The Senate Republicans’ Trumpcare bill is predicted to devastate rural Iowa hospitals and nursing homes. The proposed 25% cut in Medicaid spending will put these Iowa facilities at risk of severe cuts in services or outright closure. Will Senators Grassley and Ernst vote for a healthcare plan that these healthcare stakeholders warn will destroy rural Iowa communities? Iowa’s senators failed to raise their voices while their Republican senate colleagues arrogantly crafted a plan in secrecy, without public input and without hearings. Grassley and Ernst have betrayed their responsibility to represent their constituents by remaining silent.
Governor Reynolds was asked about her support for the Senate bill at her Monday press conference. She pivoted away from addressing the cuts to Medicaid by suggesting jobs were the answer. Apparently, she is suggesting Medicaid recipients need to find a job with health benefits.
“There’s a lot of different ways that we can work with vulnerable Iowans. It starts with helping them get the skills that they need to fill the jobs that are available today,” she said.
Is Reynolds suggesting that disabled or elderly Iowans on Medicaid need to find a job with benefits? Is she referring to Iowa’s working poor on Medicaid? The vast majority have jobs but aren’t offered benefits. Reynolds seems clueless to the reality of Medicaid recipients. In addition, the Republicans cut the minimum wage so these poor working Iowans are struggling to survive at low wage jobs with no benefits.
Both Grassley and Ernst are non-committal on the proposed Senate legislation. Iowa healthcare leaders from Iowa went to Washington but Senator Grassley and Ernst were unavailable to meet with them. Kirk Norris, the head of the Iowa Hospital Association, led the delegation that met with the Senators’ staff.
Norris points to the importance of Medicaid funding for rural Iowa hospitals. Medicaid funds 10-20% of these hospitals’ patients and the proposed cuts would force these hospitals to slash services. Norris predicts that both mental health and addiction-treatment would be the first services they would be forced to chop.
Many of the 118 Iowa community hospitals have stabilized their finances as a result of the increased insurance coverage for thousands of Iowans under Obamacare. The Affordable Care Act (ACA), Obamacare provided 150,000 Iowa residents healthcare through Medicaid and 40,000 Iowans were able to purchase private insurance though the Exchange. Prior to the ACA these local hospitals were forced to treat these patients without insurance reimbursement.
These hospitals estimate the ACA has reduced their charity care expense by $300 million dollars per year due to the ACA coverage. Broadlawns, Polk County’s safety net hospital has reduced their charity cases from 51% to just 6%. Not only has Broadlawns stabilized their finances, they are adding mental health beds and staff. Broadlawns’ success has been well publicized and both Grassley and Ernst are on record claiming they understand the importance of rural hospitals to local communities. If they understand, why are they refusing to defend hospitals like Broadlawns that benefited from the ACA and will be devastated by the Republican plan?
The Senate’s proposed $800 billion cut to Medicaid threatens Iowa nursing homes as well. Steve Ackerson, President of the Iowa Health Care Association predicts the slashing of Medicaid funding would put many nursing homes out of business. More than half of the Iowa nursing homes’ residents are covered by Medicaid. Medicaid covers about 600,000 of Iowa’s 3.1 million residents. “Just imagine what would happen after a 20 to 25 percent cut (to Medicaid),” Ackerson said.
The limited economic and employment opportunities in many Iowa towns make these local hospitals and nursing homes vital to their communities’ survival. Much has been written about the importance of retaining local public schools in order to maintain the viability of many communities. Iowans know losing their local hospitals and nursing homes can devastate their communities as well.
In some Iowa communities the local hospital and nursing homes are major employers providing essential jobs to local residents. Losing these critical employers can devastate communities already struggling from lack of employment opportunities.
Just as parents shop for good schools, they also expect nearby quality health care facilities. Many communities nursing facilities house loved ones from that community. Closing the homes would force local residents to relocate their loved ones at a greater distance or take them into their own homes.
Iowa communities losing their local hospital or nursing home will exacerbate the rural decline. The Senate’s slashing of Medicaid funding by $800 billion is a cruel and unconscionable blow the most vulnerable Americans. Not only will many Iowans lose their health care, their communities will suffer under the cruel Republican cuts. Are Reynolds, Ernst and Grassley going to be complicit in a blatant attack on the health care of the most defenseless of Iowans?
by Rick Smith