House committee approves Branstad’s Healthy Iowa plan

DES MOINES - A House committee pushed through Gov. Terry Branstad's Healthy Iowa plan Monday even as some members of the majority Republican Party expressed misgivings about the plan.

“I'm being a good soldier,” said Rep. Dave Heaton, R-Mount Pleasant. “Today I helped move the bill forward at the governor's request and when it comes to the floor, it's a whole other ball game.”

Heaton was one of 14 House Republicans who voted unanimously to move the bill out of committee so it could be taken up on the floor. Democrats cast 11 unanimous dissenting votes.

The Healthy Iowa plan is the administration's response to Medicaid expansion as called for in the Patient Protection and Affordable Care Act. The Democrat-controlled Iowa Senate supports Medicaid expansion.

Expansion increases Medicaid eligibility in the program to all Iowans making up to 138 percent of the federal poverty line, adding an estimated 150,000 people to the existing program rolls in Iowa. It would be paid for entirely by the federal government for three years, but goes down to 90 percent payment after that.

The Branstad administration argues they don't trust the federal government to make good on its promise and offered Healthy Iowa as an alternative. That plan covers up to 100 percent poverty and offers tax credits to get to 138 percent. It's paid for by a combination of federal, state and local funds.

It also requires the state get a waiver approved by the U.S. Department of Health and Human Services to operate. That waiver request is due by the end of June.

Rep. Walt Rogers, R-Cedar Falls, who is responsible for running the bill through the House, called Medicaid a “broken system” and Healthy Iowa a “modern way of delivering health care.” He said the Healthy Iowa plan would save Iowans money in the long run when Medicaid payments drop.

Democrats hammered the proposal, saying there were too many unanswered questions, and they didn't like the answers to the questions there were answers for.

“It covers fewer Iowans, for fewer services at a greater cost to Iowa taxpayers,” said Rep. Tyler Olson, D-Cedar Rapids, ranking member on the committee.

Heaton, meanwhile, called it the “most important vote” he'll take in his 20 years at the Statehouse.

“This is a whole new way of looking at health care in our state, a whole new structure, an infrastructure, to deliver health care,” Heaton said. “Up to now, it's been your family doc at the doctor's office. Now we're talking integrated health systems and basically by the time this bill is fully developed in the years ahead, we'll be dealing with capitated rate payments rather than fee for service and the federal government will be determining those capitated rates and basically will have full control of the health system in our state. It's scary.”