Medicaid compromise a winner

Gazette Editorial Board--

Iowa's governor and Statehouse leaders can apparently toast their success, and we do, too. We're talking about a hard-fought, bipartisan compromise passed earlier this year that would extend health insurance to tens of thousands of low-income Iowans. It's basically Iowa's alternative to the Medicaid expansion sought through the federal Affordable Care Act.

This week, the federal Centers for Medicare and Medicaid Services approved most of the Iowa Health and Wellness Program, allowing enrollment to move forward with little time to spare. Thousands faced losing coverage Jan. 1 without approval.

The federal government did reject one rule that would have charged a small monthly premium to recipients with incomes between 50 percent and 100 percent of the poverty level. The premium, 3 percent of income, would be waived if a client completed wellness initiatives.

Federal officials said they wouldn't allow anyone below the poverty line, about $11,500 annually for an individual, to be charged a premium. Gov. Terry Branstad had pushed for its inclusion. We also thought the idea had merit.

There was talk of appealing that decision. But now the sticking point has been resolved, the governor's office said late Thursday.

The state will be allowed to charge a small amount to people above 50 percent of the federal poverty line. But they will not lose insurance coverage if they don't pay it. The state would, however, pursue payment as a debt if the person continued seeking medical coverage. The premium would be levied only if a person doesn't engage in required healthy actions, such as getting a risk assessment or an annual physical. And it would be waived the first year, meaning a person wouldn't ever have to pay it as long as he or she continued engaging in healthy behaviors.

Federal officials still are allowing Iowans with incomes up to 138 percent of poverty to get insurance coverage through the private exchange, with wellness incentives, too.

The Iowa goal, to expand coverage while not simply expanding an already expensive Medicaid program, is intact.

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