Today’s virtual House graphic: Iowa impact of ACA repeal

170119-IFP-ACA-F1

Yes, whatever actions are taken on the Affordable Care Act will come from Congress, but state legislators may be left to pick up the pieces. Iowa legislators, are you paying attention? Are you talking to your federal counterparts about this? (Some are in the state this week.)

What many may not know is the impact the ACA has had on reducing the uninsured population in Iowa. The Medicaid expansion under the ACA is one of the big reasons we have seen a greater share of the Iowa population covered by either public or private insurance.

For more information on how the ACA has affected uninsurance in Iowa — and the stakes of repeal without an adequate replacement — see Peter Fisher’s policy brief, Repealing ACA: Pushing thousands of Iowans to the brink.

Editor’s Note: The Iowa House of Representatives now denies the ability of lawmakers to use visual aids in debate on the floor. To help Iowans visualize what kinds of graphics might be useful in these debates to illustrate facts, on several days this session we are offering examples. Here is today’s graphic, to illustrate the impact on Iowa, and potentially on state finances and responsibilities, if the federal Affordable Care Act is repealed.

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

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

But what have you done for me lately?

An astounding number of people have no idea what their government does for them — even as they benefit from government programs.

Source: Suzanne Mettler, "Reconstituting the Submerged State: The Challenges of Social Policy Reform in the Obama Era," via Sara Robinson, Campaign for America's Future

This NYTimes blog post is interesting enough, but what really caught my attention was a table from a recent academic political science paper that has made its way from liberal bloggers to a former Reagan economic advisor.

An astounding number of people have no idea what their government does for them, even as they benefit from government programs.

 

Posted by Andrew Cannon, Research Associate

Implementing Health Reform: Early Successeses

A number of health-reform provisions already have taken effect, and are showing results.

Andrew Cannon, research associate
Andrew Cannon

The new health reform law is already helping thousands of Iowans and small businesses.

Though the major provisions of the health reform law won’t be implemented until 2014, a number of provisions have already gone into effect.

The new law provides tax credits to small businesses that offer health insurance to their employees. The rapid growth of premiums over the past decade have made insurance provision extremely difficult for small businesses. According to the Agency for Healthcare Quality and Research’s Medical Expenditure Survey, In Iowa, just 28 percent of firms with 10 or fewer offered insurance to employees, compared to 92 percent of firms with 100 or more employees.

The Wall Street Journal‘s Janet Adamy reported Tuesday that the percentage of small businesses with three to nine employees offering health insurance to employees has increased significantly over the past year — from 46 percent to 59 percent. Researchers at Bernstein Research attribute that growth to the health reform law’s small business tax credits.

In addition to small businesses, health reform is helping Iowa prepare for full implementation of the law and helping Iowa’s seniors. The state received a $1 million grant to plan for a Health Insurance Exchange, one of the key components of the overhaul.

Though Medicare recipients gained prescription drug coverage through Medicare Part D in 2003, the law had a $2,000 gap in coverage — often called the “donut hole.” Early implementation of health reform lessens that gap, by providing a $250 tax-free rebate to Medicare recipients. In Iowa, 17,774 Medicare beneficiaries have received the rebate.

Posted by Andrew Cannon, Research Associate

Health Insurance Help Arrives for Small Businesses

Health reform has brought an immediate potential benefit to many small businesses.

Andrew Cannon, research associate
Andrew Cannon

Help has finally arrived for small businesses and their employees. The rapidly rising cost of health insurance has made it extremely difficult for many small businesses to provide their employees with health insurance, and entirely precluded many others. In addition, because they lack the bargaining power and large risk pooling of larger employers, small businesses face higher premiums than larger employers.

Health reform, or the Patient Protection and Affordable Care Act (PPACA) should ease this problem for some small businesses. Firms that pay for at least half of their employees’ premiums and have 24 or fewer employees may qualify for a health insurance premium tax credit of up to 35 percent of the premium’s average cost.

An Iowa Fiscal Partnership policy brief details the small business health insurance premium tax credit. The table below illustrates potential credits based on number of employees and how much they are paid.

table-HC creditsFamilies USA, a national consumer advocacy group, and Small Business Majority, released a report this week estimating that as many as 51,100 Iowa small businesses may be eligible for some portion of the tax credit, with as many as 14,000 of those eligible for the full 35 percent credit.

Though similar state-level incentive programs have had varying levels of success in inducing small businesses to provide insurance to their employees, the PPACA credits appear poised to make a real difference for small businesses.

Blue Cross Blue Shield of Kansas City saw the tax credits as an opportunity. It began marketing the new tax credit to small businesses that were not providing insurance benefits to employees.

Its efforts had a tremendous payoff for Blue Cross Blue Shield of Kansas City, to small businesses in that area, and to their employees. Sixty small businesses in the area that had previously not offered health insurance to employees signed up for BCBS’s small business health insurance plan. As a result of the tax credit and BCBS-KC’s marketing efforts, Small Group sales have increased 179 percent between April and June of this year, meaning 5,000 new customers for it, and 5,000 more Kansas Citians with health insurance.

Posted by Andrew Cannon, Research Associate