Medicaid Expansion Helps Iowa Hospitals and Patients

Nov 18, 2014

Credit Jennifer Morrow

Since the passage of the Affordable Care Act, 110,000 Iowans have enrolled in Medicaid through the Iowa Health and Wellness Plan.  The income threshold for those eligible went from 100 percent of the poverty level, to 138 percent. 

CEO of the Iowa Hospital Association Kirk Norris talks with Morning Edition about how Medicaid expansion has affected Iowan hospitals. 

Clay Masters: It’s Morning Edition on Iowa Public Radio. Good Morning. I’m Clay Masters.

The Affordable Care Act, commonly called Obamacare has been in place for more than a year now and one key part of it was expanding Medicaid. That’s the joint federal/state healthcare program for low income people, but states were given the option to expand it.

Here in Iowa, an alternative to Medicaid expansion was passed by state lawmakers and now, new data from the Iowa Hospital Association says the Iowa Health and Wellness plan is benefiting both hospitals and patients. Kirk Norris is the organization’s CEO, and he’s with me this morning. Good morning, Kirk.

Kirk Norris: Good Morning.

Clay Masters: So what does this data tell us?

Norris: What the data tells is that the original objective of expanding the Medicaid program is being borne out by the facts. The original objective was to get more people into the system. We can demonstrate now that there is 4,000 fewer uninsured patients being seen by hospitals in the first six months of 2014, as compared to the same time period, in 2013.

And so as a result those folks are enrolled in the system, they’re seeing a primary care physician. Basically we’re getting them into the healthcare system in Iowa.

Masters: What’s it doing to the amount of people who are stopping by emergency rooms, for emergency room visits?

Norris: Basically it’s been no affect. One of the arguments that was raised in opposition to expanding Medicaid was that, once folks had insurance they were going to use services more, and be seen more in the emergency room. And quite frankly we’ve seen no growth in the emergency room visits as a result of having 110,000 more Iowans enrolled in Medicaid.

Masters: This new data that causes this conversation today, what’s it done for day-to-day operations in hospitals?

Norris: It obviously has allowed hospitals to see folks outside the emergency setting, so in a lower cost setting. Get them enrolled into the same type of programs that you and I are enrolled in, in terms of if you have chronic illnesses. Seeing them more regularly. Getting folks onto medications. Managing those chronic illnesses in a proactive fashion.  Versus seeing folks on a limited basis in the ER, and then perhaps having to put them into the hospital.

So you’ve really moved from a high cost center of care, to much lower costs in terms of managing chronic illness, and so hospitals have been able to do a better job of working with folks that historically were uninsured.

Masters: Now shifting gears a little bit into something that has been in the headlines recently.  This term, the U.S. Supreme Court will hear King vs. Burwell. Now the court will determine if people enrolled in the federal healthcare exchange are still eligible for federal subsidies. Now that’s opposed to a state-based exchange. And in Iowa, we have a partnership exchange. How could this decision affect Iowans and hospitals?

Norris: Iowa as well as all other states by 2015, need to decide if they want to run their own state exchange. Where today we have 30,000 Iowans that have purchased insurance on that state-federal partnership exchange that you talk about. The argument is that, the language of the law only allows for subsidies if you purchased insurance on an exchange run by a state.

If Iowa elected not to set up its own exchange and the Supreme Court said, “You’re not eligible for subsidies if you buy your insurance on a federal exchange,” that would mean that 30,000 Iowans would not receive subsidies for buying insurance. Which would place into doubt whether or not next year they would have that insurance.

So it’s a critical question. I think it’s one the state could deal with proactively by setting up its own exchange, which really, regardless of the Supreme Court decision would remove that question.

Masters: OK, Kirk Norris, thanks so much.

Norris: You’re welcome.