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me-mapDuring the first six months of this year, the number of people hospitalized in Iowa without insurance fell by 45.7 percent compared with the same period last year, an IHA analysis has found.  The analysis is based on data collected from 101 Iowa hospitals from January through June.

According to the study, out of about 159,000 hospital discharges from January to June in 2014 and 2013, 4,445 patients were uninsured this year compared with 8,181 in 2013.

The reductions are linked to the state’s expansion of Medicaid through the Iowa Health and Wellness Plan, which has helped thousands of low-income Iowans gain health insurance coverage.  Because of Medicaid expansion, in a six-month span, Iowa hospitals cared for fewer uninsured patients in all settings, including patients admitted for inpatient care as well as those seeking care at hospital emergency rooms and at outpatient clinics.  Similar results are being seen in other states that expanded Medicaid under the Affordable Care Act.

IHA President and CEO Kirk Norris said, “This analysis provides further evidence that Medicaid expansion is doing what it was intended to do – making health care more accessible and affordable for the 110,000 Iowans who have gained eligibility and coverage.”

For the period January 1-June 30, overall inpatient admissions at Iowa hospitals declined 4.4 percent compared with the same period in 2013.  Within that decline, the number of uninsured hospitalized patients with no source of payment for their health care fell by 45.7 percent in 2014.

Additionally, fears that expanding coverage would make care so easily accessible that use of hospital emergency rooms would rise to unprecedented levels have not materialized, the IHA analysis found.  Total visits to emergency rooms increased less than 1 percent when comparing the six-month spans in 2013 and 2014, despite approximately 30,000 patients with new policies purchased through the Health Insurance Marketplace.

With more Iowans now insured, hospitals’ charity care losses fell 18.5 percent, yielding a total six-month improvement of $32.5 million.

“Our health care system works best for those who are insured,” Norris said. “Coverage does more than help pay medical bills, it brings people into the system. It helps them establish a relationship with a personal physician and create a medical home from where care can be managed and coordinated with other providers.”

value-based-healthcare“Sustainable” is an adjective that gets thrown around a lot in virtually any debate.  It’s almost always in response to the affordability question and the answer is almost always in the negative, as in, “This program in unsustainable.”

But sustainability isn’t a bottom line – it’s a choice.  It’s the small choices a person makes about what to eat, what to wear and where to go on weekends.  It’s the much more significant and long-term choices we make about the work we do, where we live, what we drive and where we send our children to college.  It’s about our habits, goals and priorities.

In the same way, sustainability is addressed at the community level.  Not everything a community chooses to do (through its duly elected representatives) pays for itself – far from it.  Public transportation, recreation, security and human services that could never stand on their own are implemented and subsidized with public funds.

The same thing happens at the state and national level, only with much greater sums and, it seems, much less empathy as the distance from taxpayer and beneficiary to policymaker grows.  But, again, it is about priorities driving choices, choices driving investment and investment creating value.

Much of the argument against Medicaid expansion hinges on its alleged sustainability with regard to its reliance on federal funding.  Of course, right from the starting line the wheels begin to fall off that argument once the opponent is confronted with the reality that (1) expansion is paid for through the existing taxing and fee provisions of the Affordable Care Act and (2) the majority of funding for the governor’s alternative plan comes from Washington, D.C.

So it’s really not about sustainability; it is about priority and will.  For the last several decades, the federal government and presidential administrations from both major parties have willingly made Medicaid a priority and supported it as such.  This is consistent with the general will of voters, who desire to assist our most vulnerable citizens with the most basic needs, from food and shelter to transportation and education.  And yet for some, suddenly, it’s become debatable whether or not health care belongs on that list.

You don’t have to be a health care provider to find that absurd, but it seems providers are still needed to remind policymakers that health is the bedrock supporting the foundation of society.  What good is education for a child who is too sick to attend class?  What good is economic development to someone who can’t stay well enough, long enough to keep a job?

There are too many Iowans who lack access to health care because they are uninsured – that much of this debate is all but settled.  The unsettled question is how do we change that.  The governor advocates a plan that is overly limited in terms of the people it assists, the providers they can use and the services they can receive.

Proponents of this plan cloud these shortcomings with talk about patient buy-in, coordinated care and incentives for wellness and outcomes, as if Iowa health care providers had never heard of such things or could not manage their implementation without government involvement.  Iowa hospitals’ priority to ensure high-quality, patient-centered care, address overall health and control costs predate the fresh-from-the-oven (though not yet fully baked) Healthy Iowa Plan by years, if not decades.  That the “Triple Aim” has suddenly penetrated the thick walls of the Statehouse is to providers’ credit.

But what providers do and what legislators now realize about the Triple Aim matters little to low-income Iowans who are not engaged with the health care system.  Innovation becomes meaningless when basic access is denied.  Legislators need reminding that providing access is not so much a matter of dollars, but of remembering our Iowa priorities and mustering the will to sustain them.

cartoon Recent communications from opponents of Medicaid expansion, including items published in newspapers, have included confusing and misleading information.  These statements have generally fallen into two broad areas: the growth of Medicaid and the quality of care provided to Medicaid beneficiaries.

In newsletter articles to constituents as well as newspaper columns, expansion opponents in the Legislature have noted that Medicaid enrollment in Iowa has risen substantially since 2000.  This is true, of course, and for a number of reasons, not the least of which are more than a dozen policy decisions made by legislators which added more than 80,000 people to the Medicaid rolls, as well as the economic downturn – the worst since the Great Depression – which saw tens of thousands of Iowans lose their health insurance.

