Iowa health care professionals brace for possible Obamacare repeal

Dec. 18--As Eastern Iowa health centers try to read the tea leaves of what's to come in 2017, officials say they remain hopeful but are preparing for major confusion.

In the month since the Nov. 8 election of Donald Trump, there has been a lot of talk regarding the future of the Affordable Care Act, President Barack Obama's signature health care law that extended coverage to more than 20 million people.

Republicans have put forward the idea of repealing the law immediately but delaying the replacement pieces until they are better able to hammer out the details. Congressional Republicans have made repeal of the law a key campaign tactic, but they haven't been able to agree on the replacement portion.

The Washington Post reported this week that the current battle centers on when exactly to schedule the ACA's sunset. But other fights are just around the corner, it said, including whether Medicaid expansion of Obamacare will continue, whether lawmakers also now should tackle the future of Medicare, and how Congress should assist insurers during the transition.

"All health care providers are in an uncertain landscape," said Joe Lock, chief executive officer of the Eastern Iowa Health Center, which cares for low-income residents in Cedar Rapids. Lock added that he hopes legislators don't have a "knee-jerk reaction."

"With so many millions of lives affected, one would expect they come up with some sort of measured process for us all to follow for a smooth transition."

Access to insurance

Despite its flaws -- rising premiums and insurers pulling out of markets -- the ACA has extended coverage to millions of Americans and hundreds of thousands of Iowas, helping bring the uninsured rate down to a historic level of 10 percent.

The Urban Institute, a Washington, D. C-based think tank, estimated that a repeal of the ACA could impact about 230,000 Iowans who gained health insurance through the health care exchange or through Medicaid expansion.

Thirty-two states, including Iowa, and Washington, D.C., opted to expand their Medicaid programs, allowing adults living up to 138 percent of the federal poverty level (about $16,000 for an individual) to enroll.

In Iowa, the Iowa Health and Wellness Plan -- bipartisan legislation passed in 2013 -- extended coverage to more than 146,000 people. What's more, according to a Kaiser Family Foundation analysis, 136,000 of those individuals would be at risk for losing Medicaid coverage if states no longer have an option to extend Medicaid eligibility.

It also could affect Iowa's budget. The ACA gave states 100 percent federal funding for the costs of adults made newly eligible under the Medicaid expansion from 2014 to 2016, with the federal share phasing down to 95 percent in 2017 and to 90 percent by 2020 and beyond.

Repeal of the ACA could lose Iowa $7.4 billion in federal funding over a 10-year period to meet the health needs of its residents, according to the Urban Institute.

Back to the free clinic?

The Eastern Iowa Health Center, a primary-care clinic that serves low-income individuals, has seen a sharp increase in patients since the ACA's passage. Patient encounters -- or an interaction between a patient and health care provider -- jumped 63 percent from 2014 to 2015 -- increasing from 24,273 to 39,594.

In addition, the number of homeless patients served soared 176 percent in that same time frame, rising from 377 to 1,319, according to health clinic data.

The Eastern Iowa Health Center's Lock contributed a large percentage of that jump to a shift in patients from the Community Health Free Clinic to the EIHC.

The free clinic on average signs about 100 people up for insurance each month, said Darlene Schmidt, its chief executive. Employees then refer those patients to other health care providers better equipped to manage chronic conditions such as diabetes or high blood pressure.

The EIHC has inherited a large percentage of these new patients.

But if a large portion of individuals suddenly were to become uninsured again, Lock said it's possible those patients could be pushed back to the free clinic or to hospital emergency rooms.

That's because the EIHC does not have a lot of room in its budget to care for patients without it receiving reimbursement, Lock said.

"There needs to be a relief valve," he said, adding that excluding vulnerable populations from affordable health care is "never the right thing to do."

"People will have to go somewhere. So I'm remaining hopeful," he said.

Schmidt remains optimistic the issues will be worked out, adding the clinic is waiting for more concrete information before further plans are made. Even still, she has called for a strategic planning meeting in January.

"We'll have to come up with resources," she said "Right now we don't have the dollars or the volunteers to provide (that level) of care."

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

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