Plug the Medicaid gap

The Gazette Editorial Board

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The debate over whether to accept the federal government's Medicaid expansion or opt for Gov. Terry Branstad's Healthy Iowa alternative plan has drawn plenty of attention and fiery debate this legislative session.

Both plans are aimed at expanding health care access for low-income Iowans. We've leaned toward the Medicaid option because it appears to cover more Iowans with real needs while costing the state less overall, although we do like parts of the governor's plan that call for more accountability while promoting healthier lifestyle choices.

As of late Thursday, the impasse appeared unresolved in the Legislature. The governor had even floated the idea of a special session later this year to settle this issue.

Meanwhile, another related item has not been taken care of. Last year, legislators did not finalize the health and human services budget. They couldn't resolve differences on publicly funding abortions in rare situations. The money appropriated for the state's share of Medicaid funding for the rest of this fiscal year is expected to run out early next month. A shortfall of at least $35 million is projected, according to David Roederer, director, state Department of Management.

Legislators still appear to be divided on the abortion issue.

A serious debate, but it shouldn't further delay what they need to do in the short term: Take care of this shortfall with a supplemental appropriation.

If they don't, soon there will be serious consequences.

The biggest is what to do about health care services for the poor. If they're maintained, the state's debt will pile up. If they are continued but Medicaid providers aren't paid, or if services to Iowans in need are cut, it likely would increase demand on hospital emergency rooms for charity care - which comes at a much-higher cost. And that also is something federal Medicaid officials frown upon and may spark a federal penalty.

Those aren't great options for the state's budget or the Iowans who truly need Medicaid services at a time when more people can't afford or access insurance coverage.

Take care of this now, or pay more later. The choice is clear.

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