Will the U.S. Senate rescue Iowa GOP?

Iowa’s Republican legislators should be pleading with their U.S. Senate counterparts to rescue them.

The future of health care in Iowa is dangerously dicey right now, thanks to a toxic combination of U.S. House Republicans, Gov. Branstad, President Obama and the formerly Democratic Congress, the GOP legislators themselves, and President Trump.

What each player in the combination is responsible for:

• The Republican majority in the U.S. House earlier this month, by a narrow 217-213 margin, approved the American Health Care Act (AHCA), their bill to supplant the Affordable Care Act (ACA, nicknamed Obamacare).

Among other changes, the new bill would end Medicaid expansion by 2020, cutting taxes on the wealthy by $880 billion over the next 10 years.

Medicaid funding is shared by the federal and state governments. It provides health care coverage for millions of low-income, disabled, elderly and mentally ill Americans. For instance, a large component of nursing home populations are served by Medicaid.

• Gov. Branstad in 2015-16 led the charge in Iowa to privatize Medicaid administration.

Since then, Iowa’s health care provider community, including hospitals, doctors and caregivers of all kinds, has complained, to no avail, of delayed payments, denied payments and unresponsiveness on the part of the three health management companies that now hold the health care of Iowa’s Medicaid recipients in their hands.

And all three of those companies are themselves complaining that they are losing money for their trouble, and are demanding that the state increase their reimbursement levels.

The state has already agreed to some level of increase.

• President Obama’s signature Obamacare program, in part by not enforcing the requirement that everyone either buy insurance or pay a penalty, has made the system top-heavy with older and unhealthy participants, and not enough young, healthy folks.

As a result, insurance companies have been forced to increase premiums sharply. Iowa has been complicit in that laxness.

Obamacare was adopted in 2010 by Congress without a single Republican vote.

What’s more worrisome, those companies that have been selling individual policies in Iowa have all announced that in 2018 they either will abandon the more than 70,000 Iowans who own those policies or are strongly considering doing so, claiming that in Iowa they’re providing policies at a financial loss.

• The Iowa Legislature, under Republican control, went along with Gov. Branstad’s Medicaid privatization plan.

The GOP legislators now own it, and are having trouble proving to their constituents that the state is indeed saving the $120 million annually promised by the governor, and that Medicaid patients and their providers are as well off as they were under state Medicaid administration.

• A few days ago, President Trump released his budget plan for the coming year, with additional proposals for subsequent years.

The Trump plan calls for even more cuts to Medicaid, slashing more than $800 billion from the program over the next 10 years.

Since Iowa is one of the dozen or so states that signed up for Medicaid expansion under Obamacare, those cuts would directly reduce care for a big chunk of the half-million Iowans who depend on Medicaid for their health.

My guess is that politically savvy Republicans in the Iowa Legislature are well aware of the backlash they will face if the American Health Care Act that the U.S. House approved (with all three Republican members from Iowa voting yes) is likewise approved in the U.S. Senate.

Every member of the Iowa Legislature has hundreds of Medicaid recipients and their relatives residing in his or her district.

Most of those recipients are working to support their families, some of them holding down two or more jobs. Many, through no fault of their own, are bearing the burden of serious chronic disease or mental illness.

Republicans in the Iowa Legislature, if the American Health Care Act is approved by the U.S. Senate and signed by President Trump, will face the choice of either continuing to support their national party’s health care legislation or angering their conservative base by publicly opposing the Act.

Neither option is desirable.

I’m guessing that Senators Grassley and Ernst are beginning to get private calls from their GOP colleagues in the Iowa Legislature, seeking rescue from what’s likely to happen in the 2018 election if the U.S. House action is allowed to take effect.

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