Too soon to know impact on Iowa of Obamacare repeal and replace, Lt. Gov. Kim Reynolds says

May 09--CEDAR RAPIDS -- It's too soon to know what changes Iowa will want -- or have -- to make to its Medicaid program as a result of changes Congress is contemplating in its repeal and replace of the Affordable Care Act, Gov. Terry Branstad and Lt. Gov. Kim Reynolds said Monday.

"I'm not going to speculate because we don't know," Reynolds said at the administration's weekly news conference.

"It's a long way from done ... and it won't look the same when they get done with it," she said, referring to the U.S. Senate, which hasn't taken up the plan the House approved last week.

The changes are necessary, she said, because the ACA -- or Obamacare, as it's known -- is "unaffordable, unsustainable, unworkable." Changes are "essential" to ensure that Iowans can buy health insurance in the individual market.

"Because Obamacare is collapsing, there are 80,000 Iowans who potentially might not have any coverage at all," Reynolds said.

That's because private insurance companies are pulling out of the Iowa market. Medica warned state officials last week that it may join Wellmark Blue Cross and Blue Shield and Aetna in leaving Iowa's individual insurance market in 2018.

"In some states, they are down to one choice," Branstad said. "I think in 94 counties we're down to no choice."

However, they expressed confidence that Iowa will be able to maintain, and perhaps improve, its Medicaid program that serves more than a half-million elderly and low-income Iowans as well as people with disabilities.

U.S. Health and Human Services Secretary Tom Price, with whom Branstad has met, and Seema Verma, director for the federal Centers for Medicare and Medicaid Services, are familiar with the Iowa's $5 billion Medicaid program, which the state handed over to three out-of-state insurers a year ago.

Verma helped Iowa win approval to privatize its Medicaid program. But since her appointment by President Donald Trump to head the agency, she has recused herself from weighing in on any decisions.

However, Branstad said they have shown support for the flexibility his administration has requested, "which we had to fight for under the previous administration."

"So we think maintaining what we have should be very easy," he said. "In fact, we think we will get even more flexibility to make it better going forward."

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