IowaCare is poor substitute for comprehensive insurance

The Des Moines Register


Washington lawmakers reformed health care because voters demanded it. When millions of Americans are a broken leg or heart attack away from financial ruin, people eventually get fed up. Congress and President Obama acted because this country’s system of paying for health care is broken.

Yet opponents of reform would have us believe everything was just fine before Washington intervened. Gov. Terry Branstad is among them. He offers no clear plan to get low-income Iowans insured, but he opposes an opportunity under the law to expand Medicaid and help them. In addition to leaving thousands of Iowans uninsured, the governor wants to continue covering thousands in a state program called IowaCare that is a poor substitute.

Meeting with The Des Moines Register editorial board recently, he said he may pursue another federal waiver to continue IowaCare. That makes no sense for poor Iowans or the state budget.

IowaCare began in 2005 to cover low-income Iowans ages 19 to 64 who were not eligible for Medicaid and Medicare and couldn’t afford other insurance. With Washington’s approval, the state has used federal money to get them limited coverage. Though the program has been better than leaving them with no insurance, many enrollees are forced to drive across the state to visit approved providers in Des Moines and Iowa City.

Iowa’s waiver expires at the end of 2013. What will more than 60,000 Iowans do then?

Beginning Jan. 1, 2014, almost all of them could be covered by the expansion of Medicaid. They could have comprehensive insurance, including prescriptions and mental health services. The could visit doctors in their hometowns. The federal government will pay for 100 percent of their care for the first two years and almost the entire bill after that, which is more than the federal matching rate for IowaCare.

Instead, Branstad wants federal permission to continue an inadequate program that will cost the state more and provide care that is much less convenient for the patients. And the logic is baffling.

The governor says he is opposed to a Medicaid expansion because he is concerned about the federal government’s ability to pay for it going forward. Yet he’s more than happy to ask that same federal government to let Iowa use federal money to cover people in the IowaCare program. The health reform law is paid for anyway, Kirk Norris, president of the Iowa Hospital Association, said. The only question is whether Iowa is going to take the money.

The state’s hospitals hope he does. Norris wants the governor to expand Medicaid. “We are taking care of these people anyway,” he said. When they are uninsured, hospitals do not get paid. When they are enrolled in IowaCare, hospitals may not be reimbursed for all services they provide.

Obtaining a waiver to continue IowaCare is a bad idea. There is no guarantee the federal government would grant it, and Branstad has outlined no plan if they don’t. Washington is doing everything it can to finally get all Americans health insurance. Iowa’s governor should have the same goal.



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