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Neighbors Growing Together | May 21, 2018

Iowa politicians debate health care options

By Ed Tibbetts, Quad City Times | Jun 23, 2017

Even as congressional Republicans are eyeing sharp cuts to Medicaid as part of their plan to revamp the Affordable Care Act, Democrats in Iowa say the program could, instead, be a lifeline for people struggling in the state's ailing individual health insurance market.

A small group of Democrats want to let Iowans buy into Medicaid, using ACA subsidies along with state money now going to managed care companies who run the program.

State Sen. Matt McCoy, D-Des Moines, one of the Democrats pitching the plan, said it would bring younger and healthier people into the system. He and state Rep. John Forbes, D-Urbandale, unveiled the idea in Des Moines on Wednesday along with former Sen. Jack Hatch, D-Des Moines.

The proposal would appear to face steep odds. Republicans are in control at the national and state level, and Iowa just went to a managed care system for its Medicaid program last year.

However, Democrats say they plan to push the plan, as well as other ideas, as the the debate over how health care should be delivered and paid for is up for debate.

Congress is debating how to replace the Affordable Care Act. Meanwhile, the state of Iowa is struggling to deal with an individual insurance market that is in dire shape.

Just one company, Minnesota-based Medica, has filed to sell policies in the state for 2018. And it asked for a 43 percent rate increase over this year.

Iowa Insurance Commissioner Doug Ommen said this week that Medica's filing doesn't resolve Iowa's difficulties. And he worried, if premiums continued to increase for people who make too much money to get federal subsidies, it will just make the situation worse.

"Under the current framework, even if this could potentially last one more year, it prices thousands of Iowans out of the market," he said.

The insurance division has asked the Trump administration to approve a stopgap plan that would take Obamacare subsidies and restructure them to entice younger, healthier people into the marketplace, as well as create a reinsurance pool, which would help insurance companies with higher cost members. The proposal would allow companies to offer a single, standardized insurance plan.

Ommen said, even with Medica's filing, the state still faces a crisis.

"I appreciate Medica's filing, but at the same time, it does not provide stability to our market," he said.

Subsidies that rise with premiums and insulate many of the people on the exchange from price increases only serve to hold back competition, he said.

"A federally funded monopoly is no longer a market," he said.

Wellmark Blue Cross & Blue Shield, the state's largest insurer, has said it will enter Iowa's individual market for 2018 if the Trump administration approves the state's request.

McCoy said he has concerns about the insurance division's plans because it will mean older people in the marketplace will pay more than they would have otherwise.

"It puts them at a real disadvantage," he said.

He and other Democrats say Iowa should take a more aggressive role. They point to the Nevada legislature, which passed a bill this month that would allow its residents to buy into a government-run insurance plan. The proposal was vetoed by the state's Republican governor, Brian Sandoval, but Iowa Democrats say there's no reason such an option shouldn't be explored here.

"There are things Iowa can do," Iowa Senate Democratic Leader Rob Hogg, D-Cedar Rapids, said Thursday.

The Iowa Democrats' plan comes as congressional Republicans are seeking to cut Medicaid. The House and Senate health care bills would convert traditional Medicaid to a "per capita" system. That would save the federal government hundreds of billions of dollars by spending less on the program, which pays for health care for the some of the nation's poor, elderly and those with disabilities.

A Congressional Budget Office analysis said the House bill would reduce projected Medicaid spending by more than $800 billion over 10 years.

Currently, Medicaid, which is jointly financed by the federal government and the states, is open-ended and pays for qualified and approved care.

Republicans in Des Moines and Washington, D.C., have complained for years about the rising costs of Medicaid, even before the Affordable Care Act's expansion of the program. On a conference call with reporters Wednesday, Sen. Chuck Grassley, R-Iowa, said that after having an "open checking account" for 60 years, "we've come to the conclusion that is not a fiscally responsible way for us in Congress to handle the taxpayer's money."

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