Plan spends a lot, but returns little

By Jack Hatch

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In June, Gov. Terry Branstad announced he had a better idea on health care than the idea of expanding Medicaid. While eight other Republican governors moved forward with Medicaid plans, Iowans waited.

Branstad, the former president of a medical school, was going to work for extra credit. On April 3, more than nine months after the governor's announcement, and more than three months into this year's legislative session, Iowans at long last had a chance to take a look at his proposal.

To say Branstad turned his homework in late and didn't complete his assignment is an understatement. Turns out he wants to spend too much to do to little for too few Iowans.

The proposed “Healthy Iowa Plan” fails to be comprehensive, leaving out as many as 70,000 Iowans. It would not create seamless access to health care plans for Iowans. It would spend far too much of Iowa taxpayers' hard-earned money for poorer outcomes and make it more difficult for the emerging middle class to participate.

The Branstad proposal asks Iowa to just give up on insuring all Iowans, which was a major focus of the 3-year-old federal Affordable Care Act. Love it or hate it, the ACA is clear. Americans have a new system for becoming insured, either in private insurance plans or through Medicaid for low-income people.

Perhaps most important, the governor's plan is fiscally irresponsible and would spend too much state money on too little care. It would take $163 million annually to cover just more than half of the Iowans who would be covered by expanded Medicaid. Branstad also has invented another complicated financing formula for state government, using county mental health funds, the Polk County Property Tax Levy for Broadlawns, and general fund money every year. The result is unfunded mandates to counties and an indecipherable financing process.

This is the kind of centralized, big-spending approach to government Branstad claims to oppose.

The Senate plan passed in late March, SF 296, leverages federal money set aside to cover 150,000 uninsured Iowans. And, expanded Medicaid spends less than $5 million of state funds - a 32-to-1 state spending reduction when compared with the governor's bloated program.

And his plan would spend $1.14 billion Iowa taxpayer dollars by year seven, while the Senate plan would spend $168 million of the same dollars over that period. Put another way, the Branstad plan raids the state treasury for seven times as much money over seven years.

For Americans who are covered, we are spending too much money on health insurance premiums and not getting enough for it. With all this spending, the USA is still 38th by the World Health Organization's ranking of health systems but first in health care spending per capita.

In Iowa, we have done our part. Five years ago, we passed legislation that declared by 2012, all Iowa children would be covered by health insurance. Today, Iowa has one of the highest percentages of children covered; with the passage of the ACA, we can meet our goal. We know how to do health care the right way in Iowa and the Branstad plan isn't it.

Once upon a time, Iowans put together policies that upheld the middle class. I know we can still believe in the American dream of having a home, providing an education for the kids, having a good job and getting and staying healthy. The Republicans have given up on supporting a safety net for Iowans.

l Jack Hatch is a Democrat and state senator from Des Moines. Comments: jack.hatch@legis.iowa.gov