Possible Medicaid compromise is encouraging

By The Des Moines Register

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For months Gov. Terry Branstad has opposed a straightforward offer from the federal government: Expand Medicaid health insurance to cover more than 100,000 additional low-income Iowans and Washington will pay the bill.

Democrats in the Iowa Senate approved legislation to do so - a move dozens of interest groups support. The Iowa House passed a bill to implement an alternative plan proposed by the governor that would insure fewer people, cost the state more money and perhaps not be approved by the federal government. A conference committee made up of both Democrats and Republicans has the task of crafting a solution that both parties could agree on.

On Monday, it appeared progress was being made. Branstad indicated he would be willing to accept a form of Medicaid expansion if it came with assurances that if the federal government reduces funding for the program in the future, Iowans would not be left picking up the cost. On Tuesday, Sen. Jack Hatch, D-Des Moines, said legislative leaders and the governor's staff have been meeting frequently and may have a deal soon.

The final, compromise plan should capture the maximum amount of federal money available, insure Iowans earning up to 138 percent of poverty level and be able to gain approval by the federal government. Whether elected officials are successful remains to be seen, but there is more hope now than there was a week ago. Lawmakers must finish the job before they adjourn. They could accomplish something important this session and provide the certainty thousands of Iowans need to plan for the future and move forward.

There is no certainty now. Low-income Iowans don't know whether they will have Medicaid coverage. Health care providers don't know if they are finally going to be paid to treat previously uninsured Iowans. Hospitals, which employ about 70,000 people, face the uncertainty of whether their payments from the federal government will be reduced or whether their job numbers will have to be cut if they are not compensated.

Under Medicaid expansion, the federal government pays the entire cost of care for new enrollees the first few years and the vast majority of the cost after that. Not knowing what Iowa will do raises questions about the next year's state budget. It also forces state agencies to dedicate resources and money to concurrently planning for different scenarios to try to get Iowans care.

And imagine the uncertainty average Iowans are feeling. Many, including uninsured young people, some with mental health problems, have been hoping for comprehensive Medicaid insurance that people in many other states will receive on Jan. 1. They don't know if they'll have that, too.

The more than 60,000 Iowans who now rely on a program called IowaCare for health services wonder what will happen when that program expires in a few months. The hundreds of HIV-positive people who depend on the state to obtain needed medications don't know if federal funding will continue for that program or if they will instead be eligible for Medicaid to get help with drugs.

After decades of leaving millions of Americans uninsured, the health reform law offers states a way to finally help them. Elected officials in Iowa must ensure Iowans are among those who receive this help.