RHSHC Board of Trustees chair travels to D.C.


CRESCO - Regional Health Services of Howard County (RHSHC) Board of Trustee Chair George Willis traveled to Washington, D.C. recently to discuss the impending Senate vote on the Better Care Reconciliation Act.
The Iowa Hospital Association and Regional Health Services of Howard County sponsored Willis’ trip.
RHSHC CEO Robin Schluter said she feels Willis’ trip was an important way for rural communities to give voice to concerns about the Better Care Reconciliation Act.
“The Commonwealth Fund is projecting rural hospital uncompensated care costs in Iowa will spike by 66 percent, and they project the operating margins for those hospitals would drop to 8.9 percent,” Schluter said. “The visit was well worth the effort and the time to give our community’s perspective of the potential impact of this legislation.”
She continued, “In Iowa, we’ve already taken a financial hit from the Medicaid services rolling into the managed care program, and the BCRA would only further our financial burden for caring for those on Medicaid services or those who lose their Medicaid eligibility.”
Schluter notes Willis and others on the board serve in a volunteer capacity:
“The Board of Trustees is all-volunteer, and for George to go out to Washington, D.C. on our behalf shows how important this issue is to our organization.”
George Willis comments
Willis shared his perspective on his visit to D.C. and the ensuing discussion with Senators Charles Grassley and Joni Ernst and their teams with the Cresco Times Plain Dealer:
“I was very humbled to be one of the 12-person delegation from the state of Iowa to be asked to go on this trip to Washington, D.C. to discuss the repeal of the American Health Care Act (AHCA). There were 11 CEOs. I was the only Board Chair, and what made it even better, I was representing our hospital, Regional Health Services of Howard County,” Willis said.
He continued, “There was a lot of discussion on the issues, but I mostly wanted to push the importance of not de-funding the Medicaid and Medicaid expansion. A couple of things I brought to the senators’ table: First of all, Medicaid still has the stigma of mostly being used for young folks having babies, non-working folks with kids, etc. If you look at the statistics now, it is now supporting more of our senior citizens, and one of the most important medical conditions that used to be out of the reach of many folks is mental health care and special needs. The Medicaid expansion has allowed this to happen.”
Willis presented a hypothetical local situation: “If Featherlite was to have a temporary layoff, this program would help assist these people with their health insurance, which they would otherwise not be able to keep because of the cost. It may be enough to just keep them here (in Cresco) until we can hire them back, and maybe even enough to keep them from moving to another city. 
“This program has also helped make it possible for hospitals to grow and put in place departments to handle these special needs folks. To stop this program, you would also cause some hospitals to have to close their doors because of how they are reimbursed through this program.”
Willis told the Senators, “Medicaid was not even part of the original bill, but now it has been thrown into this one and is in jeopardy of being dismantled, and thousands of Americans and Iowans could lose the health care and assistance. Don’t you think that you should at least read it for yourself and make your decision from what you have read? 
“Also, the American people should be allowed to see it before the vote. Is Obamacare (the Affordable Care Act) the answer? Is it perfect? No, not by any means. However, don’t destroy the entire program that would cause thousands of Iowans to lose the health insurance they currently have and dismantle the Medicaid program. Take the parts that are causing such great concerns and as a group rework that. It is imperative that you vote ‘No’ on this bill until it has been given the time needed to be reviewed and re-worked.”
Distinctions between health care plans
The Modern Healthcare website describes the differences between the Affordable Care Act (Obamacare), the House’s American Health Care Act and the Senate’s Better Care Reconciliation Act. Among the distinctions:
Medicaid expansion
ACA: Enhanced federal match for expansion population is 95 percent this year; 94 percent next year; 93 percent in 2019; and 90 percent in 2020 and beyond.
AHCA: Match would remain as described in the ACA until 2020, with the enhanced match until beneficiaries cycle out of the program.
BCRA: Ninety percent match in 2020; 85 percent in 2021; 80 percent in 2022; 75 percent in 2023. No grandfathering. After 2023, federal contribution is based on general state match percentage.
Medicaid financing
Current law: States design plans, provider payment levels and eligibility. Federal match rate varies depending on the wealth of the state, ranging from 50 percent to 73 percent.
AHCA: In 2020, a per capita cap that could grow by either the medical component of the Consumer Price Index or medical CPI plus one percentage point. The aged and disabled adults would be under the more generous per capita cap. Each state’s base figure would be based on historic per enrollee spending.
BCRA: Per capita cap takes effect in 2020, excludes children who are on disability. In 2025, the cap would grow at standard inflation, a much lower rate than medical CPI. States could set the base rate.
Current law: Available to persons or families between 138 percent and 400 percent of federal poverty level, as long as they don’t have access to affordable plans through work, and are based on age, income and local cost of insurance.
AHCA: Available for everyone except those insured through work. Age-based only and more generous than current law to younger customers.
BCRA: Available o those below 350 percent of poverty. Based on age, income and local cost of insurance. Those age 50 and older, starting at 200 percent of poverty receive lower subsidies than under the ACA; 60 –to-64-year-olds could have to spend as much as 16 percent of their income on premiums before subsidies compared to 9.7 percent in the ACA.
Essential Health benefits, medical underwriting, pre-existing conditions
Current law: Ten essential health benefits, such as prescription drugs, maternity care and mental health care are mandated. Plans must sell to everyone and cannot charge sick people more.
AHCA: States may apply for waivers to drop essential benefits or the rules on charging sick people more, but those changes only apply to those who did not maintain continuous coverage.
BCRA: States may apply for waivers, but not for rejecting sick applicants or charging them more.
Individual and employee mandates
Current law: Everyone must have insurance or face a tax penalty. Companies with at least 50 employers are required to offer insurance.
AHCA: Those who don’t buy insurance can be charged 30 percent more per month, for one year when they try to come back in. No employer mandate.
BCRA: No mandates
Current law: Taxes on insurers, hospitals, medical-device manufacturers, rich employer-based plans and investment income, among others, help pay for the expansion. Some of those taxes, especially the Cadillac tax on rich employer plans, were so unpopular they were never implemented. The investment income tax is the biggest funder.
AHCA: The taxes are repealed, though not all immediately.
BCRA: The taxes are repealed, some retroactively, such as the investment tax, and some in 2018 and 2023. The Cadillac tax is temporarily repealed, but returns in 2026.

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