Iowa governor rolls out alternative to Medicaid expansion

Branstad: Healthy Iowa Plan will be better for state in long term

Mike Wiser
Published: March 4 2013 | 12:56 pm - Updated: 28 March 2014 | 12:14 pm in
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UPDATE: Gov. Terry Branstad’s Medicaid expansion alternative received a cool reception from Senate Democrats, who would have to agree to the plan to make it a reality.

Dubbed The Healthy Iowa Plan, Branstad’s proposal covers roughly 89,000 uninsured Iowans, while Medicaid expansion is estimated to cover 150,000 uninsured Iowans. Branstad’s plan also costs tens of millions more for the state than Medicaid expansion would.

But the plan is a better deal for Iowans in the long run because there’s no way the federal government is going to follow through the obligations it made under voluntary Medicaid expansion, the governor said.

“When the cut comes, it’s not going to be as big,” he said during a news conference Monday where he announced the plan. “Let’s realize the reality that the federal government is broke.”

Senate Democrats were quick to criticize the plan.

Senate President Pam Jochum, D-Dubuque, sent out a statement calling the proposal “second-class health care (for) tens of thousands of working Iowans,” and Sen. Jack Hatch, D-Des Moines, repeated his promise for a drawn-out session if both sides insist on digging in their heels.

“I think we have to stay here until we have an agreement,” he said. “Otherwise people just won’t have insurance on next January 1st; that’s just something we won’t do.”

Medicaid expansion would cover people with incomes below 138 percent of the federal poverty level and covers people up to 250 percent of the poverty level in some instances.

The Healthy Iowa Plan requires that everybody pay at least something for their health care coverage, but people who fall below the poverty line could have those payments waived if they take part in services such as health assessments and annual physicals. Iowans above the poverty level can receive tax credits to subsidize purchasing private health insurance.

Branstad said it’s set up this way so people have “skin in the game” by paying for their health care. He likened it to being at a wedding with an open bar and or a cash bar, where “there’s going to be a lot more liquor consumed with an open bar.”

That brought a rebuke from Sen. Mary Jo Wilhelm, D-Cresco, who said on the Senate floor that the governor should apologize for saying it and “never say that again.”

Iowa hospital groups and health care advocates have lobbied for Medicaid expansion.

If agreement is reached, the plan still has to be approved by the U.S. Department of Health and Human Services as a waiver. That waiver request is due this summer.

“Gov. Branstad’s proposal is a step forward in terms of providing health coverage to all Iowans. What Iowa needs now is clarification from the federal government on whether the Centers for Medicare and Medicaid Services is in a position to approve the major aspects of the plan as presented,” Child and Family Policy Center executive director Charles Bruner said in a statement Monday. “Iowa cannot afford to spend time preparing a waiver proposal that can’t be approved.”

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