Why not a special session?

Now is the time to be speaking frankly about the longer-term impacts of health care policy — and that might make a special session useful, sooner rather than later.

Long-term impacts could be decided in short order;
Might not our state lawmakers want to weigh in?

If anything has been clear about the current health-care debate in Washington, it is that little is clear — except the likelihood that (1) people will lose insurance coverage and thus access to health care, and (2) this will pose new challenges for state government.

That being the case, it seems a good time for the Legislature to return to Des Moines and sort it out, sooner rather than later. It will be easier for legislators to talk to their federal counterparts about all this before legislation passes than afterward.

Because of the Affordable Care Act (Obamacare), the Medicaid expansion serves about 150,000 Iowans, and would serve an estimated 177,000 Iowans in 2019 if preserved. But those Iowans — and some 55,000 more — would be in jeopardy of losing insurance under legislation pending in the Senate. If the enhanced federal share of funding for Medicaid expansion is reduced or eliminated under any legislation to come — and both the House and Senate bills currently would do this — states would have a choice: Fill in the gap or let people go uninsured.

Oh, and if you’re going to choose to fill in the gap, go ahead and plan now on what will have to be cut to compensate for it. K-12 education, perhaps? Even more cuts to the regents institutions? Child care? Water protection? Law enforcement and corrections?

Already, legislators and Governor Kim Reynolds are facing those kinds of questions amid a looming fiscal shortfall and speculation about a possible special session.

In The Des Moines Register this week, columnist Kathie Obradovich suggested Governor Reynolds “is prudent to wait until fall to make a decision on a special session but that doesn’t mean she should avoid talking about it. Now is the time to be speaking frankly with Iowans and individual legislators, identifying the causes and consulting on potential solutions.”

Now is also the time to be speaking frankly about the longer-term impacts of health care policy — and for that reason, waiting until fall might be too late. Legislative leaders and the Governor right now could be bringing in experts for a special session to discuss the potential impacts, and reach out to the congressional delegation, before decisions are made that restrict state budget choices for many years to come.
Unless, of course, they want to see budget crunches and special sessions more frequently.
Mike Owen, Executive Director of the Iowa Policy Project
mikeowen@iowapolicyproject.org

Health reform turns 1

Despite heated rhetoric, health reform will help thousands in Iowa receive better and more affordable coverage, and better protect their rights as patients.

Andrew Cannon photo
Andrew Cannon

A year after it was signed into law, confusion about the health reform law remains high. With the heated rhetoric and widespread misinformation about the law, citizens can hardly be blamed for not yet understanding the Affordable Care Act.

Over the course of this week, the Iowa Fiscal Partnership — a joint project of the Iowa Policy Project and the Child and Family Policy Center — has tried to combat some of that confusion and outright misinformation. In a series of five “issue snapshots,” we have succinctly explained how certain groups of Iowans will be impacted by the health law.

On Monday, our brief snapshot described some features of the law designed to help small businesses, which provide insurance to employees in far lower numbers than larger firms. Small businesses may qualify for tax credits if the provide coverage to employees now, and will have access to a new health insurance marketplace beginning in 2014.

Our Tuesday release focused on how senior citizens will be impacted by the new law. Gaps in Medicare prescription drug coverage will gradually be phased out and Medicare enrollees need no longer worry about co-pays for approved preventive treatments.

On the actual anniversary of health reform becoming the law of the land, our Wednesday snapshot explored some of the consumer protections featured in the law. Patients’ need no longer worry about bumping against a benefits ceiling; lifetime benefit limits are eliminated and annual benefits limits will be phased out. The law enshrines the right of patients to choose their own provider; that choice may not be dictated by insurance carriers or the government.

Our Thursday snapshot focused on the law’s impact on Iowa women. Many women are only one family tragedy away from losing their coverage. Just 28 percent of Iowa women have their health coverage through their own job.  In 2014, Iowa women, along with all Iowans, will have a host of new health coverage options. Medicaid eligibility will be raised and lower- and middle-income families will be eligible for premium assistance from the government to purchase insurance coverage in the new state-based marketplaces.

Today, our snapshot details some of the law’s benefits for Iowa’s youth — from infants up to 25-year old young adults. The 51,300 Iowa children with a pre-existing condition will never be denied coverage for that reason; insurers are prohibited from denying children health coverage due to pre-existing conditions. Young adults through age 25 may also remain on their parents’ insurance plans, regardless of whether they are in school or just starting a career.

In spite of some of the heated rhetoric that continues against health reform, it will help thousands of Iowans receive better and more affordable health coverage, as well as protecting their rights as patients.

Posted by Andrew Cannon, Research Associate

Reform should halt large rate increases

Health reform — the Affordable Care Act — attempts to make the market more affordable for individuals by allowing them to pool their risk together in a regulated marketplace called an exchange.

Andrew Cannon, research associate
Andrew Cannon

If Blue Shield of California gets its way, some of its individual market customers will see rate hikes as high as 59 percent.

You read that right: 59 percent. At the same time, we learned that health expenditures increased by their lowest rate in 2009.

So what gives?

We won’t know for sure until the state performs an actuarial review of the company’s request, but it seems that the problem in California is the same problem faced by customers of Anthem Blue Cross of California and Iowa’s Wellmark last year: The individual market doesn’t work.

Unlike employer-provided plans, which are purchased on the group market, the risk of medical cost in plans sold on the individual market is borne completely by the individual. Within a workplace, the risk that someone will fall ill is countered by the likelihood that other enrollees in the plan will stay healthy. Similarly, plans on the individual market are often subject to aggressive medical underwriting — or calculation of future medical costs based on medical history; plans in the group market are usually underwritten only on the age and sex of plan enrollees.

Health reform — the Affordable Care Act (ACA) — attempts to make this market more affordable for individuals by allowing individuals to pool their risk together in a regulated marketplace called an exchange. In addition to allowing individuals to pool their risk with other individuals, starting in 2014, the exchange will also tightly regulate how insurers deal with their customers.

Under the ACA, insurers will no longer be able to exclude pre-existing conditions, deny coverage, or base their premiums on anything other than age, sex, region the customer lives in, and smoking status. Further, individuals with income up to 400 percent of the federal poverty level ($88,200 for a family of four) will be eligible for assistance with their insurance premiums, on a sliding scale.

Though those affected by Blue Shield’s outrageous rate increase request won’t benefit from these reforms in the short term, the rate increase request illustrates the need for a robust exchange that provides attractive insurance options for individuals and small businesses and also provides a workable market for insurers to operate in.

Posted by Andrew Cannon, Research Associate