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The uninsured rate among veterans less than age 65 declined by nearly 40 percent during the first two years of the Affordable Care Act (ACA), according to a new study by the Urban Institute with funding from the Robert Wood Johnson Foundation.

The uninsured rate fell from 9.6 percent in 2013 prior to ACA, to 5.9 percent in 2015, according to the report. Approximately 429,000 veterans gained coverage, and the gains were broad-based across demographic groups.

Among veterans ages 45 to 54 and those who served in the era between the Vietnam and Persian Gulf wars, the uninsured rate dropped by almost 50 percent.

Before the ACA’s implementation, nearly one million veterans — almost one in 10– were uninsured, the study said. By 2015, the number of uninsured veterans fell to 552,000.

While many veterans have access to healthcare through the Department of Veterans Affairs, not all use or qualify for these services, the report said.

The study found that Medicaid expansion also helped to lower the uninsured rate for veterans. The uninsured rates in 2015 averaged 4.8 percent in expansion states, compared to 7.1 percent in states that didn’t expand the program. Iowa is one of 31 states that have expanded Medicaid.

For veterans with incomes up to 138 percent of the federal poverty level and eligible for Medicaid in expansion states, the uninsured rate dropped by 43 percent.

Veterans’ families also benefited from ACA, the study said. Using data from the 2013–2015 American Community Survey, researchers found uninsured rates for veterans’ spouses dropped from 9.2 percent in 2013 to 5.5 percent in 2015 and from 4.5 to 2.9 percent for their children.

Among black and Hispanic veterans, uninsured rates fell from 10.6 to 6.5 percent and from 11.0 to 7.1 percent, respectively, by 2015.

“The coverage provisions of the ACA have led to a 40 percent decline in uninsurance for non-elderly veterans,” said Katherine Hempstead, senior adviser at the Robert Wood Johnson Foundation. “Expansion of Medicaid in remaining states would increase those gains.”

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Fifty-five percent of Americans now support the Affordable Care Act (ACA), a major turnaround from five months ago when 42 percent approved and 53 percent disapproved, according to a new Gallup poll. This is the first time a majority of Americans have approved of the health care law, also known as Obamacare, since Gallup first asked about it in this format in November 2012.

Since the ACA’s passage, the law has been a significant political issue in each of the past four national elections. Republicans’ opposition to the ACA helped them win control of the House in 2010, control of the Senate in 2014 and the presidency last year.

However, Republicans’ plan to repeal and replace the health care law foundered last month, as House leaders’ replacement bill ran into stiff opposition within the party.

Republicans, Democrats and independents are all more likely to approve of the ACA now than in November, a few days after Donald Trump’s victory in the presidential election left Republicans in control of the legislative and executive branches. Independents have led the way in this shift toward approval, increasing by 17 percentage points compared with 10-point changes for both Republicans and Democrats.

Although the ACA never garnered majority support in Gallup polling before this month, nearly half of Americans (48 percent) approved of it the first time the current version of the question was asked in November 2012. In response to a previous version of the question that asked whether Americans thought passing the health care law was a good thing or a bad thing, 49 percent said it was a good thing when the question was first asked in early 2010. However, support was a few percentage points lower each of the next two times it was asked.

Though a majority of Americans now approve of the ACA, only about one in four (26 percent) want to keep it largely as it is. Forty percent want to keep the law in place but make significant changes, while 30 percent want to repeal and replace it.

What Americans want Congress to do next regarding health care hinges on their views of the ACA:

  • Twenty-six percent want to keep the law in place largely as it is.
  • The 40 percent who want to keep the law but make significant changes are evenly split: 49 percent want Congress to continue to work on healthcare in the next few months, while 49 percent would like to see Congress turn its attention to other issues for the time being.
  • Among the 30 percent who want the ACA repealed and replaced, most (64 percent) say Congress should continue to work on health care. Another 32 percent say Congress should turn to other issues.

The Gallup poll was based on phone interviews with 1,023 US adults in all 50 states and was conducted April 1-2. Its margin of error is plus or minus 4 points.

