Iowa Insurance Commissioner Outlines Potential Effects Of Repealing Obamacare

NPR's Audie Cornish talks to Republican Iowa Insurance Commissioner Nick Gerhart on what a GOP push to repeal the Affordable Care Act could mean for the insurance market and the U.S. economy.

AUDIE CORNISH, HOST:

One of the first things Donald Trump says he'll do as president is repeal the Affordable Care Act. That's made a lot of people nervous about what might come next, including some Republicans who aren't keen on Obamacare. Iowa Insurance Commissioner Nick Gerhart is one of them. Welcome to the program.

NICK GERHART: Thanks for having me.

CORNISH: Now, you wrote in a blog post about this on LinkedIn. You said people were coming up to you in church, asking about Obamacare and whether it will be repealed. What do you say to them?

GERHART: Well, you know, I tell people to take a deep breath. Nothing's going to happen overnight. And then I also inform them that, you know, even if it's unwound, it's not going to happen in a quick order. It's going to probably have a transition period.

And then finally I tell them, you know, the law is still in place today, so go and get coverage that meets your needs, still go out and find coverage that makes sense for you and your family.

CORNISH: But you still have Vice President-elect Mike Pence out there saying, yes, this will happen quickly.

GERHART: Yeah, I think they're going to act quickly in the sense of a law. I think they're going to either have a replacement, or I've read today they'll have to a two-year transition period, you know? In my blog, I talk about, you know, if you're going to repeal this, I hope that there's a replacement stapled to that bill. I think I actually use those words.

And then I also talk about, you know, the need for a transition period. So I wrote the piece hoping that people would read that and, you know, hear from somebody on the ground that has been working on the Affordable Care Act for many years.

CORNISH: Right. You've said that an immediate repeal could have devastating consequences. What do you mean by that?

GERHART: Well, I mean folks here in Iowa and across the country are using these plans for their care for their loved ones. Some may be going through some treatments now that require that care to be in place and that coverage in place.

You know, the average Iowan doesn't have, you know, a hundred thousand dollars sitting in a bank account to write out a check for something in these cases that could impact them, so - and what I meant by that is, you know, insurance is there to lay off or mitigate your risk that you can't assume yourself. That's why you buy insurance. You buy it and hope you never use it to be honest with you. But when you want and need it, you want it to work for you.

And so if people lose their health coverage and their affordable tax credits and things like that, it will cause massive disruption, and you'll have folks that, you know - they won't know where to turn, so they'll go to the ERs. They'll go for free care. It would just be - have disastrous consequences potentially for a lot of people.

CORNISH: So can there be any kind of partial repeal, or does it have to have, as you say, something stapled to it to replace it?

GERHART: Well, again, we got to keep in mind, the Affordable Care Act - 2,700 pages - right? - there's - I don't know - anywhere from 20,000 to 30,000 pages of regulations probably behind it. So you know, I think you have to look at what you're looking to fix.

In my world, we spend a lot of time on the insurance piece of it obviously because that's what I deal with. I'm the insurance commissioner. But like I've said time and time again here in Iowa, I don't think really matters if we call it repeal, replace or transform. It needs a lot of work, and it needs to have some quick changes put in place because it's not going to be sustainable on its current trajectory no matter what.

CORNISH: In your piece, you talk about this Manhattan-style project. What would that look like?

GERHART: I think if you were to put everything aside and say, we want to have the smartest people that understand medical devices, payment systems for hospitals, providers, insurers, consumers - I think would be good to have in there as well - and have a robust dialogue around what has worked with the Affordable Care Act and what hasn't worked - you know, I think you need to look at everybody as part of this ecosystem. It's not just the insurers. It's the drug manufacturers. It's the providers, the doctors, the device makers.

Everybody got a little piece of it, in my opinion, from Obamacare and the Affordable Care Act. They all got the ability, you know, to have different things in there. But I don't think we actually addressed the cost, which is really what's driving it. At the end of the day, the insurers are required to pay out 80 percent of every dollar towards health care.

And so from my perspective, I think we need to look at, what is driving cost? You know, it's the chronic conditions. It's the lifestyle choices, end of life. You know, a lot of decisions go into this. And if we don't get our arms around it, you know, we're going to have depressed wages. We're going to have a drag on GDP growth. And I think we're going to have a real problem with Medicare and Medicaid.

CORNISH: Iowa Insurance Commissioner Nick Gerhart, thank you for speaking with us.

GERHART: My pleasure. Thanks for having me.

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