Iowa House panel urged to ‘set the bar high’ on health care expansion

An Iowa House panel considering expanding access to health care for low-income Iowans was advised to be bold.

“Set the bar high,” AARP lobbyist Anthony Carroll told a House Appropriations Subcommittee Wednesday afternoon. Whatever plans the Legislature adopts, it should at least be equal to the Medicaid expansion that is part of the federal Affordable Care Act. “Then let's figure out how to get there.”

For most of the speakers at the 90-minute hearing, the quickest and easiest route there was through Senate File 296, a plan approved by the Democratic-controlled Senate.

Lobbyists did not whole-heartedly endorse SF 296, but were significantly less supportive of Gov. Terry Branstad's alternative, House Study Bill 232, the Healthy Iowa Plan.

Iowa Medical Society lobbyist Kate Walton's tepid endorsement of SF 296 was typical. Medicaid reimbursement is inadequate, she said in response to a lawmaker's question, but it supports expansion because of the benefit to patients.

The society has reservations about both plans. SF 296 would put 600,000 people into medical homes by 2015. That's unworkable, she said. There are only 500 Iowa providers signed up to provide medical homes and only seven are successfully billing Medicaid.

In regard to HSB 232, the society believes it would be “administratively burdensome” to collect the $3 per visit co-pay from low-income Iowans, Walton said.

Greg Boattenhamer, lobbyist for the Iowa Hospital Association, said adopting the ObamaCare-financed Medicaid expansion would give the state “great latitude” in addressing some of the governor's concerns such as personal accountability and improving outcomes.

Medicaid is unlikely to approve a program requiring HSB 232's requirements that low-income Iowans pay premiums and co-pays, he said. However, those components may be allowed under a state Medicaid expansion plan.

Although the hospital association sees Medicaid expansion as being extremely flexible, House Republicans see it as being extremely restrictive, Rep. Linda Miller, R-Bettendorf, said.

“That's why we are not eager to embrace it,” the chairwoman of the House Human Resources Committee said. “We don't know what we would be embracing.”

For Linda Hinton, Iowa State Association of Counties lobbyist, the concern was the $43 million in county mental health property tax dollars HSB 232 would scoop.

“Those dollars are part of the linchpin of what we are doing with mental health redesign,” she said, referring to another priority of the 2013 Legislature.

Access to health care a basic human right and SF 292 extends it to more Iowans, according to lobbyists for the Catholic and Methodist conferences.

Medicaid expansion should be considered economic development, added Sarah Eide, a lobbyist for Mercy Health Network. Health providers have taken cuts in reimbursement and without Medicaid expansion, she said, “it will cost jobs around the state.”

“Going forward, look at this as an economic engine,” Eide said.

Earlier in the day, Sen. Jack Hatch, D-Des Moines, suggested Branstad to spend his time on a long flight to China later this week studying SF 296. He called the governor “deceptive and dishonest” in comparing the Democrats' plan to the Healthy Iowa Plan.

The governor's office fired back that Hatch is a “political opportunist hoping to launch a gubernatorial campaign on the backs of Medicaid recipients.”

“Jack Hatch is angry, because he attached his health care hopes to a failed, 1960s program like Medicaid while Gov. Branstad instead offers a modern health care plan that will make its patients healthier,” according to the governor's spokesman Tim Albrecht.

According to the governor, his plan would cost $23 million a year compared to an $83.4 million price tag on the Senate plan.

However, Hatch accused Branstad of “trying to hide the fact you are taking $43 million in property tax from every county, $42 million from Broadlawns (Medical Center), $13 m from University of Iowa Hospitals and Clinic and another $42 million in general fund money.”

Albrecht did not call Hatch deceptive, but said he “frolics in a fantasy world that tells him the federal government's program will make everything OK, when that's simply not the case.”

“The Medicaid program will not make our most vulnerable Iowans healthier,” he said. “It is wrong to offer people an expensive health care program that offers no incentive to live longer, healthier lives and try to claim you are helping people.”

Subcommittee Chairman Walt Rogers, R-Cedar Falls, plans to have another meeting after a House Appropriations Committee public hearing at 5:30 p.m. April 16 in the House Chamber. Speakers will have three minutes or may submit written testimony at

housechiefclerk@legis.iowa.gov

with “Testimony” in the subject line.