BCRA Undermines Coverage and the Health of Iowans

Without health insurance, many people put off seeking medical treatment until their conditions are so severe they require care in a hospital emergency department — the most expensive place to receive care.

But because of Medicaid expansion and the Affordable Care Act’s (ACA’s) health insurance exchange, thousands of Iowans have obtained coverage. As a result of this coverage expansion, Iowa has one of the lowest uninsured rates in the nation, which will allow residents to be healthier and more productive in the long run.

In considering any changes to the current system, coverage must be the top priority. The Better Care Reconciliation Act (BCRA), the health care bill being discussed by the US Senate, raises serious concerns in that regard. It is estimated that 22 million people, including more than 200,000 Iowans, will lose their insurance coverage by 2026, 15 million fewer people would have insurance in 2018 than today and 49 million people would be uninsured by 2026.

The BCRA’s Medicaid provisions are most concerning because they would roll back Medicaid expansion and reduce vital federal support for this program. BRCA would shift additional Medicaid costs onto the state, reducing federal Medicaid spending by $772 billion, or 26 percent, over 10 years. At a time when the Iowa state budget is struggling to make ends meet, this massive shift would overwhelm state finances, leading to budget cuts, higher taxes or reductions in the Medicaid program that threaten the health of poor, disabled and elderly Iowans.

This is simply not sustainable.

The Senate bill would also lower the threshold for subsidies that help individuals with low income afford health care coverage and lower the subsidies themselves. States could seek waivers from insurance regulations so that policies would no longer have to cover things such as maternity care, emergency services and mental health treatment.

And the BCRA would repeal or delay the taxes — mainly on the wealthy — that help offset the cost of Medicaid expansion. It is fair to say that the price for these tax cuts for higher income Americans is deep Medicaid spending cuts for lower-income, disabled and elderly Americans.

Health care coverage for Americans must remain the priority. Unfortunately, BCRA moves in the opposite direction, particularly for our most vulnerable citizens. This proposal would likely trigger deep cuts to the Medicaid program that covers millions of Americans with chronic conditions such as cancer, along with the elderly and individuals with disabilities who need long-term services and support. Medicaid cuts of this magnitude are unsustainable and will increase costs to individuals with private insurance.