Iowan To Joni Ernst: The ACA Helped My Rural Hospital

Sen. Joni Ernst told a crowd of constituents at a recent town hall meeting her “commitment to rural America is very strong” because she lives in rural Iowa.

Josh Dahle challenged that statement, explaining to Ernst how the Affordable Care Act benefited a rural hospital where he used to work, and how her votes to repeal the ACA were, in fact, not good for rural America.

Rather than make a humanitarian argument for the ACA — that all Americans should have health insurance — Dahle said he has reframed the discussion around economics when talking to Republicans about the benefits of the ACA.

“This is something that I’ve been a pretty strong advocate for,” said Dahle, 28, a former human resources professional at Stewart Memorial Community Hospital in northwest Iowa. “When those votes were going through Congress, she voted for several different provisions to repeal the [ACA]. I was calling her office just about everyday to voice my concerns, and then informing people I knew and some of the groups that I was involved with, on some of the messaging about the economic impact the rural hospitals have on rural communities.”

In Lake City, where Dahle lived and worked, the hospital is Calhoun County’s largest employer, providing jobs for about 300 people in a city of less than 1,500.

“A large percentage of people worked for the hospital,” Dahle, who now lives in Des Moines, told Starting Line. “Not only those people, but the jobs that depend on the economic activity from that hospital,” like downtown businesses, home values and the school system.

The economics of the hospital have “huge, huge ripple effects that nobody is really talking about,” he said.

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Stewart Memorial Community Hospital, and others like it that depend on government reimbursements for health care services, benefitted financially from the ACA’s expansion of Medicaid.

Hospitals in rural America typically have a higher percentage of Medicaid patients than urban or suburban areas. Prior to the ACA, people who were uninsured but still required health care services resulted in a financial loss to health care providers. But under the ACA’s Medicaid expansion, more people were eligible for Medicaid, thus creating more opportunities for hospitals and clinics to be reimbursed for services they provided to the poor and disabled.

“With the Medicaid expansion that Iowa participated in, that meant less medical debt write-offs, more people were able to be covered under those [government] programs, so the government reimbursed the services so the hospital had to write off less bad debt,” Dahle explained.

He referenced findings from an independent foundation researching health care policy, the Commonwealth Fund, that analyzed how repealing the ACA would effect the finances of rural hospitals.

As part of its findings, the Commonwealth Fund concluded in its 2017 report: “Estimated savings across all hospitals in Medicaid expansion states totaled $6.2 billion. The largest reductions in uncompensated care were found for hospitals in expansion states that care for the highest proportion of low-income and uninsured patients. Legislation that scales back or eliminates Medicaid expansion is likely to expose these safety-net hospitals to large cost increases.”

At the Aug. 17 town hall in Polk County, Ernst defended her 2017 votes to repeal former president Barack Obama’s ACA, telling the crowd it “expanded access to health insurance” but did not succeed in bringing down the cost of health care.

“What happens is, yes, we have access to health insurance, but what did it do to address the root cause of the issue, which is the actual cost of health care?” said Ernst, up for re-election for the first time in 2020. “So, my commitment to rural America and to the metro areas, is to actually address the issues associated with the cost of health care.”

Instead of building on the ACA — 2019 enrollment was estimated at 8.5 million, not including those insured through the Medicaid expansion — Ernst said she was “working on reducing the cost of prescription drugs” and, at the time of the ACA repeal votes, advocated for an alternative system with an “invisible risk pool.”

According to Ernst, the plan worked “quite successfully in Maine” and “protected people with preexisting conditions.”

As described in an article by the Association of Health Care Journalists, so-called “invisible risk pools” help drive down premiums because insurance companies receive financial assistance from the government if they insure someone with a preexisting condition or significant health risks. Rather than waiting to provide payment until a patient incurs a high medical bill, the payments are doled out to insurers ahead of time, as a way of incentivizing coverage of expensive patients.

“I have family members with preexisting conditions,” Ernst said. “Two members of my family are juvenile diabetics. They have lived on insulin shots their entire lives, and I would never want to take away their health insurance. The ACA, some may support it, but I think there are better ways of doing business.”

In addition to cutting the ACA’s advertising budget and shortening the open enrollment window, President Donald Trump and Republicans in Congress have supported a reduction in cost-sharing payments to insurers that help keep premiums affordable.

“Her answer about rising premiums was so disingenuous,” Dahle said. Republicans “purposely limited funds for the reinsurance programs and the cost-sharing programs that were meant to help insurers establish better” insurance pools, “so her actions directly led to higher premiums.”


By Elizabeth Meyer
Posted 8/23/19

7 Comments on "Iowan To Joni Ernst: The ACA Helped My Rural Hospital"

  • Why doesn’t The Starting Line point out that the US Congress and ALL their Staff receive their health care coverage via an ACA plan that “they” have made work very well for them at a very low cost. And “they” can’t do this for the rest of America?!

  • Sen. Ernst and GOP have tried to destroy the ACA for many years, but they do not have any alternative plans for health care. It is easy to criticize specific points of the ACA, but overall it has saved many rural hospitals such as SMCH in Lake City.
    There were many hospitals in the South that closed due to the governors of those states who refused Medicaid expansion. It also happened in Kansas and Oklahoma. By playing politics, the politicians hurt many people.

