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DES MOINES, Iowa – Democrats in charge of the Iowa Senate approved a major expansion of Medicaid coverage for at least 100,000 needy Iowans Monday over the objections of Gov. Terry Branstad and some of his GOP allies in the split-control Legislature.
Senators voted 26-23 along party lines to offer Medicaid services provided for by the federal Affordable Care Act for adults between the ages of 19 and 64 with income up to 138 percent of the federal poverty level and for foster care children up to age 26 beginning next Jan. 1. That would equate to a single person making about $15,856 a year or a family of four with an income under $32,488.
"We won't turn our backs on this opportunity to control health care costs for everyone and improve our health care system," said Senate President Pam Jochum, D-Dubuque, floor manager of Senate File 296. "We won't continue pointless, partisan bickering when we have an opportunity to improve the lives of Iowans and tonight the Iowa Senate will not throw working Iowans under the bus."
Before passing their plan, senators approved a compromise amendment that would allow the state to opt out of the expanded Medicaid program if the federal government fails to meet its financial obligation – 100 percent of the cost for the next three years followed with the federal match eventually decreasing to 90 percent.
"It's premature to have this debate and it's premature to be having this vote tonight," said Sen. Jack Whitver, R-Ankeny, while Sen. Mark Segebart, R-Vail, said lawmakers must conduct more "due diligence" before making one of the session's most important decisions.
Republicans said the Senate-passed approach faces an uncertain future in the Iowa House, where Republicans hold sway by a 53-47 edge and plan to begin work soon on Branstad's Healthy Iowa Plan that seeks to increase coverage for working Iowans needing it most while focusing on patient outcomes and decreasing Iowa's uninsured.
"We have developed an alternative which we think is better," Branstad told reporters Monday.
The IowaCare waiver program laid out by the governor would cover Iowans below 100 percent of the federal poverty level and would require monthly contributions co-pays and deductibles which could be waived if preventative services are completed. The mechanisms are not intended to create financial savings for the state, but rather to encourage health and cost-conscious behaviors.
Branstad's concern about expanding Medicaid coverage has been that the federal government, faced with debt and an inability to deal with budget issues, would not meet those obligations which he called unsustainable. He said his approach offers a better course of action.
"We'll get it and look over it at the leadership level and talk with our members," said Rep. Walt Rogers, a Cedar Falls Republican who will floor manage the legislation in the House. Rogers said he expected at least one subcommittee on the bill next week and a full committee vote by the following week.
Critics say Branstad approach – funded by state and federal dollars – would cost the state more, cover fewer Iowans, and provide fewer services than Medicaid expansion.
By setting eligibility at 100 percent of the federal poverty level, Senate Majority Leader Mike Gronstal, D-Council Bluffs, said Branstad's plan would leave out about 65,000 needy Iowans. He also said the governor has had nine months to come up with a plan and so far has produced a four-page pamphlet.
"Tonight we have two choices," said Sen. Jack Hatch, D-Des Moines, who urged his colleagues to join a majority of U.S. states in expanding Medicaid coverage in Iowa.
Hatch called the governor's plan insufficient to meet the demands and needs of Iowans, unaffordable with its high premiums and high deductibles, inefficient by trying to establish a lesser plan that duplicates what Medicaid already does and would cost Iowa $150 million more over seven years.
Since 2000, according to Branstad, Medicaid in Iowa has expanded by 65 percent from 250,000 to more than 400,000 covered adults with costs rising by more than 129 percent. Despite the increased coverage, health indicators for the Medicaid population and the state as a whole have fallen.