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The Iowa Hospital Association is pleased that the American Health Care Act was not pushed through the House on a wave of political pressure. There is far too much at stake – and too many unanswered questions – to force through a bill that would jeopardize health insurance coverage for more than 20 million Americans, including 200,000 Iowans.

The Affordable Care Act is not perfect, but Iowa’s hospitals are committed to working with elected officials and agency administrators on addressing those problems and making it better, just as we have been for the last seven years.

However, the AHCA was not the answer. It endangered the health of thousands of Iowans – senior citizens, children and families, the disabled, veterans and others – who have received health coverage under the Affordable Care Act. It threatened the Medicaid program that serves 630,000 Iowa residents. And it would have been an economic disaster for our state budget as well as hospitals and other health care providers that all Iowans depend on.

Iowa’s hospitals will continue to work with our congressional delegation as advocates dedicated to improving the health and lives of Iowans.

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Iowa hospitals are urging the state’s congressional delegation to vote against the American Health Care Act (AHCA), the bill designed to “repeal and replace” the Affordable Care Act (ACA) and which is expected to be voted on in the House today.

It’s estimated that this legislation would cause 24 million Americans to lose insurance coverage. In Iowa, it is estimated that 200,000 individuals who gained coverage under the ACA would lose their health care coverage. Because of this loss of coverage, Iowa’s hospitals would be called upon to care for more uninsured individuals through more expensive means, often in the emergency room.

Uncompensated and charity care will drastically rise again, causing concern for the viability of health care services in rural communities in Iowa and throughout the nation. Despite this loss of coverage and expectation for hospitals to shoulder the increased burden, the AHCA fails to restore billions of dollars in cuts to hospital payments that were part of the ACA.

Additionally, the proposal to change Medicaid from a federal-state partnership to a program that simply provides per-capita lump-sum payments to the states raises serious worries about the future coverage of 630,000 Iowa residents who depend on the program. Most notably, this fundamental change in Medicaid could eventually force the state, facing another tight budget year, to reduce care or tighten eligibility requirements, creating more uninsured, unhealthy Iowans.

The AHCA will not improve the health and well-being of Iowans. In fact, it will do the opposite. This legislation would return the nation to the dark days when the uninsured rate reached double digits and millions of families didn’t have access to primary and preventive care. That means a less healthy population and higher health care costs. It also means that health care providers will once again carry the burden of providing safety-net care. The impact will be borne by all health care consumers and taxpayers who will experience cost shifts to pay for that care.

AHCA will leave more Iowans without health insurance coverage and harm Iowa’s hospitals and communities.

IHA is asking hospital advocates to reach out to their US House members to vote “no” on AHCA. If you stand with Iowa’s hospitals, click here to send a message to Congress.

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(This article was provided by Kaiser Health News.)

After literally years of promises, House Republicans finally have a bill they say will “repeal and replace” the Affordable Care Act.

Some conservative Republicans have derided the new proposal — the American Health Care Act — calling it “Obamacare Lite.”  It keeps intact some of the more popular features of the ACA, such as allowing adult children to stay on their parents’ health plans to age 26 and, at least in theory, ensuring that people with preexisting conditions will still have access to insurance.

In some cases the elements of the law that remain are due to political popularity. In others, it’s because the special budget rules Congress is using — so Republicans can avoid a Senate filibuster — do not allow them to repeal the entire law.

But there are some major changes in how people would choose and pay for health care and insurance. Here are some of the biggest:

Tax Credits To Help Buy Insurance

Both the GOP bill and the ACA provide tax credits to help some people pay their premiums if they don’t get insurance through work or government programs. And in both, the credits are refundable (meaning people who owe no taxes still get the money) and advanceable (so people don’t have to wait until they file their taxes to get them). But the GOP’s tax credits would work very differently from those already in place.

Under current law, the amount of the credit is tied to a person’s income (the less you earn the more you get) and the cost of insurance where you live.

