Any way you cut it — Americans lose health coverage

The stakes for some 200,000 Iowans are significant, jeopardizing recent health-care coverage gains and putting vulnerable Iowans at risk.

First, let’s make no mistake: Both the Senate and House bills to repeal and replace the Affordable Care Act (ACA) represent substantial cuts in health coverage, including Medicaid.

People will lose coverage, have less coverage, and/or pay more for it. This is a public policy choice being offered in the drive to repeal ACA’s enhancement of insurance coverage for millions of Americans. In Iowa alone, uninsurance dropped from over 8 percent to 5 percent in just two years.

It is at best disingenuous for anyone to suggest otherwise, or to downplay the cut. Those who want to promote this legislation, for whatever reason, have to own the impact. If they’re afraid of the political disadvantage of admitting it, that’s another story.

The stakes for some 200,000 Iowans are significant, jeopardizing recent health-care coverage gains and putting vulnerable Iowans at risk. An Iowa Fiscal Partnership report from Peter Fisher of the Iowa Policy Project sets the context for this week’s discussions in the Senate.

A new report from the Center on Budget and Policy Priorities (see graph at right) shows how the Senate bill would drive up costs for the 31 states that — along with Washington, D.C. — expanded Medicaid under the ACA.

For Iowa, the estimates are daunting: In 2021, Iowa would have $54 million more in costs, and in 2024, $395 million more — a 315 percent increase.

That CBPP report is part of the exceptionally good information available even in the short time frame we have to understand what is emerging from the backrooms of Washington, out of public view.

See these reports, just produced in the last couple of days by tremendously reputable organizations:

This is our business. We can demand to know the facts and we might just want to know them before the Senate votes — even if some in the Senate might be uncomfortable with that.

By Mike Owen, Executive Director of the Iowa Policy Project

Health premiums rise again; is there an end in sight?

Stagnant wages give health insurance premium increases more sting — and employers are requiring employees to contribute more toward premiums as they keep rising.

Andrew Cannon photo
Andrew Cannon

Anyone hoping for a reprieve from rising health insurance costs — everyone, in other words — won’t like the results of the Kaiser Family Foundation’s annual “Employer Health Benefits Survey.”

Heck, even those of us who were just hoping for premium growth near the inflation rate are disappointed.

The survey, in which more than 2,000 businesses are interviewed about the health insurance plans they offer (or in some cases, do not offer) to employees, revealed that premiums for singles increased by 8 percent while family premiums increased by 9 percent in 2011. The average premium for single coverage passed $5,400, while family coverage costs averaged $15,000.

Fifteen-thousand dollars. That’s more than the federal poverty level for a family of two. It is more, as Kaiser Family Foundation President and CEO Drew Altman noted, than the cost of a small car.

Stagnant wages give this spike even more sting. Increases in income are not offsetting these increases, and employers are requiring their employees to contribute more and more toward premiums as they continue to rise.

So, is there any end in sight? How long will premiums keep rising, and how high can they go?

It’s hard to say. Health care costs are driven by a number of factors and, as the Kaiser report illustrates, remain difficult to predict.

The health reform law, the Affordable Care Act, offers some hope for relief: Small businesses that offer health insurance to employees can receive tax credits, low- and middle-income households that do not receive insurance through an employer will be eligible for premium assistance, and the law features a number of pilot programs aimed at reducing costs.

Like any policy, however, it will require constant monitoring and occasional tweaking to meet its goals: making health care affordable and accessible for all.

Posted by Andrew Cannon, Research Associate

Medicaid cuts would hurt Iowa

Reducing federal deficits is a worthy goal, but only as part of a balanced approach and not at the expense of America’s and Iowa’s most vulnerable.

Andrew Cannon photo
Andrew Cannon

The recently passed House budget plan, authored by Representative Paul Ryan, would radically alter Medicaid as we know it. These changes would push hundreds of thousands of Iowans off the Medicaid rolls and into the ranks of the uninsured, and would reduce federal payments to the state by billions.

Under the proposal, states would receive a set amount of federal money, known as a block grant, for Medicaid, rather than the matched federal funding in the present form of Medicaid. The proposal would also repeal the Affordable Care Act, affecting a projected 16 million Americans who would be covered through the new health law’s expansion of Medicaid.

The Kaiser Commission on Medicaid and the Uninsured estimates that the the House Budget Plan’s repeal of the Affordable Care Act alone would result in 56,000 Iowans losing Medicaid coverage. Over 10 years, Iowa would lose $6.6 billion in Medicaid funds.

And the state wouldn’t be the only entity to take a financial hit: Iowa hospitals would lose out on over $300 million in Medicaid payments in 2021 because of the House budget.

Converting Medicaid to a block grant program would require states to drastically reduce their Medicaid programs.

Putting the results of the proposal in human terms is a bit stickier, as state Medicaid programs are required to serve certain populations by federal law and may, at a state’s discretion, cover other populations. Further, these groups cost wildly different amounts of money to cover. For instance, children make up well over half of Iowa’s Medicaid enrollees, yet account for just 16 percent of all Medicaid spending in Iowa. By contrast, only about 20 percent of Iowa’s Medicaid enrollees are persons with disabilities, yet Iowa spends nearly half of its Medicaid funds on persons with disabilities.

Under Kaiser estimates, various approaches could cut from 153,000 to 273,000 Iowans from Medicaid.

In one model, Kaiser assumed cuts caused by a Medicaid block grant would be spread evenly across all enrollment groups. In this model, the House plan would require cutting as many as 153,000 Iowans from the Medicaid rolls.

If, on the other hand, Iowa lawmakers decided to shield the elderly and persons with disabilities from Medicaid cuts necessitated by the House plan, children and adults would bear most effects: 273,000 Iowa children and adults under age 65 would be cut from the Medicaid roles.

Reducing federal deficits over the long term is a worthy goal. But it should as part of a balanced approach that includes revenue improvements, and not at the expense of our most vulnerable citizens.

Posted by Andrew Cannon, Research Associate

Labor Day Weekend Thought…

If you have health insurance through work, consider thanking union members this Labor Day.

Andrew Cannon, research associate
Andrew Cannon

It’s not a surprise that labor union employees benefit from their union membership. Paul Fronstin, a senior research associate at the Employee Benefit Research Institute, found that while 94 percent of union workers have health insurance through their employer, compared to just 76 percent of nonunion workers (see page 15 of this EBRI report).

That’s what unions do — help workers negotiate better wages, benefits, and working conditions.

But new data from the Kaiser Family Foundation (KFF) and Health Research & Educational Trust (HRET) suggests that nonunion employees might benefit from having unionized coworkers.

In the latest installment of their annual Employer Health Benefits Survey, KFF and HRET found that the presence of “some union workers” increases the likelihood that an employer offers health insurance benefits. Among firms with some union employees, 94 percent offer health insurance benefits. Conversely, just 67 percent of firms with no union employees offered health insurance to their employees.

So if you have health insurance through your work and you have union colleagues consider thanking them this Labor Day weekend.

Posted by Andrew Cannon, Research Associate