Iowa Senate caught up in 'Medicaid mania'

UPDATE: As Iowa's Medicaid expansion battle heats up this week, Gov. Terry Branstad hinted at changes to his plan that may help ease some criticisms of his proposed alternative.

Among those changes would be increasing the number of facilities where Iowans could seek treatment under the state alternative Medicaid program.

Branstad is one of many Republican governors who have decided not to expand Medicaid as dictated by the Patient Protection and Affordable Care Act.

The governor criticizes that plan, which would increase the number of Iowans covered under the federal insurance program by an estimated 150,000, for being unsustainable with federal budget problems and for not working to improve health care.

Instead he has proposed an alternative plan that would expand the current IowaCare program.

Democrats and liberal groups have been stepping up the pressure on Branstad to agree to Medicaid expansion. Senate Democrats have proposed adopting the expansion with a clause that would allow Iowa to opt out if the federal government fails to fulfill its funding commitment

At the same time, a coalition of groups have banded together to call on Branstad to adopt the federal program.

Later this week, the Iowa House is scheduled to introduce a bill following Branstad's recommendations. Rep. Walt Rogers, R-Cedar Falls, will lead that bill.

The governor has outlined the ideas he wants to see in his “Healthy Iowa Plan,” but the specifics will be seen as the bill is introduced. On Monday, Branstad said it would expand the current IowaCare program, but would include some changes.

One of the criticisms of IowaCare is that patients need to get treatment at Broadlawns Medical Center in Des Moines or the University of Iowa hospital in Iowa City. For low-income residents who qualify for IowaCare, the cost of transportation and time to get to those facilities can be a problem.

“It is a program where we would ask for a federal waiver, and is an expansion of what has been our IowaCare program, but has been expanded to be offered on a statewide basis so people would not have to travel to Iowa City or to Broadlawns,” Branstad told the Waterloo Downtown Rotary Club Monday.

Branstad's proposal would require health risk assessments and give a waiver for the small monthly payments for recipients if they participate in wellness programs. It's intended to move Iowans in the program toward more preventive care rather than simply using the insurance for expensive emergency room visits.

“We think this is much more in tune with our Healthiest Iowa Initiative and designed to get people involved with getting people involved with taking ownership of their own health as well,” Branstad said.

Lt. Gov. Kim Reynolds, also in Waterloo with Branstad, said the state has to look at ways to change behaviors to drive down health care costs.

She also believes the federal government has “grossly underestimated” the cost of Medicaid expansion.

Related:

Iowa governor rolls out alternative to Medicaid expansion