Branstad doesn’t see Medicaid expansion

DES MOINES - Gov. Terry Branstad said he doesn't trust the federal government to make good on its Medicaid promises and doesn't intend to expand the state's program if he's not forced to.

That stance is being criticized by state Sen. Jack Hatch, D-Des Moines, who has been part of the national reform effort and said the governor's position would kick thousands of Iowans off the health care rolls.

“I just wish the governor cared less about being a partisan spokesman for (presumptive Republican presidential nominee) Mitt Romney than about the health care of Iowans,” he said.

The issue comes out of Thursday's U.S. Supreme Court decision that upheld the requirement that most Americans have to buy insurance. It also ruled that the federal government doesn't have the authority to punish states that don't expand Medicaid coverage.

Branstad called the proposed punishment “federal blackmail” when he spoke to reporters Monday morning.

That decision has led to states questioning whether they should expand Medicaid coverage. The federal government establishes baseline coverage rules for the Medicaid program, but states can go beyond those regulations, so who qualifies for coverage may vary from state to state.

Medicaid and Medicare programs now cover at least some medical bills for 400,000 Iowa residents. The federal government covers a bit more than two-thirds of total cost of care under Medicaid; in fiscal 2011, for example, Iowa's share of the Medicaid bill was $950 million out of $3.2 billion overall.

Administration officials estimated an additional 150,000 people would be put onto the Medicaid rolls if the state goes through with the expansion. That includes 60,000 people who participate in the Iowa Cares program, which is set to expire in 2014. That program covers some of the same costs as Medicaid for people who earn up to 200 percent of the federal poverty level, with some restrictions.

The Medicaid expansion in the Affordable Care Act covers people who earn up to 138 percent of the poverty level. Without either Iowa Cares or the Medicaid expansion in place, the cutoff, in most instances, would be 78 percent of the poverty level.

In addition to the now unconstitutional stick of losing federal funding, the Affordable Care Act gave states the carrot that the federal government would pick up 100 percent of the expansion through 2017. The reimbursement would fall until 2020, when it hit 90 percent, then stay at that level.

“Here's the problem. The federal government has done this again and again: ‘Buy into our program, and we're going to do all these things for you,' and then it doesn't happen, and then the taxpayers of the state get stuck with it,” Branstad said Monday.