Q: Why are changes needed to fix the Affordable Care Act?
A: No piece of legislation is perfect, especially one that restructures one-sixth of the U.S. economy. The Affordable Care Act is a prime example. When President Obama signed this sweeping health care overhaul into law seven years ago, Americans were promised lower insurance bills, better coverage and more access to high quality health care. In the meantime, the law raised taxes, enacted mandates, added penalties and created thickets of regulations. Even with an individual insurance mandate and generous federal subsidies for Americans not covered through their employer or public health care programs, more than 28 million Americans were still uninsured in 2016. Since the law’s enactment, thousands of Iowans tell me that soaring premium increases, co-pays and deductibles are making access to health care more unaffordable. Many have asked: “What’s good about having health insurance if I can’t afford to use it?” That’s the crux of the matter. Decreasing the number of uninsured Americans is an important policy goal. However, a one-size-fits-all, government-driven solution is not the right solution. Since passage of the ACA, health care premiums keep climbing higher and higher. Congress is working to fix flaws in the law to provide stability in the health insurance marketplace and drive down the cost of coverage for consumers. On top of cost, insurers across the country are abandoning the ACA marketplaces, leaving millions of Americans in the lurch without access entirely. That includes 72,000 Iowans. Two carriers in Iowa have announced they are leaving the individual insurance market. Only one has said it plans to offer coverage to Iowans next year, but that it would raise premiums by more than 43 percent on average. It’s beyond dispute that reforms are necessary to fix this broken law.
Q: What would happen if no changes are made to the ACA?
A: The individual insurance market would continue to collapse, bringing more uncertainty and making health care insurance even more unavailable to even more Americans. Without reform, taxpayers would be on the hook for rising deficits and unsustainable Medicaid spending as far as the eye can see. Medicaid was enacted 52 years ago to serve Americans who are disabled and those living in poverty. Since 1965, the lion’s share of federal anti-poverty spending has gone to health care. As with any federal program paid for by taxpayers, good fiscal stewardship and oversight is essential to help ensure sure every dollar spent is spent as intended. Well-intended, but poorly constructed incentives -- whether we are talking about defense dollars spent by the Pentagon or health care dollars spent under the Medicaid umbrella -- have fostered a system of runaway spending. As the Senate continues to debate solutions to expand affordable coverage to Americans, I will keep listening to individual Iowans, health care providers and state officials who will be impacted by proposed changes to the ACA. I’ll continue working for solutions that give states more flexibility to innovate and meet the needs of their populations, especially those most in need. Restoring stability in the individual insurance markets will help drive down costs and expand coverage with competition in the free market. If there’s one thing I’ve learned having served Iowans in the U.S. Senate, reaching consensus isn’t easy, especially on issues such as health care policy that affects the lives and livelihoods of American families. But it can be done. Bipartisan solutions to serious challenges are ideal, and we should work to achieve them. Bipartisan legislation tends to withstand the test of time because it results from thoughtful negotiation and compromise. As always, I will keep my nose to the grindstone. It’s the right thing to do.
