Over 70,000 Iowans will lose their access to health care on January 1st, 2018. For all these thousands of Iowans this is an urgent emergency. It is a catastrophic blow to these Iowa families’ ability to have access to quality healthcare. Lacking the opportunity to buy health insurance coverage for themselves and their families puts them into a healthcare crisis.
The three principle insurance companies offering coverage: Wellmark, Aetna and Medica have announced that they plan to leave Iowa’s Obamacare exchange effective 2018. The future of Gunderson, a small carrier handling a few counties in NE Iowa, is unknown.
These Iowans’ only remaining option will be to seek hospital emergency room services. Hospital emergency rooms are the choice of last resort, the most inefficient use of health care resources and fail to offer adequate health care. They don’t offer preventive care, and it’s called emergency because that’s the mission. It isn’t meant to provide routine health care needs.
It is simply unacceptable that Iowa’s Republican political leadership is ignoring and claiming they can’t act on this looming health care emergency. Doug Ommen, Iowa’s Insurance Commissioner, says his hands are tied and denies he can act.
“This is a federally created situation, and we need a federally created solution,” he said.
Branstad appointed Ommen and he can direct Ommen to act. The Pottery Barn rule applies to the loss of insurance coverage for these 70,000 Iowans. Republicans broke this and they own it. We must hold them accountable to fix it. It’s crucial we remind Branstad/Reynolds of these three critical facts.
- Branstad demanded when Iowa’s Obamacare Exchange was established that it be a joint state/federal model and that the state retain control.
- The three insurance companies have left the Exchange citing the instability in the market created by the Republicans’ attacks on Obamacare.
- There are alternatives that Iowa can pursue to guarantee these 70,00 Iowans have insurance coverage in 2018.
Fact #1. It’s important to recall that the Iowa Exchange was set up to meet Branstad’s demands for a state/federal exchange. When his Insurance Commissioner says his hands are tied he is ignoring his responsibility. Iowa’s exchange is a partnership with the federal government. There are three types of Exchanges: federally managed exchanges, state managed exchanges and partnership exchanges managed by the states. Iowa is one of the partnership exchanges and they retain management control. Branstad sent a letter to Health and Human Services (HHS) Secretary Kathleen Sebelius on December 14, 2012 stating his intention to reject both the state or federal model and establish the state/federal partnership model.
“Iowa will avoid a costly state-based model and will instead pursue a state-federal partnership to retain autonomy over Iowa’s healthcare system and minimize costs…“Maintaining responsibility and operational control will also enable our efforts to modernize health care and to change our payment methods to reward quality and improve Iowans’ health instead of procedure volume.”
Now Branstad refuses to acknowledge that he has management control over the custom partnership exchange he demanded and created. An independent health care group says, “the state is responsible for plan management, consumer assistance, and Medicaid eligibility determination.” Branstad and now Reynolds owns this partnership and must be held accountable.
Fact # 2. Each of the three insurers cite the instability in the market created by the Republicans repeal efforts as their reason for pulling out of the market. The Wellmark spokesperson said this, “the problem will likely get worse because President Donald Trump has told his administrators to stop enforcing the coverage penalty.” An Aetna spokesman agreed, it was “a result of financial risk and an uncertain outlook for the marketplace.”
Fact # 3. Branstad’s Iowa appointed Insurance Commissioner says his hands are tied and lays the responsibility for a fix on the federal government. However, the well-respected resource Healthinsurance.org explains that there are alternatives.
One alternative was used by Massachusetts in 2014. They received a waiver from HHS temporarily putting 325,000 people on MassHealth (Medicaid). That could be an option for the 70,000 Iowans in need of insurance.
The other alternative would require Congress or the administration to fund cost-sharing subsidies through at least the end of 2018. There are solutions but Iowa Republicans are refusing to take any responsibility.
While Branstad and Reynolds are sitting on their hands as Iowans agonize over the loss of insurance, Iowa Democrats are acting. Senator Matt McCoy is speaking at a public forum on May 22nd at the Des Moines Franklin Library at 6:30 pm on this topic. Other Democrats are discussing calling a special session of the legislature and looking at many alternatives. Iowa Democrats aren’t going to ignore the insurance crisis of 70,000 Iowans.