Federal budget aside, it would be wrong to leave needy Iowans uninsured

By The Des Moines Register

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For decades the United States, the richest nation on Earth, left millions of its citizens without health insurance for the simple reason that they were poor and couldn't afford the premiums. It has been a national embarrassment. The health reform law passed by Congress in 2010 generated revenue and made cuts in spending to help pay the cost to cover them. Beginning next year, many more low-income people will be eligible for Medicaid, with Washington paying almost the entire bill.

Even Republican governors who were initially reluctant to expand Medicaid in their states have changed their minds. The offer is too good for states to pass up. But Iowa's governor does not see it this way. Terry Branstad says he opposes accepting federal money to insure more than 100,000 Iowans in Medicaid because Washington cannot afford the cost. He says the federal government, which has funded Medicaid for almost 50 years, may not be able to sustain the commitment.

Washington's finances are a legitimate concern. But Branstad's approach to reducing federal spending could be a fiscal disaster for Iowa. Nearly every department and agency in state government relies on money from Washington. In 2012, for example, the cost of operating Iowa's state government and its programs that millions of Iowans depend on was about $14.6 billion. While $6.1 billion came from state tax revenues, and other sources provided $2 billion, the federal government provided $6.5 billion, according to the Legislative Services Agency.

The governor's position on Medicaid - that the feds can't afford to spend that money on poor Iowans - raises a worrisome question: Does Branstad also want Iowa to forfeit federal money we receive for other programs?

Let's hope not. Iowa would lose the majority of funding for everything from nursing home inspectors to foster care services. Almost the entire Department on Aging - and its programs that provide meals to seniors - is paid for with federal money. So is the $556 million in food stamps that are spent at Iowa grocery stores. Should Iowa decline to accept the $59 million that the state receives for Head Start or the $860 million for Pell Grants that help Iowans obtain early and higher education?

If Branstad wants to save the federal government money, is he going to find hundreds of millions of additional state dollars to fund education, natural resources and public health?

Branstad talked at length last week about “unsustainable” and “unaffordable” federal entitlement programs, including Social Security, Medicare and Medicaid. But does he think 430,000 Iowa seniors should send their Social Security checks back to Washington next month, or that they shouldn't use their Medicare health insurance, which is largely paid for with general tax revenues from Washington?

Here's the irony of the governor not wanting to expand Medicaid because of fears about federal finances: He plans to ask Washington to help fund his Healthy Iowa Plan for the poorest 90,000 Iowans. He also wants the federal government to foot the bill for tax credits so about 60,000 low-income people can buy private health insurance instead of relying on Medicaid.

It is the responsibility of leaders in Washington to carefully reduce spending and generate revenue to ensure that the needs of Americans are met. It is the responsibility of state leaders to take care of their citizens, their state's economy and their state budget. If Branstad is going to worry about the cost of Medicaid expansion, then he should worry about $6 billion in other federal aid Iowa receives, too.