Medicaid deal could be good for Iowa

Gazette Editorial Board

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Gov. Terry Branstad should not be too quick to reject an expanded Medicaid program for Iowans just because Supreme Court justices have ruled he can.

Such a knee-jerk response could hurt some Iowans, as well as negatively impact the state budget.

Expanding Medicaid eligibility could help cover many of the state's uninsured, while saving taxpayer money.

Especially with the Iowa Cares program set to expire in 2014, failing to choose the option which will provide the greatest coverage to the most needy Iowans at the lowest cost to Iowa taxpayers - just to prove a political or ideological point - could be a grave mistake.

Last week, when the U.S. Supreme Court upheld the constitutionality of the Affordable Care Act, justices also ruled the federal government can't punish states for failing to comply with some of its provisions - including expanding Medicaid eligibility to more people.

Branstad was quick to join other Republican governors who said that means they won't expand Medicaid, even though doing so would provide medical coverage for some of their states' poorer residents - with little additional investment of state funds.

Already, about 400,000 Iowans have medical expenses at least partially paid through Medicare and Medicaid programs. Expanding Medicaid eligibility could add up to 150,000 more Iowans to the rolls. That number includes 60,000 people who now participate in the Iowa Cares program - which covers many of the same costs. The Legislative Services Agency has estimated that state and local governments would save $50 million if Medicaid picks up people now on IowaCare.

The federal government foots the bill for more than two-thirds the cost of care for those already covered by Medicaid. Under the Affordable Care Act, the feds would pay 100 percent of the costs of covering the expanded number through 2017. After that, the reimbursement would gradually decline to 90 percent by 2020, and then stay at that level.

That seems like a relatively good deal.

The governor, however, says he's simply not convinced the feds will come through.

“The federal government has done this again and again: ‘Buy into our program, and we're going to do all these things for you,' and then it doesn't happen, and then the taxpayers of the state get stuck with it,” Branstad told reporters last week.

Yet he gave no specific examples to back up his mistrust when it comes to Medicaid honoring its commitments.

The governor's spokesman has said the administration will look for state-based alternatives to ensure more Iowans have access to health care. But does that make sense if a better alternative is already being offered?

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