Health Care Access for Iowans
Repealing ACA: Pushing thousands of Iowans to the brink
Likely turmoil in insurance market, higher premiums, and harm to the economy


Printable version of this news release or full report
IOWA CITY, Iowa (Jan. 19, 2017) — About 230,000 Iowans, including 25,000 children, will lose health coverage in 2019 if the Affordable Care Act (ACA) is repealed without an adequate replacement.

“This is a threat to the health and economic well-being of the most vulnerable people in our state,” said Peter Fisher, research director of the nonpartisan Iowa Policy Project (IPP).

“Plans in Washington to repeal the ACA threaten health coverage for thousands of adults working in low-wage jobs — such as those waiting tables, working on construction sites, bagging groceries, or providing care to children, the sick, and the elderly.”

Fisher’s new report for the Iowa Fiscal Partnership also found:

• In families previously unable to afford health coverage on the individual market, coverage subsidized by tax credits could disappear and 42,000 individuals would lose insurance.
• More Iowans would turn to hospitals and other health providers for uncompensated care, , leaving those who are insured to pay the bill through their own premiums, or for health-care providers to swallow the cost, with total uncompensated care costs tripling to $1.2 billion annually.
• The economy would suffer as $446 million in federal funds would be withdrawn, reducing employment and spending in local businesses.
• The insurance market would be thrown into immediate disarray, raising premiums and reducing insurance options.
• The number of uninsured Iowans dropped by nearly 93,000 in the first and second years of implementation of the ACA, as the percent of Iowans uninsured declined from 8.1 percent to 5 percent.
• Repeal of the Medicaid expansion portion of the ACA would leave Iowa with fewer persons insured than in 2013, before health reform, when IowaCare supplemented traditional Medicaid.

“What people may not realize is how much the Affordable Care Act dramatically expanded health insurance coverage in Iowa,” Fisher said. “Some 47,000 more individuals bought insurance with the help of subsidies from the ACA, and about 70,000 more Iowans obtained health insurance from Medicaid.”

About 28,000 more obtained coverage through their employer since the ACA began in 2014, he noted, so the expanded public insurance was not just picking up people dropped from employer plans as some had feared.

In addition, he noted, Census data show that the large drops in uninsurance that came with the ACA included improvements in nine of the state’s 10 most populous counties — often by a substantial amount, nearly by half or better in Dallas, Polk, Pottawattamie, Scott, Story and Woodbury counties.

All told, about 41,000 fewer Iowans in the 10 largest counties were uninsured in 2015, while 52,000 fewer Iowans in the remainder of the state had coverage.

“This illustrates the stakes in Iowa for decisions in Washington on the ACA,” Fisher said.

The report is available at

The Iowa Fiscal Partnership is a joint public policy analysis initiative of two nonpartisan, nonprofit Iowa organizations: the Iowa Policy Project in Iowa City, and the Child & Family Policy Center in Des Moines. Reports are at

# # # # #