Iowa provider groups weigh in on Affordable Care Act replacement plan

March 10--Groups representing the state's hospitals and physicians are expressing serious concerns with House Republicans' plan to repeal and replace the Affordable Care Act, more commonly referred to as Obamacare.

The bill -- which was unveiled Monday night and already has run into opposition on both sides of the political aisle -- would tie tax credits to age rather income as well as roll back federal funding for the Medicaid expansion starting in 2020 and move the entitlement program to a per capita cap, among other changes.

An analysis by the Kaiser Family Foundation found that, generally, the ACA offers higher tax credit amounts than the replacement plan would to lower-income people -- especially for older individuals living in higher-cost areas -- and lower credits for those with higher incomes.

Under the ACA right now, about 66 percent of those enrolled in a marketplace plan nationally make less than $31,250 a year. In addition, about 36 percent of enrollees are under age 35, 37 percent are ages 35 to 54, and 27 percent are 55 or older, according to Kaiser.

And while that could have a negative effect on the 52,000 Iowans who purchased subsidy-eligible health plans through the marketplace, the providers' biggest worry lies with changes proposed to the Medicaid program.

"The Medicaid piece is the most concerning and impactful," said Scott McIntyre, spokesman for the Iowa Hospital Association, which represents the state's 118 hospitals. "In terms of number of people affected -- it's more than half a million Iowans and every hospital and most everybody providing health care."

The federal government and states currently share the cost of the program -- which provides health insurance for 73 million of the country's elderly, poor and disabled and nearly 600,000 in Iowa. Health care experts say that moving to a block grant or per capita cap -- which would set baseline financing per person and grow at a fixed, annual rate -- can shoulder states with more of the burden if that growth doesn't keep up with health care costs.

"We are reviewing provisions of the bill still but share in the concerns expressed by the (American Medical Association) and have concerns about the impact on Medicaid," said Clare Kelly, chief executive officer of the Iowa Medical Society, which represents 6,600 of the state's physicians, residents and medical students.

The AMA sent a letter to the chairmen and ranking members of the Congressional committees working to move the legislation on Tuesday, saying it does not support the Republican's plan as drafted "because of the expected decline in health insurance coverage and the potential harm to vulnerable patient populations."

"Our Medicaid program has already been through quite a bit in the past few years, through the Medicaid expansion and the transition to managed care. Both beneficiaries and providers need time to work through that."

Kelly added the state has made strides to ensure that it's most vulnerable residents have both coverage and access -- those strides could be at risk under a per capita cap.

"You can have an insurance card and have coverage, but that doesn't mean you have access to the care you need in the right setting at the right time," she said.

Iowa along with 30 other states took part in the Medicaid expansion, which offered care to low-income adults living under 138 percent of the poverty level. The expansion -- which provided health care coverage to 150,000 Iowans and about 15 million Americans -- helped drive down the uninsured rate, which in turn helped bring down charity care at hospitals.

Insured patients cost less in the long run, the hospital association's McIntyre said. That's because patients are more involved with their care and learn how to properly navigate the system -- when to go to the emergency room, when to go to urgent care and when to see a primary care physician.

"Emergency rooms aren't designed to be primary care places -- no one would ever use the ER model to create a health clinic," he said.

What's more, these patients often deal with food insecurity, transportation issues and other problems.

"If health care is one constant in their life, it can make huge difference to their quality of life overall," McIntyre said.

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