Iowa Democrats’ Medicaid compromise a ‘first step,’ Branstad says

Iowa Democrats are touting a compromise on Medicaid expansion they call more affordable and sustainable than the Healthy Iowa Plan proposed by Republican Gov. Terry Branstad.

The Democratic plan would allow the state to opt out of the expanded Medicaid program if the federal government fails to meet its financial obligation – 100 percent of the cost for the next three years, followed with the federal match eventually decreasing to 90 percent.

Branstad's concern has been that the federal government, faced with debt and an inability to deal with budget issues, would not meet those obligations.

However, Senate President Pam Jochum, D-Dubuque, said the opt out language protects Iowa taxpayers from shouldering the entire cost of providing Medicaid to as many as 150,000 working poor.

“In short, if the federal sky falls, we'll be off the hook,” Jochum said, adding that the federal government has never failed to meet its Medicaid obligation in nearly 50 years and the program is not affected by the current sequestration.

The Branstad administration welcomed the offer as “a first step.”

“This is not a grand bargain,” spokesman Tim Albrecht said. “We still have a long way to go. As President Obama noted of Medicaid in 2009, ‘We can't simply put more people into a broken system that doesn't work.'”

Since 2000, according to Branstad, Medicaid in Iowa has expanded by 65 percent, from 250,000 to more than 400,000 covered adults, with costs rising by more than 129 percent. Despite the increased coverage, health indicators for the Medicaid population and the state as a whole have fallen.

His Healthy Iowa Plan would increase coverage for those working Iowans needing it most, while focusing on patient outcomes and decreasing Iowa's uninsured, Albrecht said.

Democrats, insisting they wouldn't write legislation in a news conference, offered few details. They flatly rejected Branstad's plan to spend $163 million in state revenue on the Healthy Iowa Plan that Democrats said offers fewer Iowans fewer services than Medicaid.

Legislative Republicans took a wait-and-see position, but insisted they want to improve health care outcomes, not just increase spending to expand a government program.

Democrats, Senate Minority Leader Bill Dix, R-Shell Rock, said, seem to have “lost sight of a really key point in this and stopped listening and caring about the quality of care.”

“Republicans want to make sure we are offering opportunities for care that will actually improve their health,” he said. “Just talking about the money for expanding government programs doesn't accomplish that.”