The GOP tax credits would be tied largely to age, with older people getting twice as much ($4,000 per year) as younger people ($2,000). But the Republican plan would also let insurers charge those older adults five times as much as younger adults, so even a credit twice as big might not make up the difference in the new, higher premiums.

The GOP credits also do not vary by location, so they would be worth more in places where health care and health insurance is less expensive.

The GOP credits do phase out gradually, starting with incomes above $75,000 for an individual and $150,000 for families.


The biggest changes the Republican bill would make are to the Medicaid program. Starting in 2020, it would roll back federal funding for the ACA’s expansion that allowed states — if they so chose — to provide Medicaid coverage to all low-income individuals under 138 percent of the poverty level, rather than just the specific categories of poor people (children, pregnant women, elderly, disabled) who were previously eligible. Thirty-one states opted to pursue this ACA provision. People who are covered under the expansion would continue to be funded by the federal government after that, but states would no longer be allowed to enroll anyone under those expanded criteria. And an enrollee who loses eligibility for the expansion program could not re-enroll.

But the bill would go further as well, making changes to the underlying Medicaid program that House Energy and Commerce Committee Chairman Greg Walden (R-Ore.) described as “the biggest entitlement reform in the last 20 years.”

Currently, Medicaid costs are shared between states and the federal government, but the funding is open-ended, so the federal government pays its percentage of whatever states spend. Under the proposed bill, the amount of federal funding would be capped on a per-person basis, so funding would go up as more people qualify. But that per-capita amount might not grow as fast as Medicaid costs, which could leave states on the hook for an ever-increasing share of the costs of the program.

“Capping federal contributions to the Medicaid program will likely force states with already tight budgets to limit eligibility and cut benefits to at-risk Americans,” said the American Public Health Association in a statement.

Help For Wealthier People

If you earn a lot of money, or even just enough to put aside something extra for health expenses, the GOP bill will provide a lot to like.

First, it would repeal almost all of the taxes that were increased by the ACA to pay for the expansion of health coverage. Those include higher Medicare taxes for high-income earners, a tax on investment income, and various taxes on health care providers, including insurance companies, makers of medical devices and even tanning salons.

The bill would also provide new tax advantages for those who can afford to save — including allowing more money to be deposited into health savings accounts, and lower penalties for those who use those accounts to pay for non-medical needs.

In addition, the plan would lower the threshold for deducting medical expenses on income taxes and allow people with job-based tax-preferred “flexible spending accounts” to put away more pretax money. It would also restore over-the-counter drugs as eligible for reimbursement from those accounts.

Mandates To Buy Or Provide Coverage

The GOP plan doesn’t actually repeal either the requirement for individuals to have coverage or for employers to provide it. That’s because it can’t under budget rules. Instead, the bill would reduce the penalties in both cases to zero, rendering the requirements moot.

The individual requirement was used by the health law to force healthy people into buying coverage to help improve insurers’ risk pools since they could no longer bar customers with preexisting conditions. Instead of the requirement that most people obtain health insurance or pay a penalty, the Republican plan would provide a penalty for those who do not maintain “continuous coverage.” Those with a break in insurance coverage of more than 63 days could still purchase insurance without regard to preexisting health conditions, but they would be required to pay premiums that are 30 percent higher for 12 months.

The employer “mandate,” which requires firms with 50 or more workers to offer coverage or pay a fine, has actually had relatively little impact on insurance coverage, analysts have concluded, and probably is not necessary to prevent employers from dropping coverage. In both the ACA and the GOP bill, however, workers whose employers offer coverage could not decline that coverage and get a tax credit instead.

How To Pay For It

With all the taxes and fees stripped from the ACA, how will Republicans pay for their tax credits? The answer is not clear yet.

“We are still discussing details, but we are committed to repealing Obamacare and replacing it with fiscally responsible policies that restore the free market and protect taxpayers,” said the Republican fact sheet that accompanied the release of the bill.

Also still missing is an estimate from the Congressional Budget Office that will detail not only how much the proposal will cost, but also how many people would gain or lose health insurance. Republicans insist that estimate will be available before the full House votes on the bill.

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