those who have gained insurance through the ACA in Iowa have been through Medicaid expansion. The Iowa Health and Wellness Plan, the state's version of Medicaid expansion, has about 146,000 Iowans enrolled in it.

What's more, Fisher said, because the state rolled a program for low-income adults called IowaCare in the Iowa Health and Wellness Plan, adults no longer would have IowaCare as an option for coverage.

Critics of the law have pointed to rising insurance premiums. But authors of the Iowa report says that at least 85 percent of Iowans buying plans on the marketplace received tax subsidies to help pay for coverage.

The average monthly premium for those purchasing insurance on the exchange was $425, with $303, or 71 percent of this cost, covered by the credit, according to the report.

The report gathered data from the U.S. Census Bureau's American Community Survey and the Urban Institute, among other sources.

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