opinion

Senate's latest health bill offers no lifeline for Iowa

Gov. Kim Reynolds jumped aboard the latest Republican effort to repeal most of Obamacare as if it were the last lifeboat off the Titanic.

“You know, this can work and I believe right now, this is the only vehicle we have to address Obamacare, that’s failing,” she said Tuesday.

She was talking about legislation co-sponsored by Republican U.S. Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana. The bill would put states in charge of designing their own health-care systems, with federal money from existing Obamacare taxes. Expansion of the federal program for low-income Americans, Medicaid, would end in 2020 and states would get block grants instead.

The block grants, however, would end in 2026. Furthermore, the legislation would benefit states that did not expand Medicaid at the expense of those like Iowa that did, according to the Kaiser Family Foundation, a nonprofit health policy research organization.

Under the proposal, states could allow insurers to refuse payment for some health-care costs for people with pre-existing conditions. Insurers would be allowed to collect premiums five times higher from older people than younger ones, unless states decide otherwise.

The legislation may not be worse than doing nothing, considering that no action would mean Iowa’s individual insurance market would be down to one, not-very-affordable insurer as of next year. But Iowa’s troubled, privately managed Medicaid system is already under pressure from the for-profit providers for more money. It’s hard to imagine what that program might look like after the feds bow out.

Actually, Reynolds gave a hint as to what it might look like.

“It’s worked before. If you take a look at welfare reform in the ‘80s, where they gave states, through block grants, the flexibility to manage their population, they cut the rolls in half,” she said.

She clarified that she’s not looking to cut the Medicaid rolls in half. But the implication is obvious that roll-cutting is a desirable goal. Unless the state finds a miracle cure for poverty that no other governor has discovered, that probably tosses some lower-income, elderly or disabled people overboard.

By the way, Iowa had about 10.8 percent of people in poverty in 1980, before welfare reform. In 2008, there were about 11.8 percent of Iowans below the poverty line, according to the Iowa Data Center.

Graham-Cassidy is not the only vehicle to fix the federal health-care program. It’s just the only one that still resembles a repeal of Obamacare, if you squint hard enough. Even that isn’t enough for Sen. Rand Paul of Kentucky, who has said he’ll vote against it because it doesn’t repeal Obamacare.

Iowa's insurance commissioner reported Tuesday that the state is on course for approval of its “stop-gap” measure to shore up its individual insurance market. That's not a permanent solution, but it will buy time while keeping two insurers operating in the state.

Meanwhile, the Senate Health, Education, Labor and Pension (HELP) committee has continued to hold hearings on proposals to shore up the individual insurance market nationally. “And that’s the kicker for Iowa,” Sen. Joni Ernst told me just two weeks ago when I visited her in D.C.

In fact, during that visit both Ernst and Sen. Chuck Grassley said they didn’t expect much activity on health care this fall as tax reform took center stage.

Now, however, it appears they’re grabbing at a political lifeline. Grassley said Wednesday that Republicans have a political imperative to support the bill, even if they don't particularly like it.

“You know, I could maybe give you 10 reasons why this bill shouldn’t be considered,” Grassley said. “But Republicans campaigned on this so often that you have a responsibility to carry out what you said in the campaign. That’s pretty much as much of a reason as the substance of the bill.”

Grassley’s already expressed his opinion that unless Republicans repeal Obamacare, they’re going to lose the Senate majority. Last I checked, however, the 2018 elections were more than a year away. This doesn’t have to be a desperation dive.

Back in August, Reynolds said she and other governors were looking for more flexibility to manage health care. That’s what Graham-Cassidy does, no question. But Reynolds also said something else: “Now, that means they have to adequately fund it. That doesn’t mean shifting the cost to the states. … It has to be balanced,” she said.

With no score yet from the Congressional Budget Office, we don’t know for sure how Graham-Cassidy stacks the scales. But what we’ve seen so far looks like it kicks the can — and the cost — to the states. Republicans in Congress are passing the buck and the political liability to governors like Reynolds.

There’s time for Reynolds to hold out for a better deal. Iowa’s health-care ship may be in perilous waters, but it’s not sinking yet.

Kathie Obradovich is the Register's political columnist. Contact: kobradov@registermedia.com Twitter: @kobradovich