The governor's Medicaid malpractice

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If you picked Medicaid expansion in the Statehouse summer stalemate pool, I like your chances.

And yet, it seems like it could have been avoided.

At the end of June, the U.S. Supreme Court upheld much of Obamacare, but ruled that the feds can’t force states to expand Medicaid to cover more low-income folks. Expansion must be voluntary. On July 2, Gov. Terry Branstad declared that Iowa would not take the offer. “We want to look at a better and different alternative,” he said.

We didn’t even get a glimpse of “better” until March 4. Eight months later. And almost no one beyond the governor’s political allies thinks it’s better. It costs the state a lot more, covers far fewer uninsured Iowans and requires a federal waiver that’s unlikely to be granted. Hospitals and health care providers want Medicaid expansion instead. Newspaper editorial boards normally supportive of the governor are panning it.

The sad thing is, the governor is right about the dangers of Medicaid expansion. It probably will, eventually, increase the state’s already ballooning Medicaid costs. And Democrats, who claim that the state can simply opt out of expansion if the feds don’t cover funding promises, are spinning a fantasy.

Faced with a future federal pullback, we’re really going to yank health coverage away from thousands of Iowans? Seriously?

But instead of getting to work immediately last summer on a good alternative to cover the 150,000 Iowans who would be eligible for expanded Medicaid, the governor's office played it like a kid who blows off homework hoping for a snow day. Surely, President Obama will be defeated. Republicans will grab Congress and the Legislature. Obamacare will be a memory. Uninsured? What uninsured? To the campaign trail.

You’d think that a savvy, veteran politician would know that elections don’t always go as planned. You’d think that a former medical school president would consider tens of thousands of Iowans without health coverage as a problem worth solving, regardless of who wins in November.

Instead, we got campaign speeches, and delay, and then postelection dithering, and then an alternative plan that makes Medicaid expansion look even better. And now a potential stalemate that could jeopardize other parts of the governor’s agenda. Oh, and there are thousands of Iowans whose two-part health coverage remains crossed fingers and prayer.

If this issue were a sick patient, it would be a clear case of malpractice.


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