Opponents have also pointed out that there are as many as 81,000 people in Iowa who are eligible for Medicaid but not now enrolled.  They postulate that the publicity surrounding Medicaid expansion will encourage these Iowans to sign up for the program and drive up costs.

This is a real possibility, but it’s just as likely (if not more) that those people will “come out of the woodwork” when the individual health insurance mandate and health benefit exchanges begin in 2014.  Therefore, it makes more sense to attribute any increase to health benefit exchanges – which Iowa is now pursuing – than to expanding health insurance to an entirely new population.  It’s misleading for opponents to attribute these costs to Medicaid expansion when the state obligated itself to provide coverage to these individuals long before expansion was an issue.

No one is claiming that expansion is “free,” certainly not hospitals, which are taking billions of dollars in Medicare cuts to help finance it.  But let’s keep front and center the benefits of expansion (in addition to providing coverage to tens of thousands of Iowans and, speaking of care that isn’t free, reducing Iowa hospitals’ $1 billion in yearly uncompensated care).

The fact is the Kaiser Family Foundation, a nationally recognized nonpartisan research center, released a report in November 2012 examining the impact of expanding Medicaid on state governments.  Specifically, the Kaiser report indicated that expanding Medicaid in Iowa could save our state as much as $30 million annually in reduced costs in other areas.  Furthermore, the Iowa Medicaid program found in its research that expansion will save as much as $60 million in county property taxes for mental health services.  Additionally, independent research has shown Medicaid expansion will inject $2.2 billion into the Iowa economy and add more than 2,300 jobs across the state.

Finally, without providing any details, sources or studies, several legislators are claiming that current Iowa Medicaid recipients “are not getting any healthier.”  This flies in the face of well-documented evidence showing Iowans – all Iowans – receive some of the highest quality care in the nation.

Such statements are also an affront to Iowa hospitals, physicians and other health care professionals who are committed to continuous improvement through efforts like Partnership for Patients and the ongoing work of the Iowa Healthcare Collaborative.  Hospital advocates should not sit still for this and be quick to point out the resources that have been committed, the progress being made and the recognitions achieved because of their hospitals’ dedication to high-value, highly-coordinated, patient-centered health care.

Iowa already has an excellent health care system that is always challenging itself to get even better.  But Iowans cannot fully benefit from the system without insurance.  Medicaid expansion remains Iowa’s best opportunity to provide coverage and improved access to health care for as many as 150,000 uninsured, low-income Iowans.

Here in Iowa and across the nation, arguments for Medicaid expansion have weighed heavily on those who have taken the opposite stand.  The problem for them is the facts keep getting in the way of their rhetoric.

IHA’s media campaign is flooding the radio waves and providing persuasive video presentations to listeners and viewers across the state.  These carefully crafted messages are making the expansion argument point-by-point, showing how expansion will benefit individual Iowans and improve mental health access, for example.  The videos also make the business case for expansion and dispel the myths that have been propagated by opponents.

Meanwhile, independent research is providing further evidence to support the hospital position.  A report from George Washington University shows expansion will bring nearly $2.2 billion to the state and create as many as 2,362 jobs – more than 14 times the jobs promised by the widely heralded state economic development project in Southeast Iowa.

medicaid-rally1_t600x400Research has also shown that a solid majority of Iowans back expansion in all parts of the state.  Those same Iowans overwhelmingly want to ensure that their neighbors have access to preventive and mental health care, so when they realize expansion provides exactly that, they are even more supportive.  And when they learn of the economic benefits, their support becomes even greater.

Such mounting evidence has been very persuasive to newspaper editorial boards across the state.  Practically every major Iowa daily newspaper has endorsed IHA’s position, from Council Bluffs to Des Moines to the Quad Cities – and back again to Iowa City (including the university’s newspaper), Cedar Rapids, Mason City and, most recently, Sioux City.  At the same time, hospital leaders have stepped forward to amplify and localize the case for expansion (examples here, here and here.)

There is still much work to be done.  The Iowa business community has been, for the most part, noncommittal on the question, even as the business, economic impact and popular opinion data have clearly favored expansion.

More evidence came to light recently as an analysis showed $17 billion in federal Disproportionate Share Hospital funding will be cut, with the expectation that Medicaid expansion would cover the difference.  For states that don’t expand?  Well, that’s just another hit (along with exploding uncompensated care) that private payers (meaning employers) will have to help offset.

Also this week, Jackson Hewitt Tax Service reported that Iowa’s failure to accept expansion would cost state businesses between $12.7 and $19.1 million a year in “shared responsibility” penalty payments related to uninsured Iowans seeking coverage through the state’s insurance exchange.  Bottom line: “State government efforts to constrain Medicaid costs growth in and after 2017 may lead to higher net taxes for employers…beginning in 2014.”

Meanwhile, another analysis shows Medicaid expansion will benefit our military veterans.

These are the pro-expansion realities that eclipse the oppositional rhetoric.  These are the facts that bear repeating to legislators and locals because understanding has done nothing but nurture support.

Medicaid expansion remains a win-win-win for Iowans, Iowa government and Iowa businesses.  But the argument will not be won until everyone understands just how much is at stake.

Mental health care is something that all Iowans need access to just as much as they do any other form of care. But the governor’s proposed health care solution leaves this crucial need unfulfilled.  Aside from providing more access, Medicaid expansion in Iowa is predicted to help counties save up to $60 million in local funds that are supported by property taxes. These funds can then be used to help other local programs and benefit others outside of providing health care services.  The latest video from IHA examines the benefits of keeping mental health in the fight for why Iowa needs to expand its Medicaid program.