Supreme Court upholds key insurance subsidies for Iowans

Thursday's Supreme Court ruling to keep health care subsidies intact for 6.4 million people in 34 states - including some 39,000 Iowans - brings a sense of stability to Iowa before the next Open Enrollment season, some in the health care field say. But the decision was not without political controversy.

In a 6-3 ruling, the court said that the federal tax credits provided to those in states that did not create their own insurance exchanges are legal.

'The Iowa Insurance Division is currently reviewing the Supreme Court's decision, but it appears from early news reports that Iowans currently receiving tax credits while using the federal health exchange will be able to continue doing so,” said Iowa Insurance Commissioner Nick Gerhart in a statement.

The ruling comes months before the 2016 Open Enrollment season, which begins in November, that will bring a handful of new insurance companies selling products in Iowa, including Medica Insurance Co., United Healthcare of the Midlands and United Healthcare Insurance Co.

On average, about 86 percent of the more than 45,000 Iowans buying insurance on the federal health exchange, Healthcare.gov, were eligible for tax credits to help pay for coverage, the Insurance Division reported. The average monthly tax credit was $260.

Pete Damiano, director of the University of Iowa's Public Policy Center, said while individuals may never stop challenging parts of the law's legality, and politicians will continue to try to disrupt the law, the issues at least have been addressed in the near term.

'It lends some aspect of stability,” he said.

However, Damiano added, there is a lot of activity on the state level to reform aspects of the law on the health care delivery side, such as the ongoing debate in Iowa over Medicaid Managed Care.

The highly anticipated ruling brought in opinions from groups and individuals around the state - some breathing a sigh of relief with others continuing to call for repeal.

Health care groups, including the Iowa Hospital Association - which represents the state's more than 100 hospitals - and Des Moines-based UnityPoint Health - with hospitals across Iowa, Illinois and Wisconsin, including St. Luke's Hospital in Cedar Rapids - praised the decision, saying it will allow hospitals to provide better, more cost-efficient care.

'The court's decision impacts tens of thousands in our state with moderate to lower incomes who would have lost eligibility for tax credits and, as a result, become uninsured and left without affordable options for coverage,” said Scott McIntyre, IHA spokesman. 'With the number of uninsured in Iowa continuing to drop, hospitals can continue to focus on providing patients with medical homes, preventive care and necessary treatment in a timely manner.”

UnityPoint Health Chief Executive Officer Bill Leaver said the ruling will enable patients to continue accessing care in the most cost-effective setting.

'With their coverage intact, these residents will continue to have access to a full range of health care services,” he said in a statement. 'They will not be forced to seek treatment in hospital emergency rooms, the most expensive route to care.”

'This is good news for Iowans and Iowa hospitals,” said Tim Charles, president and chief excecutive officer of Mercy Medical Center in Cedar Rapids. 'The challenge that remains is to design a system that achieves the goals of the (Institute for Healthcare Improvement's) Triple Aim - health care of the highest quality that is affordable for all and delivered, as we do, with the Mercy Touch.”

Meanwhile, many of Iowa's Republicans, from Gov. Terry Branstad to Sen. Joni Ernst, expressed their disappointment in the ruling.

'As Obamacare again finds itself under scrutiny of our highest court, it's further affirmation that we need a workable solution for the millions of Americans who continue to face uncertainty over their health care due to this disastrous law,” Ernst said.

'Gov. Branstad has always worked to make health care insurance more predictable and affordable for Iowa families and businesses, while also working to achieve better patient outcomes through the Iowa Health and Wellness Plan and the Healthiest State Initiative,” said Jimmy Centers, the governor's spokesman. 'Unfortunately Obamacare continues to be unaffordable and unsustainable.”

Sen. Chuck Grassley said while he respects the role the Supreme Court plays, he continues to believe the Affordable Care Act is a 'terrible law.”

'Now the debate returns to the Congress and next year's presidential election,” he said. 'The current majority in Congress is committed to repealing Obamacare and replacing it with effective reforms driven by the marketplace, not the heavy hand of government.”

But U.S. Rep. Dave Loebsack, a Democrat, called the decision a relief.

'Congress clearly meant for these tax breaks to be available to anyone who qualified, no matter where they lived,” he said. 'It is time we move forward and work to strengthen this law, not continue to try and dismantle it.”

Gazette Reporter Rod Boshart contributed to this story.