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Affordable Care Act Repeal and Replace - Resources

ACA Replacement and Repeal Efforts Remain Alive

Senate Majority Leader Mitch McConnell (R-KY) on Wednesday indicated he will bring to the Senate floor early next week a Motion to Proceed to a vote on legislation to repeal parts of the Affordable Care Act (ACA). It remains unclear if he will bring up a revised version of the Better Care Reconciliation Act (BCRA) or the most recent legislation that repeals parts of ACA without replacement, the Obamacare Repeal Reconciliation Act (ORRA).

The Congressional Budget Office (CBO) projects that ORRA, an updated version of the 2015 repeal bill that passed the Congress but was vetoed by President Obama, would result in 32 million more people uninsured in 2026 and $842 billion in reduced federal spending on Medicaid from 2017-2026.

In addition, CBO said the revised draft of BCRA would still result in 22 million individuals losing insurance coverage over 10 years and $756 billion in federal funding being cut from the Medicaid program.

The economic vitality of hospitals, your communities and the people you serve are all at stake and both of our Senators need to understand the implications on a vote of this magnitude.

IHA's message remains simple and direct: "Hospitals cannot sustain the Medicaid cuts included in these bills and the Iowans our hospitals serve are at risk without coverage." Contact your Senators immediately and urge them to vote "no" on the Motion to Proceed on both bills. A vote could come as early as Monday or Tuesday.

Key Messages:

Maintain coverage for all individuals currently receiving benefits.

Health Insurance Coverage

  • ‚ÄčThe Affordable Care Act should not be repealed without a replacement plan that ensures access to health insurance coverage.
  • Hospitals agreed to $155 billion in Medicare and Medicaid payment reduction under the ACA, however the increased access to health insurance coverage helped to offset these cuts.
  • Any proposal that does not guarantee access to affordable coverage cannot be supported.
  • Any plan that does not include coverage guarantees should, in turn, restore these payment reductions so that hospitals have the resources needed to provide care for those who would become uninsured.

Health Insurance Marketplace

  • The Health Insurance Marketplace is in dire need of reform and additional regulatory relief and resources need to be dedicate to ensure that insurers continue to participate. 
  • Failure to support the Marketplace will result in individuals losing or dropping coverage which increases the uninsured rate and increases hospital bad debt and charity care levels. 

Medicaid Expansion and Medicaid Restructuring Proposals

  • In 2014, Iowa expanded its Medicaid program affording access to health insurance coverage to more than 150,000 previously uninsured, or underinsured Iowans.
  • Any plan should retain the ability for states to maintain the expanded Medicaid program to maintain coverage gains achieved over the past few years.
  • Medicaid restructuring—in the form of block grants and per capita caps—should not be used as a vehicle to make budget cuts in an already under-funded program.
  • Additional flexibility to the states can be provided through increased use of waivers, provided they are accompanied by safeguards that ensure sufficient funding to ensure adequate coverage.

Regulatory Relief for Hospitals

  • Iowa hospitals have always supported efforts to transform the delivery system and are proud of their ability to provide high-quality, low-cost, efficient health care services to all Iowans.  However, regulatory burdens continue to put pressure on hospitals which drives up the cost of care.
  • Congress and the Administration must enact regulatory relief to reduce these administrative burdens.

Prevent Additional Cuts

  • Prevent any further reductions in payments for hospital and health system services to ensure patients and communities continue to receive access to high-quality, low-cost care.
  • The $155 billion includes cuts in market basket updates and productivity adjustments, cuts in Medicare and Medicaid disproportionate share hospital payments, and payment reductions associated with delivery system reforms (e.g., readmissions, hospital acquired conditions).