DES MOINES (AP) — Senate Democrats on Thursday proposed a Medicaid expansion that would allow the state to back out if federal funding fell short, but it wasn't clear whether the plan would overcome Republican Gov. Terry Branstad's opposition to expanding the program in Iowa.
The Democrats, who control the agenda in the Iowa Senate, have been pushing to expand Medicaid, but Branstad has expressed concern that the federal government doesn't have the money to fulfill its promises. Senate President Pam Jochum of Dubuque called the proposal a compromise that would address Branstad's concerns.
The Medicaid program, which provides health care for financially needy children, families and disabled people in Iowa, is run jointly by the state and federal governments. Under President Barack Obama's health care overhaul, the federal government would pay the full cost for new enrollees during the first three years of the expansion, and then 10 percent of the cost gradually would be shifted to the state.
“The language we suggested would protect Iowa's taxpayers from any risk and would address the governor's concerns. In short, if the federal government's sky falls, we'll be off the hook as a state,” Jochum said.
Branstad says the cost of the program is unsustainable for the federal government and has questioned the long-term price tag for states. Asked about Iowa Democrats' offer, spokesman Tim Albrecht said the governor will work with Democrats, but continues to oppose an expansion of Medicaid.
Several other Republican governors have included similar caveats in their plans to accept funding for a Medicaid expansion. Arizona Gov. Jan Brewer and Ohio Gov. John Kasich — both Republicans — have offered plans with opt-out provisions.
About 400,000 people in Iowa are enrolled in Medicaid, with another 70,000 on a limited benefit program for low-income adults called IowaCare.
If Branstad agreed to expand Medicaid to those at or below 138 percent of the poverty level, an estimated 110,000 to 180,000 people could be added to the Medicaid rolls, including those currently on IowaCare.
Branstad has offered an alternative plan: Healthy Iowa, a revamped version of the soon-to-expire IowaCare program. The plan, which would need federal approval, would offer health coverage to those with incomes below the federal poverty level who don't qualify for Medicaid, mostly childless adults.
Details on Branstad's plan have been few, though officials said it would include prescription drug coverage and offer services in locations around the state. The cost is estimated at $162 million per year, with the federal government paying 58 percent of the costs and the rest coming from the state, local property taxes and other sources. Branstad has called it a more responsible course for the state, given his uncertainty over federal funding.
Democrats say Branstad's plan would cost the state more while providing more limited health coverage to enrollees.
“It's important to know that this is a hit on Iowa taxpayers. It's a hit that we don't have to take,” said Sen. Jack Hatch, D-Des Moines. “His proposal is unaffordable, unsustainable and unworkable.”
Republicans, who control the Iowa House, have shown little interest in a Medicaid expansion. House Speaker Kraig Paulsen, R-Hiawatha, said he would look at the Democrats' proposal, but he questioned whether the state could really back out and stop offering Medicaid coverage to new enrollees.
“Typically, particularly in the health care arena, once we have moved forward in the Medicaid program, the federal government has almost always required us to continue doing that or we put the entire program at risk,” Paulsen said.
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