DES MOINES — How would Iowans who have purchased health insurance through state or federal programs be impacted if Republican lawmakers and President-elect Donald Trump fulfill their campaign promise to repeal the federal health care law known as the Affordable Care Act, or Obamacare?
It is too soon to know, top state officials say.
Roughly 145,000 Iowans participate in the Iowa Health and Wellness Plan, according to the state, and 55,000 Iowans purchased health insurance through the federal health care program, according to federal statistics.
Some of those health insurance plans, or the government-funded financial assistance that helps make them more affordable, could soon be on the chopping block.
Republican federal lawmakers and candidates for years have called for repealing and replacing the Affordable Care Act, and Trump often said during his presidential campaign he would repeal the law on his first day.
They can make that happen, now that, with the recent election, the GOP has gained full control of the federal lawmaking agenda starting in 2017.
Because detailed plans from lawmakers have been scarce, state government and hospital officials say they are unable to predict what might happen to Iowans who have insurance through the Affordable Care Act or Iowa Health and Wellness Plan.
“We’ll have to see what happens at the federal level,” said Amy McCoy, a spokeswoman for the state health department. “It’s pretty early to speculate on anything.”
Officials note the federal health care law is expansive, and it is unclear whether the law will be repealed in full or partially, and with what programs lawmakers will replace it. The uncertainty makes it difficult to know what may come of Iowans’ health care plans.
While Trump and other Republicans have pledged to repeal the law on their first day in office, officials say that is unlikely given the law’s complexity.
“We don’t know for sure,” Iowa Gov. Terry Branstad said. “But I’d just say we’re going to be working with the new administration. We’re going to be working with the Congress to try to make sure that we have something that is affordable and sustainable for the American people.”
State insurance commissioner Nick Gerhart recently published on online opinion piece in which he warns lawmakers that an immediate repeal could lead to “devastating consequences” and “even more uncertainty” for the millions of people who have purchased health insurance through the law.
“The idea of folks having credible coverage today that is no longer there come June or July or some mid-point of the year, it really is going to be disruptive, not only to the insurance market but also to those peoples’ individual lives,” Gerhart said.
Gerhart said beyond whether the law is repealed or replaced, the nation’s health care system needs greater attention to address rising costs. He called for a “modern day Manhattan Project” in which leading health care professionals would come together to develop solutions to create a more affordable and sustainable national health care system.
A spokesman for Iowa Hospitals said some progress was made with the Affordable Care Act, and that hospitals hope that progress is considered when federal lawmakers make changes.
“For Iowa, that part of the ACA was very impactful in getting people insured and getting people into the health care system, into primary health care, to where they weren’t just dropping in on emergency rooms,” said Scott McIntyre, vice president of communications for the Iowa Hospital Association. “As was expected and promised by the ACA, we’ve seen charity care drop significantly in our hospitals, which was the way it was supposed to work ... that balance, for the most part, has occurred, and we’d hate to see that thrown out.”
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While some business organizations say they will be happy to see an end to the health care law’s requirement that businesses of a certain size provide health care for their employees, others express concern with the current uncertainty over what will replace the law if it is repealed.
“We’re concerned with Mr. Trump’s promise to repeal the ACA and the absence of a coherent replacement plan,” ReShonda Young, the owner of Popcorn Heaven in Waterloo, said in a statement issued by the Main Street Alliance, a national network of small business organizations. “If there is another approach that will increase coverage for my employees and neighbors and reduce costs then I’m all ears. But Main Street can’t be expected to take a ‘wait-and-see’ approach when our ability to create jobs and our bottom line is in flux.”
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