Legislative leaders seeking middle ground on Iowa Medicaid expansion

Governor's plan amounts to throwing away money, Fitzgerald says

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DES MOINES – Amid the partisan war of words over expanding health care access to more low-income Iowans there are hints lawmakers may be finding common ground.

Democratic leaders, who have called Gov. Terry Branstad’s plan “deceptive and dishonest,” Thursday, emphasized what the plans have in common.

“We’re focused on preventive medicine, wellness plans and how health care is delivered,” Senate President Pam Jochum, D-Dubuque, said.

Senate Democrats and the governor agree on many strategies for improving the health of low-income Iowans, she said.

“We disagree on the cost,” she added. Branstad’s plan will cost the state $162 million a year, according to Democrats, including State Treasurer Michael Fitzgerald, who was in Cedar Rapids and Davenport April 11 to encourage Iowans to reject the Branstad plan and opt for the “free” federal Medicaid expansion.

Branstad’s Healthy Iowa Plan “is real money,” Fitzgerald said. According to Senate Democrats, it will cost the state nearly $1 billion over six years and cover 89,000 Iowans with incomes up to 100 percent of the federal poverty level. Their plan would cover as many as 150,000 Iowans with incomes as high as 138 percent of the federal poverty level and the federal government would pick up the entire cost for three years.

It’s not just the money, however. Rep. Walt Rogers, R-Cedar Falls, who is floor managing House Study Bill 232, the governor’s proposal, sees a philosophical gulf between the parties’ positions.

“I’m not convinced that taking federal dollars and expanding Medicaid is the right way to go here,” he said. Even though the federal government will pick up 100 percent of the cost of Medicaid expansion for three years, doesn’t call that “free.”

“Look at those tax dollars we send to Washington and they come back in Medicaid. Is that free dollars? I don’t know,” Rogers said.

He’s read the Senate Democratic plan, Senate File 296, and expects his House Appropriations Subcommittee will do its “due diligence” on HSB 232 to “put together the policy changes that help Iowans be healthier.”

House Minority Leader Kevin McCarthy, D-Des Moines, also suggested there may be another plan out there.

“We look forward to hearing from stakeholders on whether they want to go with a plan that costs more or go with Medicaid expansion or whether there’s a third alternative offered,” he said, referring to a public hearing scheduled for at 5:30 p.m. April 16 in the House Chamber.

Senate Democrats are willing to make changes in their plan, Majority Leader Mike Gronstal, D-Council Bluffs, said. While the governor is correct that the current Medicaid is not perfect, “for 400,000 Iowans it’s a pretty good deal.”

“There’s common ground to be had there. We’re open to working with the governor,” Gronstal said. “What we’re not open to is an effort that requires us to suck out of local governments $50 million in property taxes, to take out of Broadlawns hospital here in Des Moines alone $40-some million.

“The governor alleges his plan doesn’t cost anything,” he said. “Well, it doesn’t cost anything because he’s taking it out of the hides of local governments.

“We can work these things out,” he added.

Sen. David Johnson, R-Ocheyedan, took a similar tack in remarks on the Senate floor Thursday. He believes the governor’s plan, like the Senate Democratic plan, has its good points.

“There is a possibility for a third plan” that would take the best of both plan, he said. Referring to his time in Antarctica, Johnson said the ice has been broken and there is the possibility “to open up some shipping lanes and reach some resolution instead of campaigns run on this Senate floor.”

“Let’s not make this divisive,” Johnson said. “This is a time to thaw out this freeze we’re in.”

Medicaid expansion is a “complicated issue,” but House Speaker Kraig Paulsen, R-Hiawatha.,” but has hope for something that House Republicans and Senate Democrats can support.

Paulsen hasn’t seen that “middle path” to a compromise, but “I don’t not see one either,” he added. “We need to do some more work to figure all that out.”

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