Guest Opinion
Fisher: Policy director says ACA repeal spells trouble for Iowa
By Peter Fisher, Research Director

Published February 1, 2017, by The Nonpareil, Council Bluffs
Nonpareil online link


Repealing the Affordable Care Act without an adequate replacement, as Congress appears poised to do, jeopardizes the health care coverage and well-being of the most vulnerable Iowans. It would shower tax cuts on the wealthiest while throwing the insurance market into disarray.

In Pottawattamie County, 5,600 more people had health insurance in 2015 than in 2013, the year before the ACA went into effect. The percent uninsured dropped dramatically, from 10.7 percent to 5.8 percent. Those gains are in jeopardy.

Otherwise, consider:

• About 230,000 fewer Iowans will have health coverage in 2019, including 25,000 children.
• Thousands of adults working in low-wage jobs would lose coverage with the end of the Medicaid expansion, including 8,700 in Pottawattamie and the five surrounding counties.
• ACA tax credits that reduce the cost of insurance for eligible Iowans by 71 percent would disappear, resulting in about 42,000 individuals in Iowa becoming uninsured, unable to find affordable coverage.

Repeal of the Medicare taxes financing the ACA would lavish tax cuts on the highest-income households — individuals with incomes above $200,000 or couples above $250,000. Repeal gives the 400 richest households in the country a $2.8 billion windfall in 2017 — about $7 million a year for each.

The insurance market would be thrown into immediate disarray. With no individual mandate to purchase insurance, many healthy individuals would drop coverage.

That would leave insurance companies with the sickest and most expensive customers; many would leave the state’s individual insurance market or raise rates. While participation in the exchanges has grown every year, repeal would threaten their survival.

Repeal would also endanger some of the ACA’s most important consumer protections. We could see rising deductibles, the return of limits on how much insurers will pay in benefits and failure to cover such things as maternity care, mental health or prescription drugs.

Many of the uninsured would turn to hospitals and other health providers for uncompensated care. It is estimated that yearly uncompensated care in Iowa would more than triple, from $345 million to $1.2 billion.

Iowa’s economy would suffer, as $626 million in federal funds would be withdrawn from the state, reducing employment and spending in local businesses. Iowa stands to lose about 6,100 jobs in health care and in other sectors such as construction, retail, finance and services.

Immediate repeal, with replacement unspecified and left to an uncertain future, is simply reckless. Iowans deserve better.

Peter S. Fisher, an economist and professor emeritus of Urban and Regional Planning at the University of Iowa, is research director of the nonpartisan Iowa Policy Project in Iowa City. Contact: