By Sheena Dooley | Iowa Watchdog
DES MOINES – The U.S. Supreme Court’s ruling Thursday to uphold President Obama’s overhaul of the nation’s health-care system will have broad and far-reaching implications.
Just what those entail have yet to be seen, some say.
“We have lawyers and Medicaid staff helping review those implications,” said Tim Albrecht, spokesman for Republican Gov. Terry Branstad, who had signed onto the lawsuit challenging the Affordable Care Act. “Those will take weeks to sift through.”
What is known is nearly 350,000 uninsured Iowans will have to sign onto a health plan by 2014 or face an additional tax. GOP challenger Mitt Romney has vowed to change the law, if elected in November.
The uninsured will most likely have two options for gaining coverage: through subsidized health exchanges or Medicaid, said Peter Damiano, director of the University of Iowa Public Policy Center and Health Policy Research Center.
The cost to insure those who lack coverage could reach $500 million or more in Iowa, according to estimates from eHealth Insurance, the nation’s leading online health insurance provider. It’s unclear where the funding will come from, although some Iowa policy experts say the uninsured and taxpayer dollars will cover much of the expense.
Albrecht said it’s speculation at this point and declined further comment.
“It’s really cost shifting,” Damiano said. “The uninsured were getting care before and the insured were paying for it. This should reduce the amount of cost shifting and reduce Medicare reimbursements to providers.”
“The majority of people are being moved to private insurance. The government is doing that by subsidizing the private insurance companies. Is that a cost we can bear in the long term?” he added.
Insurance providers agreed to the lower Medicare reimbursements when the law was being crafted in 2009 because it would help offset the cost of the uninsured, whom they are required to care for, said Keith Mueller, professor and head of the Department of Health Management and Policy at the University of Iowa.
To date, 43 pieces of the law have already taken affect, but those mainly pertain to children. Examples include children staying on their parents’ insurance until age 26 and free preventative-care visits.
Most of the major components of the law won’t take effect until 2014, such as the creation of health exchanges, coverage of pre-existing conditions and a requirement that prevents insurance companies from dropping people if they become ill.
“By and large, when you look at the data, it’s a good thing to provide people with health care and insurance at a price they can afford,” Mueller said. “Overall, the law seems headed in a good direction and at least now we have legal clarity. Now the battle is on during the election. Politically, do people want to move on? Legally, we are good to go.”
Iowa politicians said in interviews Thursday that health-care reform will become an election issue.
“Obviously, if Obama is elected, you’re going to continue down this road,” Republican U.S. Sen. Chuck Grassley said in a conference call with reporters Thursday. “But if Romney’s elected president … he’s going to have to deal with Congress, so all you can do is give broad outlines (for changes).”
“Our broad outlines are to repeal and replace and to make sure that we get the private sector and free-market economy making more decisions, make sure we don’t have the government between the patient and doctor, and make sure that we cut down on costs,” he added.