Sens. Joni Ernst, Chuck Grassley say they want to study the newly released healthcare bill

Iowa's pair of Republican senators have not yet come out in support or opposition of the U.S. Senate bill to repeal and replace the Affordable Care Act, also known as Obamacare, released Thursday. But the state's health care providers are urging them to vote no.

The bill would make deep cuts to Medicaid — insurance for low-income and disabled Americans — by turning it from an entitlement program into a per capita cap as well as roll back Medicaid expansion, though more slowly than the House bill.

Senate Majority Leader Mitch McConnell said he plans to hold a vote on the bill next week, and the Congressional Budget Office is likely to score the bill in the coming days.

Both Sens. Joni Ernst and Chuck Grassley pointed to the crumbling individual insurance market in Iowa as a reason why the Senate needs to act fast. Earlier in April, Wellmark Blue Cross and Blue Shield and Aetna announced they would stop selling plans on the individual market.

That leaves only Minnesota-based Medica selling plans statewide to the more than 70,000 Iowans who rely on those plans. The insurer said Monday it intends to stay in the state another year, though it would raise rates an average 43 percent.

'I'm studying it. I'm looking at the ways it would help Iowans affected by Obamacare's failures,' said Grassley in a statement. 'There will be a full debate before the Senate, with the ability for senators of both parties to offer amendments.

'We'll know the official cost estimate soon. I'm glad this process is moving forward, given the problems that continue to get worse with the current law.'

Ernst echoed those sentiments, adding that the status quo no longer is an option.

'While I'm pleased that Medica has decided to stay for another year, Iowans in the individual market will likely see a massive rate increase, all because of Obamacare. This is unacceptable,' she said.

'Traveling across Iowa on my 99-county tour, I hear from Iowans who are looking for affordable, and patient-centered health care solutions; their feedback is critical. I will be closely examining the bill to see how it will affect insurance availability and affordability in 2018 and beyond.'

But heath care providers — including the groups representing the state's hospitals and doctors — and organizations representing some of Iowa's more vulnerable residents have deep concerns regarding the Senate bill, especially when it comes to the Medicaid program, which covers 600,000 Iowans.

'It is not surprising, but it is disheartening nonetheless, that the 'discussion draft' of the Senate health bill fixes none of the House bill's core problems and actually makes some of them worse,' said Mary Nelle Trefz, health policy associate with the Child and Family Policy Center based in Des Moines.

'Sens. Grassley and Ernst should demand that the Senate delay a vote until there has been a CBO score of the final version of the bill they will vote on — and adequate time for their constituents to weigh in on its merits. At that point they should reject any bill that causes large coverage losses, caps and cuts Medicaid, or guts critical protections for people with health conditions.'

Iowa expanded its Medicaid program in 2014, giving coverage to an additional 140,000 people. The Iowa Hospital Association, which represents the state's 118 hospitals, has been vocal about the need to keep the expansion in place as well as adequately fund the non-expansion population.

'The draft bill under discussion in the Senate does not protect and improve coverage for all of Iowa's citizens. Instead, the Senate proposal includes significant cuts to the Medicaid program that will harm Iowans,' the group said.

'In Iowa, rural communities rely significantly on the program to ensure care for these individuals. This bill will result in significant and steep cuts to the Medicaid program that have the potential to adversely and irreversibly impact Iowa's hospitals and the communities they serve.'

This increase in the insured rate has led to more financially healthy rural hospitals. Small, rural hospitals often have razor-thin profit margins, but coverage expansion has helped reduce charity care costs and strengthen their bottom lines. In Iowa, charity care at non-urban hospitals fell significantly, from $74 million in 2011 to $40 million in 2015, according to data provided by the Iowa Hospital Association.

'The reality is that Medicaid is a lifeline to Iowa's rural communities and the individuals who rely on it. It is every bit as much a part of the fabric of how we care for Iowans as Medicare, and this flawed legislation should be rejected,' the group said.

The Iowa Medical Society, which represents the state's physicians and medical students, said the draft bill does have potential to provide a more long-term solution to Iowa's individual health insurance marketplace. But it still falls short, said its president, Dr. Joyce Vista-Wayne.

'Thousands of Iowans will still lose their health insurance as a direct result of the Senate proposal,' Vista-Wayne said. 'The legislation would also bring further uncertainty to Iowa's Medicaid program, which has seen tremendous upheaval over the past year with the transition to managed care.

'We will continue to closely monitor (the American Health Care Act) deliberations and encourage Iowa's congressional delegation to push for greater protections for all Iowa patients.'

l Comments: (319) 398-8331; chelsea.keenan@thegazette.com