Without more funding, Iowa's Medicaid money runs out in June

Abortion language continues to be sticking point in budget negotiations

State funding for Medicaid is slated to run out in early June, putting additional pressure on state lawmakers to resolve an ongoing impasse over language dealing with public funding of abortions that has stalled work on the health and human services budget piece this session, officials said Thursday.

Members of the split-control Legislature left the Capitol last year without finalizing the health and human services budget for the current fiscal year, when some House Republicans insisted on banning public funding of abortion in relatively rare instances in which a doctor deems it necessary and a woman doesn't have money or insurance coverage to pay for the procedure.

The impasse was not settled in the last election, in which Democrats managed to maintain a 26-24 edge in the Iowa Senate and Republicans saw their majority slip to 53-47 in the Iowa House, and now lawmakers face an approaching deadline to provide supplemental money to fund Medicaid services through June 30.

“It’s a sticky issue,” said Senate President Pam Jochum, D-Dubuque.

David Roederer, director of the state Department of Management, said Medicaid programs cost the state general fund about $3 million a day, so current funding probably will carry services into the early part of June before the estimated $43 million in supplemental money will be needed.

“It depends on a week-to-week basis,” he said. “Right now I think we have sufficient money to get probably to the first part of June, because enrollment has been down.”

Roederer said a relatively mild flu season has held hold down Medicaid costs and budget officials may have some flexibility in transferring unused funds freed up by employee reductions within the executive branch. Since Gov. Terry Branstad took office in January 2011, executive-branch employment has been reduced by nearly 1,000 positions to about 18,400 for the most-recent payroll period.

Rep. Dave Heaton, R-Mount Pleasant, co-chairman of the House-Senate health & human services budget subcommittee, said the abortion language in his budget area continues to be a sticking point within his GOP caucus, both for the current-year supplemental appropriation and the fiscal 2014 budget, where there is a $226 million difference between the GOP and Democratic spending targets.

“We’re continuing to work and develop what our approach will be to gather the 51 votes we’ll need to carry this bill to the Senate,” he said. “At the same time, we want to be able to go home on this issue and we want to be able to work with the Senate to reach agreement on the language that we come up with.”

Language on the politically volatile issue of Medicaid-funded "medically necessary" abortions for low-income women performed at the University of Iowa Hospitals and Clinics in Iowa City -- which has been in the human service budget area since the 1970s -- became a focal point of controversy during a 2011 session that didn’t adjourn until June 30, just hours before a possible state government shutdown.

The issue deadlocked during the 2012 legislative session with the GOP-led House supporting a change in current state policy, while majority Senate Democrats stuck with current law that provides for a limited number of exceptions covering cases of rape, incest and fetal deformation.

During the interim, DHS officials denied a petition brought by 41 House Republicans which contended that rules allowing for abortions funded via taxpayer dollars for fetuses that are physically or mentally deformed or those conceived in cases of rape or incest are illegal and should be rescinded.

In Iowa, 22 Medicaid-paid abortions were performed in fiscal 2012 -- which ended June 30, according to DHS data. Of those, 15 were for severe fetal anomalies, five were performed to save the life of the mother, and two were for situations that involved rape. There were no requests for Medicaid payments to abort a pregnancy caused by incest.

Sen. Jack Hatch, D-Des Moines, the other co-chairman of the House-Senate health & human services subcommittee, said it will come down to House leadership preventing a minority of the GOP caucus from “holding hostage” the funding for state human services this session.

“In the big scheme of things, abortion is not going to be determined – legal or illegal – by a vote out of an Appropriations Committee,” Hatch said. “So I think the more appropriate course would be for the House to recognize that we have to take care of more people than just 20 abortions that may happen.

“They can pass that bill with Democratic votes and with the Republican votes. But things have gotten to a point where a minority of the Republican caucus is holding it up,” he added.

Senate leaders said Thursday another major health-care battle will begin to play out next week when the Iowa Senate takes up a bill seeking to expand Medicaid coverage to another 150,000 Iowans – a plan opposed by Gov. Terry Branstad and legislative Republicans who favor expanding the IowaCare program in a way that will put more emphasis on uninsured or underinsured Iowans taking a more active role in improving their health and containing costs.

“There are a lot of roadblocks between here and when we go home, let me tell you,” said Heaton. “To be quite honest, it might take a miracle for all I know.”

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