Nonsense from the Far Right

Fortunately, the discerning Iowan can find the facts about the federal budget by looking for them, and not buying into Dick Morris’ spin.

Political consultant Dick Morris slipped into Iowa last week, and the Spin-O-Meter was in overdrive.

Now, rather than repeat Mr. Morris’ misinformation, here is a link to a Des Moines Register story about his appearance at a rally orchestrated by the national right-wing organization Americans for Prosperity.

What Iowans need to know is that (1) Morris is wrong about what is driving the federal budget deficits, and (2) the causes are clear: You can’t cut taxes and fight two wars at the same time without digging a big budget hole.

Center on Budget and Policy Priorities graph
Center on Budget and Policy Priorities

As shown in the graph at right from the Center on Budget and Policy Priorities, the economic downturn, President Bush’s tax cuts and the wars in Afghanistan and Iraq explain the vast majority of the deficit through 2019. One thing folks must recognize is that deficits caused by those factors cause more debt down the road, because we have to keep paying interest. Even after the Iraq war ended, we have to keep paying for it.

As we deal with these self-inflicted budget problems, we must maintain the fundamental and long-accepted responsibilities of our nation — to care for the most vulnerable and put them on their feet to get work and succeed in our economy.

Dick Morris has a big megaphone to try to instill something other than a factual presentation about what’s causing our deficits and debt. Fortunately, the discerning Iowan can find the facts by looking for them, and not buying into the conventional spin he delivers in his traveling medicine show.

Posted by Mike Owen, Assistant Director

Why the federal budget debate matters in the states

Want clean water? Good and safe schools and bridges? You get what you pay for.

There’s doggone near nobody who isn’t concerned about dealing with the nation’s long-term budget challenges of deficit and debt.

What not enough people will recognize, however, is the danger of diving headlong into a deficit-cutting approach that just digs a deeper hole, both for the economy and for the critical services that federal, state and local government spending supports.

Ryan budget impacts
Center on Budget and Policy Priorities

And that’s the problem with the so-called “Ryan Budget,” named for Congressman Paul Ryan. That approach, passed by the House, makes cuts to funding for state and local services that are far deeper than the cuts many expect to happen with sequestration, the automatic cut process demanded by last year’s Budget Control Act compromise.

A new report from the Center on Budget and Policy Priorities outlines the challenge for states generally with the Ryan approach:

  • Federal cuts of 34 percent by 2022 to Medicaid compared to current law, and by steadily larger amounts after that.
  • Federal cuts of 22 percent in 2014 and in later years to non-defense “discretionary” spending — which leaves Medicare and Social Security alone but hits local and state services in education, infrastructure such as roads and bridges, and public health and safety including law enforcement.

For Iowa, the non-defense “discretionary” cuts are projected at $237 million in 2014 alone, and $2.1 billion from 2013 through 2021.

Want clean water? If you live in Iowa, where the state routinely shortchanges environmental enforcement, how bad do you think things might get when the federal funds are cut as well? Concerned about the quality of your food? Or your kids’ schools? Maybe the safety of the bridge you’re approaching on the way to work?

Well, folks, you get what you pay for.

Posted by Mike Owen, Assistant Director

Iowa leads the way to kids’ health coverage

Two recent reports highlight Iowa’s success in extending health insurance coverage to children.

Andrew Cannon
Andrew Cannon

Two recent reports highlight Iowa’s success in extending health insurance coverage to children. Both reports are the work of the Kaiser Family Foundation (KFF), a nonprofit private operating foundation, based in Menlo Park, Calif., dedicated to producing and communicating the best possible information, research and analysis on health issues.

The first report — “Performance Under Pressure: Annual Findings of a 50-State Survey of Eligibility, Enrollment, Renewal, and Cost-Sharing Policies in Medicaid and CHIP, 2011-2012” — demonstrates the steps that all states are taking to cover children. For instance, hawk-i, Iowa’s version of the Children’s Health Insurance Program (CHIP), has expansive income eligibility guidelines, allowing children from families with income up to 300 percent of the federal poverty level ($67,050 for a family of four) to enroll in the program. Only two states (New York and New Jersey) have broader eligibility guidelines.

Iowa has enacted other policies that make enrolling in public programs less cumbersome, less costly, and more consistent with the goal of getting kids covered.

KFF’s second report highlights Iowa — along with Alabama, Massachusetts and Oregon — among states leading the way in children’s health coverage. “Secrets to Success: An Analysis of Four States at the Forefront of the Nation’s Gains in Children’s Health Coverage” notes that Iowa has experienced, thanks to its use of CHIP in policies including hawk-i, a nearly 20 percent decrease in the number of uninsured kids. Efforts to expand and simplify the eligibility and enrollment process are key to Iowa’s success in covering kids.

