With the U.S. Senate expected to vote on legislation to repeal and replace the Affordable Care Act by the end of June, executives of Iowa’s hospitals continue to express worry over the future of Medicaid — the state’s safety net for the poor and disabled.
Leaders of the state’s hospitals gathered in Cedar Rapids on Wednesday for the Iowa Hospital Association’s Summer Leadership Forum, with a handful speaking to reporters about their concerns during a news conference.
The American Health Care Act — the Republican-backed legislation that passed the House in May and now is being reworked by the Senate — effectively would end the Medicaid expansion, restructure the Medicaid program through a per capita cap, and replace the ACA’s tax credit and cost-sharing protections with age-based tax credits.
The Senate is expected to vote on legislation by the end of June, and hospital leaders said that senators from 12 states — including Iowa — will be crucial votes.
“We want to make it clear that the hospital community is very opposed to the American Health Care Act. We don’t want to see a movement to per capita limits on Medicaid, and we think that expansion — which has expanded coverage to 150,000 Iowans — has worked very successfully,” said Kirk Norris, chief executive officer of the Iowa Hospital Association.
The association represents the state’s 118 hospitals.
Iowa is one of 31 states to expand Medicaid to low-income adults, through the Iowa Health and Wellness Plan in 2014. The expansion, along with subsidy-eligible plans purchased through the Iowa exchange — helped push down the uninsured rate in Iowa from 10.8 percent before the ACA to 5.9 percent.
This gives Iowa the sixth-lowest uninsured rate in the country, which in turn has led charity-care levels at hospitals to fall severely, hospital leaders said. In addition, the state has brought in an extra $750 million in 2015 in federal funding to help cover those costs.
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“It really helped rein in and rationalize the delivery of care by offering coverage and the opportunity to get the right care at the right time,” said Cindy Mann, the keynote speaker of the conference and a partner at Los Angeles-based Manatt, Phelps and Phillips, a nationwide consulting firm. Mann previously was the deputy administrator and director of the Center for Medicaid and CHIP Services within the federal Centers for Medicare and Medicaid Services.
Mann said that, should federal dollars for the expansion population be done away with in 2020 as the proposed legislation calls for, more than 117,000 Iowans would lose coverage within two years — with that number growing to 148,000 by 2025.
“Virtually all of the people who gained coverage would lose their coverage,” she said.
All four of the hospital chief executives discussing the potential effects of the AHCA said the increase in coverage has helped patients afford care and better manage chronic diseases.
“People fear the health care system in this country — they fear they won’t have access and that they won’t be able to afford it. They shouldn’t have to fear it,” said Ted Townsend, president and CEO of UnityPoint Health-St. Luke’s Hospital.
Townsend said the hospital has a patient receiving kidney dialysis three days a week. Before the ACA, the patient — who has diabetes — was not able to receive the proper care and experienced total kidney failure.
“If he loses his insurance, he doesn’t know how he will pay for it,” Townsend said. “The reason he is in this situation today was that he had to make a choice between food and medicine.”
The bill also would convert the Medicaid program to a per capita cap — in which the federal government would pay a certain dollar figure for each Medicaid member and states would be responsible for costs in excess of the per capita cap.
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The federal government and state currently share the costs of Medicaid — with Washington paying about 58 percent of cost in Iowa.
According to an analysis by Mann’s consulting group, that per capita cap would cost Iowa somewhere between $450 million and $786 million in federal funding five years into AHCA implementation.
Tim Charles, president and CEO of Mercy Medical Center in Cedar Rapids, brought up a special clinic the hospital operates that works with very low income and complex patients, not only connecting them with primary care but also a social worker, pharmacist, mental health and legal services to find housing and other needs.
“These individuals require so much more than what you and I in this room experience as health care because their lives are so riddled,” he said. Medicaid “has enabled us step into that space and provide vital, necessary services. ... The (ACA) is not perfect. There are structural issues, but the way to address those issues is not to diminish the access those individuals have gained.”
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