    • Mr. Hedges, you are so right. The reason the Republicans have offered so few “alternatives” to the ACA, and those being absurdly inappropriate or inadequate, is that they know NOTHING about healthcare, and couldn’t care less about that deficiency. When President Obama came into office determined to ensure that every American would have health insurance, the Republicans immediately “went to the mattresses”, holding hundreds of town hall meetings for their base over the next year in order to send out the alarm that Democrats were trying to deny them basic health services and kill Gramma for good measure. Obama’s biggest mistake was ignoring those meetings and permitting ridiculous speculation and outright lies about the Dems efforts to take root in the fear centers of much of the population, where they continue to flourish today.

      But the Republicans major error was in remaining stubbornly uninterested in the pain and suffering of middle class Americans. They were completely unschooled in the basic conditions: insurance companies who wouldn’t enroll those w/pre-existing medical conditions, plans that would drop longtime policyholders with no notice after they were diagnosed w/serious illnesses, and people who weren’t able to GET insurance no matter what they were willing to pay. They continued to maintain that the ACA was evil, but because they’d refused to participate in writing the law, they could never cite specific serious problems with it. When forced into a corner, they’d claim that things like Health Savings Accounts were viable alternatives to the ACA. In the 7 yrs after the ACA became law (March 2010), there were at least 70 GOP-led votes in the Congress to repeal or severely limit the ACA. The message continued to be “ACA = BAD”, with no detail on WHY it was bad. And with no serious alternatives, aside from Health Savings Accounts.

      During that 7 years, millions of Americans enrolled in the ACA & were happy to finally have coverage, including many who were “against Obamacare”. When Trump was elected, and moved to have the GOP-controlled House and Senate repeal the ACA, the Republican base cheered them on. Until one of them was told that they would lose their much-needed insurance policy, and the news spread that the ACA was the official name for Obamacare.

      Suddenly, ACA enrollees of every political persuasion, including die-hard MAGAts, were demanding answers from the GOP – who didn’t have them. They couldn’t tell their ACA-satisfied voters exactly what was so bad about the ACA that it had to be immediately & totally eliminated, and they had no solid offerings to replace it (poor and middle-class MAGAts who had listened to the GOP talk for years about HSAs, sent up a collective snort of outrage when they learned it was a savings account to which THEY were expected to contribute!).

      Suddenly, the GOP was in serious straits. Their ACA-enrolled MAGAt base, who was still letting them get away with outrageous deeds, lies, and half-truths, had them up against the wall, were demanding answers, and were educating themselves on Republican healthcare doublespeak. GOP senators and congressmen stopped holding town halls & refused to meet with their constituents midway through the 2018 midterm elections.

      It was the most serious hot water they’d been in for decades; yet, the GOP continued their act. They doubled-down on the “ACA = BAD” talk, came up with “comprehensive” health “plans” that were simply more complex, more expensive Obamacare clones, whipped up alternative “comprehensive” health “plans” in 4 days that were absurd and woefully inadequate, and rejected by some of their own in the GOP-controlled Senate/House. It was President Donald Trump who diagnosed the problem: “Now, I have to tell you, it’s an unbelievably complex subject,” adding “Nobody knew health care could be so complicated.”

      Well, I’m pretty certain that the Democrats who spent a full year writing and revising the ACA, and getting it passed by the House and Senate, had a good idea of just how complicated it was. But, to this day, Republicans still do not consider health care for Americans a topic important enough to warrant any of their attention. Trump continues to claim that he’s got a plan, it’s going to be very special, really terrific, much better than Obamacare, Obamacare was a total disaster, blah, blah, blah.

    • A joke? I must have missed it. What I’m reading is astute & accurate commentary on the indirect economic effects of the ACA posted by someone who appears much better informed on this topic, and on healthcare, in general, than Senator Ernst.

      To what do you object – or find amusing – in Mr. Dahle’s argument? Does it not stand to reason that when a person leaves his job, the knowledge and skills he acquired therein stay with him, and inform him in situations occurring in his new position?

      Mr. Dahle, knowing that Republican politicians become irrational at any mention of the ACA, wisely brought up an aspect of the plan that had nothing to do with its monetary costs, instead citing its indirect fiscal benefits to the community at large, and how those stood to be lost if the ACA is totally eliminated. Since 2018, healthcare jobs have outnumbered both manufacturing and retail jobs, and its share of the job market will only get larger over the next several decades as the baby boomer generation continues aging.

      Your casual dismissal of Jon Dahle as a “28 year old no longer employed in H R” is astoundingly shallow and short-sighted. Dahle, at 28, appears to have more in-depth knowledge of the healthcare industry than any member of the entire Republican Congress, whose grasp of the importance and complexity of healthcare is frighteningly tenuous. However, if you are still offended by the author’s inclusion of Mr. Dahle as a source for this article, you are free to counter his commentary and arguments re: the ACA’s importance as a stimulant to community fiscal growth, with your own authentic* response (*not a plagiarized rant from Gateway Pundit or Breitbart or Fox News).

      Mr. Dahle has made

      But if the Senator Ernst

    • Assuming you’re referring to Dahle, are his arguments wrong? (quick answer – no; they’re not). Instead of dismissing the man, why not instead attack his statements, if you can?

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