As we noted last month, Iowa’s efforts to cover kid not only help the kids and their families, but also help the state. The U.S. Department of Health and Human Services awarded Iowa with a $9.5 million Children’s Health Insurance Program Reauthorization Act bonus payment in late December, in reward for the state’s efforts to expand children’s health insurance coverage.

Though Iowa has implemented some of the policies that led to success in kids’ coverage in the adult health coverage program, Medicaid, additional policy changes could further reduce the overall rate of uninsurance in the state. For instance, Iowa’s Medicaid eligibility thresholds are Iowa are quite low, especially in comparison to hawk-i eligibility levels

Both Kaiser reports note that Iowa, like every state, will face challenges to maintain and further improve its health insurance coverage. Budgetary pressures, burgeoning caseloads and a growing strain on information technology systems make it difficult. However, both articles illustrate a number of policies Iowa could pursue to continue to be a leader in kids’ health coverage.

Posted by Andrew Cannon, Research Associate

Expanding kids’ coverage pays dividends

Iowa is one of 23 states receiving a children’s health program bonus for its performance in 2011.

Andrew Cannon photo
Andrew Cannon

Iowa has made a huge effort in recent years to expand health insurance coverage to children. Those efforts are paying dividends to the newly covered children and their families, of course, but also to the state.

The 2009 Children’s Health Insurance Program Reauthorization Act (CHIPRA) gave states new tools to make insuring kids easier. Many of these tools meant a reduced workload for state enrollment officials, and made it easier for families to obtain coverage for their children. CHIPRA also provided cash bonuses to states that implemented the tools and excelled in enrolling children in public health insurance programs.

On Wednesday, the U.S. Department of Health and Human Services announced that Iowa is one of 23 states receiving a CHIPRA bonus for performance in 2011. Iowa is one of just five states to have implemented nearly all of the CHIPRA enrollment tools. Iowa’s $9.5 million bonus can be used to further improve enrollment and eligibility processes or to offset the cost of increased enrollment.

In addition to streamlining the  Medicaid and hawki (Healthy and Well Kids in Iowa — the state’s CHIP program) enrollment process, Iowa has also increased enrollment beyond a baseline level, further increasing the size of the bonus. In November 2011, more than 34,000 children were enrolled in hawk-i, with 248,000 enrolled in Medicaid, compared to 22,300 and 219,000, respectively, in July 2009, just months after CHIPRA passed.

Undoubtedly, the effect of thousands of Iowa parents losing their jobs and health insurance has contributed to enrollment increases. Nonetheless, the tools CHIPRA made available, as well as Iowa’s implementation of many of them, made the process of enrolling kids in public health insurance programs less onerous for many parents at a time they most needed assistance.

Posted by Andrew Cannon, Research Associate

Wellmark’s ‘uncertainty’ should not affect Iowa’s exchange

In a strong, consumer-oriented exchange, small businesses, individuals and families will want to participate. Why would Wellmark not want a share of that playing field?

Andrew Cannon photo
Andrew Cannon

Any business worth its salt can find a way to make a buck in a market with sufficient consumer demand.

Wellmark’s reported uncertainty in its ability to “break even” in the health reform-created insurance marketplace would seem puzzling for a company with 70 percent of the Iowa market.

According to an Aug. 31 Des Moines Register report (“Wellmark undecided on insurance exchange,” by Tony Leys), Iowa’s largest insurer is unsure it will participate in the health insurance marketplace created by the health reform law, citing concerns about its ability to “break even.”

This marketplace could be the place where as many as 156,000 Iowans* seek to purchase health insurance. Those with household income below 400 percent of the federal poverty line (about $89,000 for a family of four) will receive tax credits from the federal government to help cover the premium cost. And small businesses, which will also be eligible to purchase insurance in the exchange, will receive tax credits if they cover at least half of their employees’ premiums.

The stars are aligned to create consumer demand in the new insurance marketplace. Wellmark’s concern about breaking even probably should not be lawmakers’ first concern. The point of the exchange is to enhance the marketplace, not keep it restricted.

Rather, as we have repeatedly stressed, policy makers need to be focused on how to assure that lawmakers create an Iowa exchange that is fair and consumer-oriented.

Two groups heretofore are woefully underserved by the current health insurance market — individuals and families who don’t receive health insurance benefits at work, and Iowa’s small businesses. The exchange’s structure and governance should assure that Iowa individuals, families and small businesses can find affordable health insurance options.

In a strong, consumer-oriented exchange, small businesses, individuals and families will want to participate. Why would Wellmark not want a share of that playing field?

*Note: Data comes from the 2009 American Communities Survey (ACS), analyzed online using the University of Minnesota’s Integrated Public Use Microdata Series (IPUMS-USA). The ACS is conducted on an ongoing basis by the Census Bureau. Those 156,000 Iowans have household income in excess of 133 percent of the federal poverty level – the cut off point for Medicaid eligibility under health reform.

Posted by Andrew Cannon, Research Associate
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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

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