Iowa leaders brace for federal health care ruling

Iowa Gov. Terry Branstad is preparing the state for a federally mandated health exchange, even though he opposes President Barack Obama's signature law and hopes the U.S. Supreme Court invalidates it in a ruling expected Thursday.

The Republican governor says Iowa should proceed with a state-run exchange only if the controversial law is upheld. But Democrats who control the Iowa Senate say they will push for a state health-benefit program regardless of how the court rules, while leaders in the Republican-led House say the state has already enacted pieces of the law in a way that's tailored to Iowa.

Branstad spokesman Tim Albrecht said the governor still views the law as unconstitutional and unsustainable and believes it will not lower health care costs as promised. Albrecht said Branstad will start working on "patient-centered reform" for Iowa's health care system after the ruling, but added that state officials will not delve into specifics until after the ruling.

"Right now, ObamaCare is the law and, therefore, Iowa has an obligation to plan and prepare" to enact it, Albrecht said. "If the federal government forces states to have a health benefits exchange, ours should be Iowa-built rather than crafted by Washington bureaucrats."

Iowa Sen. Jack Hatch, a Des Moines Democrat, said the state should move more quickly to enact the exchanges through an open process that includes consumers, medical experts, insurance industry officials and others. Hatch said Branstad has taken "a very high-risk position" with his opposition to the health care law, which seeks to extend health coverage to nearly 50 million uninsured Americans.

"I can understand the politics of this and the election rhetoric, but we're putting people's futures and lives at risk," said Hatch, chairman of the Senate's Health and Human Services Appropriations Subcommittee. "I'm more interested in trying to get all the stakeholders together. This is too important. We have 300,000 Iowans who don't have insurance who are at risk."

Hatch introduced a bill last year that would have created a state-based health benefit exchange for residents and small businesses, but the measure stalled in committee. He said he will call for a summit in the next three to four weeks to discuss how the state should proceed regardless of how the high court rules.

"We want to bring Iowans into the discussion," he said. "This is too important to leave it to just the politicians, or just the insurance advocates or doctors or providers. We need to have a broad discussion, and we'll know what the rules are after the decision."

Roughly 366,000 Iowans - about 12 percent of the population - are uninsured, according to 2011 U.S. census data. Nationally, 49.9 million Americans - about 16 percent of the country - lack health care coverage.

Iowa has received two federal grants totaling $8 million, one of which was used to help plan the exchange and another that helped the state comply with new electronic record-keeping requirements.

Branstad also signed a measure into a law a new licensing requirement for health insurance "navigators," to comply with the federal law. The navigators act like insurance agents to guide customers through the enrollment process. The law would sunset immediately if the court declares the federal health care rules unconstitutional.

House Majority Leader Linda Upmeyer, R-Garner, said the state has enacted several other pieces of the health care law, including a website that helps Iowans buy insurance. But the website doesn't meet all the federal requirements, and Upmeyer said lawmakers would have to approve more legislation to comply.

"We have at least the framework of an exchange in place, and while it might not meet all of the requirements, it at least gives us a starting place," Upmeyer said. "Hopefully, this gets struck down and we'll be able to move forward. Everything's been on hold. I certainly don't hear Iowans begging for more bureaucracy and regulations."

Republican House Speaker Kraig Paulsen said the law will likely surface as an issue in state elections as well as the presidential campaign.

"I consistently hear about (the law), particularly when I'm meeting with employers," Paulsen said. "They're very concerned about this taking effect and what it's going to do in the efforts to employ people throughout the United States."